Try a new search

Format these results:

Searched for:

person:chacha01

in-biosketch:true

Total Results:

104


Safety of patients and providers in lung cancer surgery during the COVID-19 pandemic

Chang, Stephanie H; Zervos, Michael; Kent, Amie; Chachoua, Abraham; Bizekis, Costas; Pass, Harvey; Cerfolio, Robert J
OBJECTIVES/OBJECTIVE:The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS:Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS:Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection-13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS:Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.
PMID: 33150417
ISSN: 1873-734x
CID: 4656112

Common Germline Mutations in a Patient With Multiple Primary Lung Cancers [Case Report]

Cytryn, Samuel; Moreira, Andre; Chachoua, Abraham; Sabari, Joshua
PMID: 32127285
ISSN: 1938-0690
CID: 4339692

Food as medicine: A randomized controlled trial (RCT) of home delivered, medically tailored meals (HDMTM) on quality of life (QoL) in metastatic lung and noncolorectal GI cancer patients [Meeting Abstract]

Ishaq, O; Vega, R M; Zullig, L; Wassung, A; Walters, D; Berland, N; Du, K L; Ahn, J; Leichman, C G; Cohen, D J; Gu, P; Chachoua, A; Leichman, L P; Pearl, K; Schiff, P B
Background: Malnutrition incidence in cancer approaches 85%, disproportionately burdening those with lung, GI, and advanced stage cancers. Malnourished patients have impaired chemotherapy response, shorter survival, longer hospital stays, and decreased QoL. Home delivered meals are nutritional interventions that improve patient well- being, nutrition, and lower healthcare costs in the elderly but have not been studied as an intervention in cancer patients. HDMTM are nutritionist prescribed home delivered meals tailored to patient's symptoms, co-morbidities, and health needs. Preliminary data in 211 cancer patients showed with HDMTM 87% ate more than half of meals, 91% lived more independently, 89% ate more nutritiously, and 70% had less fatigue. HDMTM may be a strategy to reduce financial toxicity and healthcare utilization and improve QoL in cancer patients, but no primary data exists evaluating its efficacy.
Method(s): We sought to develop the first RCT evaluating patientcentered QoL improvement from nutritional intervention with HDMTM in those with metastatic lung and non-colorectal GI cancer. We established a partnership with God's Love We Deliver, a 501c3 non-profit specializing in HDMTM.
Result(s): We developed a protocol for a single-institution RCT of standard of care (SoC) versus SoC and HDMTM in metastatic lung and non-colorectal GI cancer patients with primary aim comparing QoL between arms at 12 weeks using the FACT-G questionnaire. Sample size is 180. Secondary aims assess HDMTM's impact on nutritional status, weight, mood, survival, food security, financial toxicity, healthcare utilization, and cost effectiveness. Eligible patients tolerate oral alimentation, have PS 0-3, and newly diagnosed (< 6 weeks) metastatic cancer. All patients have pre-randomization nutritional evaluation by an oncologic dietician.
Conclusion(s):We present the first PRMC reviewed and IRB approved RCT evaluating the efficacy of HDMTM in metastatic cancer patients with primary endpoint of patient reported QoL. Investigating HDMTM expands our knowledge of nutrition as an effective arm of palliative oncology
EMBASE:630551624
ISSN: 1527-7755
CID: 4265372

Novel SPECC1L-MET Fusion Detected in Circulating Tumor DNA in a Patient with Lung Adenocarcinoma following Treatment with Erlotinib and Osimertinib [Letter]

Nelson, Annie W; Schrock, Alexa B; Pavlick, Dean C; Ali, Siraj M; Atkinson, Emily C; Chachoua, Abraham
PMID: 30683294
ISSN: 1556-1380
CID: 3610812

Radiotherapy induces responses of lung cancer to CTLA-4 blockade

Formenti, Silvia C; Rudqvist, Nils-Petter; Golden, Encouse; Cooper, Benjamin; Wennerberg, Erik; Lhuillier, Claire; Vanpouille-Box, Claire; Friedman, Kent; Ferrari de Andrade, Lucas; Wucherpfennig, Kai W; Heguy, Adriana; Imai, Naoko; Gnjatic, Sacha; Emerson, Ryan O; Zhou, Xi Kathy; Zhang, Tuo; Chachoua, Abraham; Demaria, Sandra
Focal radiation therapy enhances systemic responses to anti-CTLA-4 antibodies in preclinical studies and in some patients with melanoma1-3, but its efficacy in inducing systemic responses (abscopal responses) against tumors unresponsive to CTLA-4 blockade remained uncertain. Radiation therapy promotes the activation of anti-tumor T cells, an effect dependent on type I interferon induction in the irradiated tumor4-6. The latter is essential for achieving abscopal responses in murine cancers6. The mechanisms underlying abscopal responses in patients treated with radiation therapy and CTLA-4 blockade remain unclear. Here we report that radiation therapy and CTLA-4 blockade induced systemic anti-tumor T cells in chemo-refractory metastatic non-small-cell lung cancer (NSCLC), where anti-CTLA-4 antibodies had failed to demonstrate significant efficacy alone or in combination with chemotherapy7,8. Objective responses were observed in 18% of enrolled patients, and 31% had disease control. Increased serum interferon-β after radiation and early dynamic changes of blood T cell clones were the strongest response predictors, confirming preclinical mechanistic data. Functional analysis in one responding patient showed the rapid in vivo expansion of CD8 T cells recognizing a neoantigen encoded in a gene upregulated by radiation, supporting the hypothesis that one explanation for the abscopal response is radiation-induced exposure of immunogenic mutations to the immune system.
PMID: 30397353
ISSN: 1546-170x
CID: 3455792

Percutaneous Cryoablation for the Management of Chronic Pain Secondary to Locally Recurrent Rectal Cancer with Bowel and Nerve Root Involvement [Letter]

Cornman-Homonoff, Joshua; Formenti, Silvia C; Chachoua, Abraham; Madoff, David C
PMID: 30146202
ISSN: 1535-7732
CID: 3255682

Toward the complete control of brain metastases using surveillance screening and stereotactic radiosurgery

Wolf, Amparo; Kvint, Svetlana; Chachoua, Abraham; Pavlick, Anna; Wilson, Melissa; Donahue, Bernadine; Golfinos, John G; Silverman, Joshua; Kondziolka, Douglas
OBJECTIVE The incidence of brain metastases is increasing with improved systemic therapies, many of which have a limited impact on intracranial disease. Stereotactic radiosurgery (SRS) is a first-line management option for brain metastases. The purpose of this study was to determine if there is a threshold tumor size below which local control (LC) rates approach 100%, and to relate these findings to the use of routine surveillance brain imaging. METHODS From a prospective registry, 200 patients with 1237 brain metastases were identified who underwent SRS between December 2012 and May 2015. The median imaging follow-up duration was 7.9 months, and the median margin dose was 18 Gy. The maximal diameter and volume of tumors were measured. Histological analysis included 96 patients with non-small cell lung cancers (NSCLCs), 40 with melanoma, 35 with breast cancer, and 29 with other histologies. RESULTS Almost 50% of brain metastases were NSCLCs and commonly measured less than 6 mm in maximal diameter or 70 mm3 in volume. Thirty-three of 1237 tumors had local progression at a median of 8.8 months. The 1- and 2-year actuarial LC rates were 97% and 93%, respectively. LC of 100% was achieved for all intracranial metastases less than 100 mm3 in volume or 6 mm in diameter. Patients whose tumors at first SRS were less than 10 mm maximal diameter or a volume of 250 mm3 had improved overall survival. CONCLUSIONS SRS can achieve LC rates approaching 100% for subcentimeter metastases. The earlier initial detection and prompt treatment of small intracranial metastases may prevent the development of neurological symptoms and the need for resection, and improve overall survival. To identify tumors when they are small, routine surveillance brain imaging should be considered as part of the standard of care for lung, breast, and melanoma metastases. CLASSIFICATION OF EVIDENCE Type of question: prognostic; study design: retrospective cohort; evidence: Class II.
PMID: 28298015
ISSN: 1933-0693
CID: 2490032

Osimertinib Dose Escalation Induces Regression of Progressive EGFR T790M-Mutant Leptomeningeal Lung Adenocarcinoma [Letter]

Cordova, Christine; Chi, Andrew S; Chachoua, Abraham; Kondziolka, Douglas; Silverman, Joshua S; Shepherd, Timothy M; Jain, Rajan; Snuderl, Matija
PMID: 29074213
ISSN: 1556-1380
CID: 2756442

ENCORE-601 Phase 1b/2 study of entinostat (ENT) in combination with pembrolizumab (PEMBRO) in patients with non-small cell lung cancer (NSCLC [Meeting Abstract]

Gandhi, L; Johnson, M L; Opyrchal, M; Ramalingam, S; Janne, P; Chachoua, A; Ordentlich, P; Brouwer, S; Sankoh, S; Schmidt, E; Meyers, M L; Hellmann, M
Background Entinostat is an oral, class I selective histone deacetylase (HDAC) inhibitor that has been shown in pre-clinical models to enhance anti- PD-1 activity through inhibition of immune suppressor cells in the tumor microenvironment. ENCORE 601 is a Phase 1b/2 study evaluating safety and efficacy of ENT plus PEMBRO in NSCLC, melanoma and colorectal cancer patients. We previously reported the results of Phase 1b, which identified ENT 5 mg PO weekly plus PEMBRO 200 mg IV every 3 weeks as the dose to be further explored. Methods Efficacy of ENT 5 mg PO weekly plus PEMBRO 200 mg IV q3wks is being assessed in a Simon 2-stage Phase 2 study involving two cohorts of patients with advanced NSCLC: anti-PD-(L)1-naive (Cohort 1), and progressed on anti-PD-(L)1 (Cohort 2). The primary endpoint is objective response rate. Based on investigator feedback to incorporate Phase 1b patients dosed at entinostat 5 mg into the Stage 2 go/no go assessment, revised criteria for advancement were >=4 responses observed out of 17 evaluable patients in Cohort 1 and >=3 out of 31 in Cohort 2. Tumor biopsies and blood samples for immune correlates were taken pre- and post-treatment. Results Enrollment has been completed for Stage 1 of both cohorts. In Cohort 1, 4 of 17 (24%, 95% CI: 7-50) evaluable patients achieved a partial response (PR; 2 confirmed, 2 unconfirmed). In Cohort 2, 3 of 31 (10%, 95% CI: 2-26) evaluable patients achieved a PR (2 confirmed, 1 unconfirmed). As of the data cutoff, the longest duration of response was 24 weeks (and ongoing). Baseline PD-L1 expression for responders was <1% (1 patient), 1-49% (2 patients) and not available (1 patient) for Cohort 1, and <1% (2 patients) and not available (1 patient) for Cohort 2. 31% of patients experienced a Grade 3/4 event deemed related to study drug. The most common of these events included hypophosphatemia and neutropenia in Cohort 1, and fatigue, anemia, and pneumonitis in Cohort 2. 13% of patients discontinued therapy due to an adverse event. Circulating myeloid derived suppressor cells were reduced in both cohorts at Cycle2/Day1 compared to pretreatment. Gene expression analysis of tumor biopsies and association with responses is in progress. Conclusions ENT plus PEMBRO demonstrates anti-tumor activity and acceptable safety in patients with NSCLC who are both naive to and have progressed on prior PD-(L)1 blockade. Based on the responses seen, Cohort 2 has advanced to Stage 2 and is currently enrolling
EMBASE:619370846
ISSN: 2051-1426
CID: 2859622

Stereotactic radiosurgery for focal leptomeningeal disease in patients with brain metastases

Wolf, Amparo; Donahue, Bernadine; Silverman, Joshua S; Chachoua, Abraham; Lee, Jean K; Kondziolka, Douglas
Leptomeningeal disease (LMD) is well described in patients with brain metastases, presenting symptomatically in approximately 5% of patients. Conventionally, the presence of LMD is an indication for whole brain radiation therapy (WBRT) and not suitable for stereotactic radiosurgery (SRS). The purpose of the study was to evaluate the local control and overall survival of patients who underwent SRS to focal LMD. We reviewed our prospective registry and identified 32 brain metastases patients with LMD, from a total of 465 patients who underwent SRS between 2013 and 2015. Focal LMD was targeted with SRS in 16 patients. The median imaging follow-up time was 7 months. The median volume of LMD was 372 mm3 and the median margin dose was 16 Gy. Five patients underwent prior WBRT. Histology included non-small cell lung (8), breast (5), melanoma (1), gastrointestinal (1) and ovarian cancer (1). Follow-up MR imaging was available for 14 patients. LMD was stable in 5 and partially regressed in 8 patients at follow-up. One patient had progression of LMD with hemorrhage 5 months after SRS. Seven patients developed distant LMD at a median time of 7 months. The median actuarial overall survival from SRS for LMD was 10.0 months. The 6-month and 1-year actuarial overall survival was 60% and 26% respectively. Six patients underwent WBRT after SRS for focal LMD at a median time of 6 months. Overall, focal LMD may be may be treated successfully with radiosurgery, potentially delaying WBRT in some patients.
PMID: 28536993
ISSN: 1573-7373
CID: 2574782