Beyond Concurrent Chemoradiation: The Emerging Role of PD-1/PD-L1 Inhibitors in Stage III Lung Cancer.

Concurrent chemoradiation (cCRT) with platinum-based chemotherapy is standard-of-care therapy for patients with stage III unresectable non-small cell lung cancer (NSCLC). Although cCRT is potentially curative, 5-year overall survival has hovered around 20%, despite extensive efforts to improve outcomes with increasing doses of conformal radiation and intensification of systemic therapy with either induction or consolidation chemotherapy. PD-1/PD-L1 immune checkpoint inhibitors have demonstrated unprecedented efficacy in patients with stage IV NSCLC. In addition, preclinical and early clinical evidence suggests that chemotherapy and radiation may work synergistically with anti-PD-1/PD-L1 therapy to promote antitumor immunity, which has led to the initiation of clinical trials testing these drugs in patients with stage III NSCLC. A preliminary report of a randomized phase III trial, the PACIFIC trial, demonstrated an impressive increase in median progression-free survival with consolidative durvalumab, a PD-L1 inhibitor, compared with observation after cCRT. Here, we discuss the clinical and translational implications of integrating PD-1/PD-L1 inhibitors in the management of patients with unresectable stage III NSCLC

Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review.

BACKGROUND: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. OBJECTIVE: The aim of this review was to collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. METHODS: We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 completed survey responses. RESULTS: There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even teleassessments are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. CONCLUSIONS: These competencies are increasingly important in tackling the challenges facing health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited

Comparison of a Novel Curvilinear Approach to Conventional Rectilinear Approach for Prostate Seed Implant

Purpose: To evaluate dosimetric benefit of curvilinear distribution of seeds for low-dose-rate (LDR) prostate brachytherapy with I-125 isotopes. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, P

Effects of EGFR Expression on Anti-tumor Efficacy of Vandetanib or Cediranib Combined with Radiotherapy (RT) in U87 Human Glioblastoma (GBM) Xenografts

Introduction: Vandetanib is a receptor tyrosine kinase inhibitor (RTKI) with activity against vascular endothelial growth factor receptor-2 (VEGFR-2) and epidermal growth factor receptor (EGFR). Cediranib is a highly potent VEGF RTKI that inhibits all three VEGF receptors. In this study we investigated the effect of exogenous overexpression of EGFR on sensitivity of human GBM U87 xenografts to vandetanib or cediranib, alone or in combination with RT. American Association for Cancer Research (AACR) 101st Annual Meeting April 17-21, Washington, DC

From survival to survivorship: late side effects become an issue in high-grade glioma.

“For many patients, controlling neurological symptoms, preventing cognitive dysfunction and maintaining functional independence are just as important as prolonging survival.

Observations of M87 and Hydra A at 90 GHz

This paper presents new observations of the AGNs M87 and Hydra A at 90 GHz made with the MUSTANG bolometer array on the Green Bank Telescope at 8.5" resolution. A spectral analysis is performed combining this new data and archival VLA data on these objects at longer wavelengths. This analysis can detect variations in spectral index and curvature expected from energy losses in the radiating particles. M87 shows only weak evidence for steepening of the spectrum along the jet suggesting either re-acceleration of the relativistic particles in the jet or insufficient losses to affect the spectrum at 90 GHz. The jets in Hydra A show strong steepening as they move from the nucleus suggesting unbalanced losses of the higher energy relativistic particles. The difference between these two sources may be accounted for by the different lengths over which the jets are observable, 2 kpc for M87 and 45 kpc for Hydra A.Comment: 11 pages, submitted to Ap

Effect of Cediranib, Temozolamide and Radiotherapy in U87 GBM wtEGFR and EGFRvIII-expressing Xenografts

Introduction: Glioblastomas (GBM) frequently overexpress the epidermal growth factor receptor (wtEGFR) or its mutant, EGFRvIII contributing to radioresistance. New treatment strategies for GBM include blockade of EGFR signaling and angiogenesis. Cediranib (CD) is a highly potent VEGFR-2 RTKI that inhibits all three VEGF receptors. This study investigated the radiosensitizing potential of CD in combination with temozolamide (TMZ) in U87 GBM xenografts expressing wtEGFR or EGFRvIII. Radiation Research Society (RRS) 8th Annual Meeting September 25-29, Maui, H

Evolving Role of Vorinostat Combined with Radiation Therapy in the Treatment of Brain Tumors, from the Lab to the Clinic

Purpose/Objective(s): Radiation therapy (RT) is a critical element in the treatment of both brain metastases and glioblastoma (GBM). Temozolomide (TMZ) has an established role in the upfront treatment of GBM. Down-regulated mismatch repair (MMR) is a known mechanism of resistance to TMZ. Vorinostat (SAHA), an HDAC inhibitor, has successfully been combined with a number of cytotoxic agents, including ionizing radiation (IR). We performed a series of preclinical and clinical studies to examine the role of SAHA in the treatment of brain tumors. American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, C