The Use of Patient Navigators to Improve Cancer Care for Hispanic Patients

Background Although the United States is one of the countries at the leading edge of medical breakthroughs and treatments, there are great disparities in the access to care among different socioeconomic strata. One of the most striking discrepancies regarding access to care is found among the ranks of the Hispanic population, which is the fastest growing minority in the United States, but for which cancer is the third leading cause of death. It is clear that better and timely treatment for cancer patients belonging to this minority is needed. Patient navigators can be an important tool to improve access to care of patients belonging to this minority group. Methods Through a systemic search, we identified seven articles that employed patient navigators for Hispanic cancer patients. The identified studies addressed very limited pathology, three studying breast and four colon cancer patients. Conclusions The presence of patient navigation can be an effective to remove impediments that limit the access to care in minority populations and can improve outcomes in Hispanic patients suffering from cancer. Further research to evaluate the cost of patient navigation in relationship to the added benefit early diagnosis, continued follow up and treatment is needed

Somatic SMARCB1 Mutation in Sporadic Multiple Meningiomas: Case Report

Background: Multiple intracranial meningiomas account for <10% of all meningiomas. Familial multiple meningiomas have been linked to germline mutations in two genes: neurofibromatosis type 2 (NF2) and SWIch/Sucrose Non-Fermentable (SWI/SNF)-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1). Sporadic multiple meningiomas have been associated with somatic NF2 mutations and, to date, there has been no case related to somatic SMARCB1 mutations. Here, we describe the first case.Case Report: A 45-year-old female suffered a head trauma while snowboarding. Subsequent to her injury, she experienced persistent headache, nausea, vomiting, dizziness, and flashing lights in the right eye. Magnetic resonance imaging (MRI) of her brain revealed multiple intracranial meningiomas. She underwent a two-staged craniotomy to remove frontal/parietal/temporal and occipital extra-axial tumors. Pathology confirmed the masses as meningiomas, WHO Grade I. Tumor genetic testing was positive for SMARCB1 mutation but blood genetic testing was negative for SMARCB1 mutation.Conclusion: In sporadic multiple meningiomas, somatic NF2 mutations are usually the suspected genetic alternations. Our case illustrates that somatic SMARCB1 mutation is another genetic risk factor for sporadic multiple meningiomas, albeit rare

Immunotherapy of Brain Cancers: The Past, the Present, and Future Directions

Treatment of brain cancers, especially high grade gliomas (WHO stage III and IV) is slowly making progress, but not as fast as medical researchers and the patients would like. Immunotherapy offers the opportunity to allow the patient's own immune system a chance to help eliminate the cancer. Immunotherapy's strength is that it efficiently treats relatively small tumors in experimental animal models. For some patients, immunotherapy has worked for them while not showing long-term toxicity. In this paper, we will trace the history of immunotherapy for brain cancers. We will also highlight some of the possible directions that this field may be taking in the immediate future for improving this therapeutic option

Interstitial chemotherapy with biodegradable BCNU (Gliadel®) wafers in the treatment of malignant gliomas

Malignant gliomas represent the majority of primary brain tumors, and the prognosis of the patients afflicted with these tumors has been historically dismal, with almost uniform progressive neurologic impairment and rapid death. Even with multimodal treatment using surgery, focal radiation, and chemotherapy, no major strides were made until recently. The development of interstitial BCNU wafers (carmustine wafers, Gliadel®) has led to promising results in the treatment of a selected patients with malignant gliomas, as well as with other intracranial malignancies.BCNU is one of the first systemic chemotherapies which had obtained United States Food and Drug Administration (FDA) approval for the treatment of brain tumors. However, systemic use has been hampered by the modest prolongation of survival and by the prolonged myelosuppression and potentially fatal pulmonary toxicity. The development of interstitial therapies with BCNU represented a great step forward, allowing direct delivery to the tumor bed, with virtually no systemic toxicities. Clinical studies of BCNU wafers have showed good efficacy in both newly diagnosed and recurrent gliomas, as well as a possible therapeutic role in other primary or secondary intracranial malignancies. New studies are currently underway trying to improve the efficacy of the BCNU wafers (Gliadel®) by combining them with different systemic chemotherapies. An overview of the current knowledge ranging from the preclinical developments, to the efficacy and safety seen in the clinical trials and in clinical practice following the drug approval to the future avenues of research is therefore timely

CORRELATION BETWEEN BMI, DENTAL CARIES AND SALIVARY BUFFER CAPACITY IN A SAMPLE OF CHILDREN FROM MURES COUNTY, ROMANIA

Both dental caries and malnutrition in children are serious public health problems with diet as a common risk factor. The aim of this study is to investigate the relationship between dental caries, Body Mass Index (BMI) and salivary buffer capacity in children. Materials and Method: The first part of the study was conducted on 144 children, aged between 6 and 12 years, examined in the Pediatric Dentistry Department of UMF Tirgu Mures. Nutritional status was assessed using BMI in accordance with the recommendations of the World Health Organisation. The sample was divided into four groups based on BMI: underweight, normal weight, overweight and obese for age. Dental caries were evaluated using the DMFT (Decayed Missing Filled Teeth) index for permanent dentition and dmft (decayed missing filled teeth) for deciduous dentition. Salivary buffer capacity was recorded with CRT Buffer Strips from Ivoclar Vivadent. Results: The mean age of the sample was 9.11 ± 0.19 years, the mean dmft was 2.58 ± 0.26 and mean DMFT 1.76 ± 0.2. The underweight group presented a significantly higher dmft index compared to the other groups. A negative correlation between the salivary buffer capacity and the caries index was found. Conclusions: Because the results of this preliminary study show a higher caries incidence in underweight children, the relationship between dental caries and malnutrition should be further investigated. Dentists and physicians treating children should consider malnutrition as a risk factor for dental caries

CORRELATION BETWEEN BMI, DENTAL CARIES AND SALIVARY BUFFER CAPACITY IN A SAMPLE OF CHILDREN FROM MURES COUNTY, ROMANIA

Both dental caries and malnutrition in children are serious public health problems with diet as a common risk factor. The aim of this study is to investigate the relationship between dental caries, Body Mass Index (BMI) and salivary buffer capacity in children. Materials and Method: The first part of the study was conducted on 144 children, aged between 6 and 12 years, examined in the Pediatric Dentistry Department of UMF Tirgu Mures. Nutritional status was assessed using BMI in accordance with the recommendations of the World Health Organisation. The sample was divided into four groups based on BMI: underweight, normal weight, overweight and obese for age. Dental caries were evaluated using the DMFT (Decayed Missing Filled Teeth) index for permanent dentition and dmft (decayed missing filled teeth) for deciduous dentition. Salivary buffer capacity was recorded with CRT Buffer Strips from Ivoclar Vivadent. Results: The mean age of the sample was 9.11 ± 0.19 years, the mean dmft was 2.58 ± 0.26 and mean DMFT 1.76 ± 0.2. The underweight group presented a significantly higher dmft index compared to the other groups. A negative correlation between the salivary buffer capacity and the caries index was found. Conclusions: Because the results of this preliminary study show a higher caries incidence in underweight children, the relationship between dental caries and malnutrition should be further investigated. Dentists and physicians treating children should consider malnutrition as a risk factor for dental caries

European mtDNA Variants Are Associated With Differential Responses to Cisplatin, an Anticancer Drug: Implications for Drug Resistance and Side Effects.

Background: Cisplatin, a powerful antitumor agent, causes formation of DNA adducts, and activation of apoptotic pathways. Presently, cisplatin resistance develops in up to 70% of patients but the underlying molecular mechanism(s) are unclear and there are no markers to determine which patients will become resistant. Mitochondria play a significant role not only in energy metabolism but also retrograde signaling (mitochondria to nucleus) that modulates inflammation, complement, and apoptosis pathways. Maternally inherited mitochondrial (mt) DNA can be classified into haplogroups representing different ethnic populations that have diverse susceptibilities to diseases and medications. Methods: Transmitochondrial cybrids, where all cell lines possess identical nuclear genomes but either the H (Southern European) or J (Northern European) mtDNA haplogroups, were treated with cisplatin and analyzed for differential responses related to viability, oxidative stress, and expression levels of genes associated with cancer, cisplatin-induced nephrotoxicity and resistance, apoptosis and signaling pathways. Results: The cisplatin-treated-J cybrids showed greater loss of cell viability along with lower levels of reactive oxygen species and mitochondrial membrane potential compared to cisplatin-treated-H cybrids. After cisplatin treatment, J cybrids showed increased gene expression of BAX, CASP3, and CYP51A, but lower levels of SFRP1 compared to untreated-J cybrids. The cisplatin-treated-H cybrids had elevated expression of CDKN1A/P21, which has a role in cisplatin toxicity, compared to untreated-H cybrids. The cisplatin-treated H had higher transcription levels of ABCC1, DHRS2/HEP27, and EFEMP1 compared to cisplatin-treated-J cybrids. Conclusions: Cybrid cell lines that contain identical nuclei but either H mtDNA mitochondria or J mtDNA mitochondria respond differently to cisplatin treatments suggesting involvement of the retrograde signaling (from mitochondria to nucleus) in the drug-induced cell death. Varying toxicities and transcription levels of the H vs. J cybrids after cisplatin treatment support the hypothesis that mtDNA variants play a role in the expression of genes affecting resistance and side effects of cisplatin

A Retrospective Interventional Cohort Study to Assess the Safety and Efficacy of Sandostatin LAR for Treatment of Recurrent and/or Refractory Meningiomas.

Background: Meningiomas are the most common adult primary intracranial tumors in the United States. Despite high recurrence rate of atypical and malignant subtypes, there is no approved drug indicated specifically for meningioma. Since the majority of meningiomas exhibit high density of somatostatin receptors subtypes, somatostatin analogs have been under close investigation. The aim of this study was to evaluate efficacy and safety of Sandostatin LAR (octreotide) in patients with progressive, and/or recurrent meningioma, and identify subset of patients who were more likely to benefit from this treatment. Methods: A total of 43 patients ≥ 18 years old were included in the retrospective chart review. The patients underwent treatment with Sandostatin LAR (octreotide) from 01.01.2010 to 06.01.2017 at the University of California, Irvine after confirmation of the diagnosis. Six months progression free survival (PFS6) was defined as a primary endpoint, and the overall survival (OS), safety, and toxicity were identified as secondary endpoints. Results: The OS for 6 months, 1, and 3 years for all WHO grades was 94.8, 88.1, and 67.0%, respectively. The PFS6 for WHO I, II, III, and all was 89.4, 89, 33.3, and 80% respectively. For patients with no prior surgeries, chemotherapy or radiation, the PFS6 was 88.9, 84.8, and 94.8%, respectively. Interestingly, the PFS6 was 90.5% for skull-based and 80% for 3-6 cm tumors. Patients with tumors in parasagittal location had PFS6 of 83.3% compared to PFS6 of 50.0% for patients with convexity tumors. Evaluation of PFS6 based on the effect of estrogen and progesterone on meningioma identified that ER-PR+ tumors had PFS6 of 87.8% while patients with ER-PR- meningiomas had PFS6 of 62.5%. Median TTP for WHO grade I, II, and III was 3.1, 2.40, and 0.26 years, respectively. Subgroup analysis showed that median TTP was 3.1 years for <3 cm tumors, 3.22 years for skull-based tumors, 2.37 years for patients with prior surgeries and 3.10 years for patients with no history of chemotherapy. History of radiation had no effect on median TTP. Sandostatin LAR (octreotide) was well-tolerated. Conclusions:This is one of the largest retrospective analysis of meningioma patients treated with Sandostatin LAR (octreotide) suggesting that this treatment has minimal to no adverse events and could prolong overall survival, and progression free survival especially for patients with ER-PR+ tumors who underwent surgeries for small skull-based tumors

Secondary fibrosarcoma of the brain stem treated with cyclophosphamide and Imatinib

Radiation-induced midbrain fibrosarcoma is a rare, highly aggressive tumor, which is associated with poor prognosis. We present the case of a 48-year old man with brainstem fibrosarcoma 20 years following radiation therapy received for a pituitary tumor. We discuss this case in the context of the diagnostic criteria for these tumors, and previous reports of secondary and primary sarcomas of the central nervous system