Breaking Tradition to Bridge Bench and Bedside: Accelerating the MD-PhD-Residency Pathway
PROBLEM/OBJECTIVE:Physician-scientists are individuals trained in both clinical practice and scientific research. Often, the goal of physician-scientist training is to address pressing questions in biomedical research. The established pathways to formally train such individuals are, mainly, MD-PhD programs and physician-scientist track residencies. Although graduates of these pathways are well equipped to be physician-scientists, numerous factors, including funding and length of training, discourage application to such programs and impede success rates. APPROACH/METHODS:To address some of the pressing challenges in training and retaining burgeoning physician-scientists, New York University Grossman School of Medicine formed the Accelerated MD-PhD-Residency Pathway in 2016. This pathway builds on the previously established accelerated three-year MD pathway to residency at the same institution. The Accelerated MD-PhD-Residency Pathway conditionally accepts MD-PhD trainees to a residency position at the same institution through the National Resident Matching Program. OUTCOMES/RESULTS:Since its inception, 2 students have joined the Accelerated MD-PhD-Residency Pathway, which provides protected research time in their chosen residency. The pathway reduces the time to earn an MD and PhD by one year and reduces the MD training phase to three years, reducing the cost and lowering socioeconomic barriers. Remaining at the same institution for residency allows for the growth of strong research collaborations and mentoring opportunities, which foster success. NEXT STEPS/UNASSIGNED:The authors and institutional leaders plan to increase the number of trainees that are accepted into the Accelerated MD-PhD-Residency Pathway and track the success of these students through residency and into practice to determine if the pathway is meeting its goal of increasing the number of practicing physician-scientists. The authors hope this model can serve as an example to leaders at other institutions who may wish to adopt this pathway for the training of their MD-PhD students.
Effects of M-CSF Inhibition And Radiotherapy In A Murine Model Of Colorectal Cancer [Meeting Abstract]
A Single Institution Review Of Efficacy Of Neoadjuvant Chemoradiation With Gemcitabine/Abraxane Compared to FOLFIRINOX in Pancreatic Ductal Adenocarcinoma [Meeting Abstract]
Interprofessional Image Verification Workshop for Physician and Physics Residents: A Multi-Institutional Experience [Meeting Abstract]
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]
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
Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis
BACKGROUND:In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy, watch and wait is a novel management strategy with potential to avoid major surgery. Study-level meta-analyses have reported wide variation in the proportion of patients with local regrowth. We did an individual participant data meta-analysis to investigate factors affecting occurrence of local regrowth. METHODS:We updated search results of a recent systematic review by searching MEDLINE and Embase from Jan 1, 2016, to May 5, 2017, and used expert knowledge to identify published studies reporting on local regrowth in patients with rectal cancer managed by watch and wait after clinical complete response to neoadjuvant chemoradiotherapy. We restricted studies to those that defined clinical complete response using criteria equivalent to SÃ£o Paulo benchmarks (ie, absence of residual ulceration, stenosis, or mass within the rectum on clinical and endoscopic examination). The primary outcome was 2-year cumulative incidence of local regrowth, estimated with a two-stage random-effects individual participant data meta-analysis. We assessed the effects of clinical and treatment factors using Cox frailty models, expressed as hazard ratios (HRs). From these models, we derived percentage differences in mean Î¸ as an approximation of the effect of measured covariates on between-centre heterogeneity. This study is registered with PROSPERO, number CRD42017070934. FINDINGS/RESULTS:=0Â·0330). We estimated that measured factors contributed 4Â·8-45Â·3% of observed between-centre heterogeneity. INTERPRETATION/CONCLUSIONS:In patients with rectal cancer and clinical complete response after chemoradiotherapy managed by watch and wait, we found some evidence that increasing cT stage predicts for local regrowth. These data will inform clinician-patient decision making in this setting. Research is needed to determine other predictors of a sustained clinical complete response. FUNDING/BACKGROUND:None.
Survival Outcomes and Prognostic Factors for Gastric Cancer in the Adjuvant Setting: An Analysis of the National Cancer Database [Meeting Abstract]
Cone-beam CT radiomics features as potential predictors for esophageal cancer response [Meeting Abstract]
Purpose: Esophageal cancer patients undergoing radiotherapy usually receive daily or weekly cone-beam CT (CBCT) imaging to verify positioning before treatment. The purpose of this study is to evaluate the reproducibility of texture features extracted from CBCT and its correlation with CT features for their potential use as early predictors of esophageal cancer response during the course of RT. Methods: Ten patients treated for esophageal cancer that received daily CBCT were retrospectively evaluated (Varian TrueBeam with same Thorax imaging technique: half-fan, full-trajectory, 125 kVp, 270 mAs). The planning CT (CTP) and the two initial CBCTs (day 1 and 2 of treatment) were exported from Eclipse TPS to an in-house processing pipeline. This included edge detection for couch removal, CBCT resampling and automatic 3D rigid-registration of CBCT to CTP using Mattes mutual information metric. GTVs for each patient were exported and texture features were extracted from CTP and the registered CBCTs using the Imaging Biomarker Explorer (IBEX) software. Thirty-three texture features using cooccurrence and run-length matrices were extracted. Texture reproducibility between consecutive CBCTs was evaluated using intraclass correlation (ICC). CTP and CBCTs were evaluated using Pearson's correlation. Significance level was corrected for multiple testing using Bonferroni adjustment. Results: Registration results were deemed satisfactory using mutual information as well as visual inspection within the volume that encompassed the GTV. Out of the initial 33 texture features considered, 13 presented excellent (ICC > 0.9) reproducibility between the two initial CBCTs. Out of these 13 features, 5 presented statistically significant Pearson's correlation adjusted for multiple statistical tests (P < 0.004) ranging from 0.86 to 0.89 (Table). Conclusion: Several texture features from CBCT showed reproducibility between the first two days of treatment and strongly correlated between CTP and CBCT. Therefore, derived texture features could be investigated as predictors of treatment response during the course of treatment
Presence of High Risk HPV decreases odds of APR in patients with anal squamous cell cancer [Meeting Abstract]
Purpose or Objective Definitive chemoradiotherapy is the upfront treatment of choice in anal squamous cell carcinoma while surgery is reserved to refractory cases. Anterior peroneal resection (APR) of anal cancers often necessitates life-long a lifelong ostomy, leading to lower quality of life for the patient. High risk human papillomavirus HPV subtypes have been shown to have improved outcomes in head and neck cancer. We analyze data from a large hospital based database to evaluate the impact of high risk HPV status on APR in patients with anal cancer. Material and Methods The National Cancer Database (NC
A phase I/II multi-center study of nivolumab and carboplatin/paclitaxel with radiation therapy (RT) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) [Meeting Abstract]
Background: ESCC comprises 80% of esophageal cancers worldwide. Preoperative chemoRT is a standard-of-care based on the CROSS trial (N Engl J Med 2012;366:2074-2084), which reported encouraging pathologic complete response (pCR) and overall survival (OS). Surgery is often deferred in patients with clinical CR (cCR) based on lack of overall survival (OS) benefit (J Clin Oncol 2005;23:2310-2317, J Clin Oncol 2007;25:1160-1168). Nivolumab has activity in advanced ESCC (Lancet Oncol 2017;18:631-639), and adding it to chemoRT may improve outcomes. ESCC has a high somatic mutation rate and treatment with chemoRT may augment the abscopal effect.
Method(s): Our trial aims to establish the safety and tolerability (phase I), as well as the efficacy (phase II) of nivolumab added to a standard chemoRT backbone for patients with Tany N1-3 or T3-4N0 M0 ESCC. Phase I will enroll up to 12 patients and phase II, up to 44, per an optimal two-stage design. The phase I primary endpoint is unacceptable toxicity at 28 days after the last dose of chemotherapy. Phase II primary endpoints are cCR (endoscopy + PET/CT), pCR for patients undergoing surgery, and median progression-free survival and OS, which will be estimated via Kaplan Meier curves. Extensive tumor and blood immune correlative studies are planned. (Table Presented)