Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States.

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Investigation of selectivity in C-H bond activation by platinum

The synthesis, structure, and photophysical properties of a series of novel, highly luminescent tridentate platinum complexes with general coordination geometry of (C^N*N)-PtL are reported, where "C^N" denotes a coordination of C and N to the platinum to form a five-membered metallacycle and "N*N" denotes a coordination of two N atoms to the platinum to form a six-membered metallacycle; L is a mono anionic ligand such as halides or acetylides. Compared to the known (C^N^N)-PtL type of complexes that were reported to emit with low quantum yields, the structural modification leads to dramatic improvements in phosphorescence efficiency. For example, new complexes (C^N*N)-PtL with L = hexylacetylide and phenylacetylide emitted intensely with quantum yields of 47% and 56%, respectively, latter of which is among the highest quantum yields reported so far for cyclometalated platinum (II) complexes. Selectivity in C-H bond activation by platinum and the exact mechanism of cycloplatination are issues that still remain unclear. A series of ligands which include sp²/sp³, primary/secondary sp³ C-H bonds, and aromatic/vinylic sp² C-H bonds with a carbon linker between the bipyridine and the carbon groups have been prepared. All ligands have been attempted for cycloplatination in glacial acetic acid and acetonitrile. All ligands produced the same sp² C-H bond activated complex in both solvents, which suggests that the linker atom does play a role on selectivity.M.S

SYNTHESIS AND PHOTOPHYSICAL CHARACTERIZATION OF TRIDENTATE C^N*N PLATINUM (II) COMPLEXES and, INVESTIGATION OF SELECTIVITY IN C-H BOND ACTIVATION BY PLATINUM

The synthesis, structure, and photophysical properties of a series of novel, highly luminescent tridentate platinum complexes with general coordination geometry of (C^N*N)-PtL are reported, where "C^N" denotes a coordination of C and N to the platinum to form a five-membered metallacycle and "N*N" denotes a coordination of two N atoms to the platinum to form a six-membered metallacycle\; L is a mono anionic ligand such as halides or acetylides. Compared to the known (C^N^N)-PtL type of complexes that were reported to emit with low quantum yields, the structural modification leads to dramatic improvements in phosphorescence efficiency. For example, new complexes (C^N*N)-PtL with L = hexylacetylide and phenylacetylide emitted intensely with quantum yields of 47% and 56%, respectively, latter of which is among the highest quantum yields reported so far for cyclometalated platinum (II) complexes. Selectivity in C-H bond activation by platinum and the exact mechanism of cycloplatination are issues that still remain unclear. A series of ligands which include sp²/sp³, primary/secondary sp³ C-H bonds, and aromatic/vinylic sp² C-H bonds with a carbon linker between the bipyridine and the carbon groups have been prepared. All ligands have been attempted for cycloplatination in glacial acetic acid and acetonitrile. All ligands produced the same sp² C-H bond activated complex in both solvents, which suggests that the linker atom does play a role on selectivity

Inflammatory Markers in Cancer Immunotherapy

Chronic inflammation is considered a major risk factor for cancer formation. Inflammation within the tumor environment plays a role in its response to therapy, growth, and prognosis. Cancer associated inflammation is known to occur in the tumor microenvironment and in the systemic circulation, and is correlated with disease progression and prognosis in many cancers. Blood cells such as neutrophils, lymphocytes, platelets, and circulating proteins such as C-reactive protein, and interleukins, such as IL-6, have been associated with inflammatory responses, which contribute to tumorigenesis. Cancer has found ways to evade the immune response; a pathway that can attenuate the innate immune response is via blocking immune checkpoints. Development of monoclonal antibodies against inhibitory immune checkpoints such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) have given rise to immunotherapy, which has shown remarkable responses in anti-tumor activity resulting in several U.S. Federal and Drug Administration (FDA)-approved checkpoint inhibitors. Various inflammatory markers and their prognostic and predictive implications in malignancies treated with immunotherapy will be discussed in this review

SYNTHESIS AND PHOTOPHYSICAL CHARACTERIZATION OF TRIDENTATE C^N*N PLATINUM (II) COMPLEXES and INVESTIGATION OF SELECTIVITY IN C-H BOND ACTIVATION BY PLATINUM

The synthesis structure and photophysical properties of a series of novel highly luminescent tridentate platinum complexes with general coordination geometry of (C^N*N)-PtL are reported where "C^N" denotes a coordination of C and N to the platinum to form a five-membered metallacycle and "N*N" denotes a coordination of two N atoms to the platinum to form a six-membered metallacycle; L is a mono anionic ligand such as halides or acetylides. Compared to the known (C^N^N)-PtL type of complexes that were reported to emit with low quantum yields the structural modification leads to dramatic improvements in phosphorescence efficiency. For example new complexes (C^N*N)-PtL with L = hexylacetylide and phenylacetylide emitted intensely with quantum yields of 47% and 56% respectively latter of which is among the highest quantum yields reported so far for cyclometalated platinum (II) complexes. Selectivity in C-H bond activation by platinum and the exact mechanism of cycloplatination are issues that still remain unclear. A series of ligands which include sp²/sp³ primary/secondary sp³ C-H bonds and aromatic/vinylic sp² C-H bonds with a carbon linker between the bipyridine and the carbon groups have been prepared. All ligands have been attempted for cycloplatination in glacial acetic acid and acetonitrile. All ligands produced the same sp² C-H bond activated complex in both solvents which suggests that the linker atom does play a role on selectivity

Metastatic Prostate Cancer Manifesting as Cholestatic Jaundice: A Case Report and Review of the Literature

A paraneoplastic syndrome can often present as the first manifestation of an underlying malignancy. We report a patient who presented with cholestatic jaundice as a paraneoplastic syndrome from his newly diagnosed metastatic prostate cancer. He received initial treatment with androgen deprivation therapy followed by six cycles of docetaxel resulting in resolution of his cholestatic process, normalization of liver enzyme levels, and excellent biochemical and radiographic response. To the best of our knowledge, this is the first reported case of metastatic prostate cancer with cholestatic jaundice as a paraneoplastic phenomenon to be safely treated with androgen deprivation therapy and upfront docetaxel, reflecting the latest shift in the treatment of metastatic prostate cancer

Computational and Experimental Study on Selective sp²/sp³ or Vinylic/Aryl Carbon–Hydrogen Bond Activation by Platinum(II): Geometries and Relative Stability of Isomeric Cycloplatinated Compounds

Cyclometalating ligands 6-(1-phenylethyl)-2,2′-bipyridine (<b>L4</b>), 6-(1-phenylvinyl)-2,2′-bipyridine (<b>L5</b>), and 6-(prop-1-en-2-yl)-2,2′-bipyridine (<b>L6</b>) were synthesized by the Negishi coupling of 6-bromo-2,2′-bipyridine with the corresponding organozinc reagents. The reaction of <b>L4</b> with K₂PtCl₄ produced only the cycloplatinated compound <b>4a</b> via sp² C–H bond activation. The reactions of <b>L5</b> and <b>L6</b> produced exclusively the cycloplatinated compounds <b>5b</b> and <b>6a</b>, respectively, via vinylic C–H bond activation. DFT calculations were performed on 12 possible cycloplatination products from the reaction of <i>N</i>-alkyl-<i>N</i>-phenyl-2,2′-bipyridin-6-amine (alkyl = methyl (<b>L1</b>), ethyl (<b>L2</b>), and isopropyl (<b>L3</b>)) and <b>L4</b>–<b>L6</b>. The results show that compounds <b>1b</b>–<b>3b</b> resulting from the sp³ C–H bond activation of <b>L1</b>–<b>L3</b> are thermodynamic products, and their relative stability is attributed to the planar geometry that allows for a better conjugation. Similar reasoning also applies to the stability of products from vinylic C–H bond activation of <b>L5</b> and <b>L6</b>. The relative stability of isomeric cycloplatinated compounds <b>4a</b> and <b>4b</b> may be due to the different strengths of C–Pt bonds. The steric interaction is the major cause of severe distortion from a planar coordination geometry in the cycloplatinated compounds, which leads to instability of the corresponding cyclometalated products and a higher kinetic barrier for C–H bond activation

Computational and Experimental Study on Selective sp²/sp³ or Vinylic/Aryl Carbon–Hydrogen Bond Activation by Platinum(II): Geometries and Relative Stability of Isomeric Cycloplatinated Compounds

Cyclometalating ligands 6-(1-phenylethyl)-2,2′-bipyridine (<b>L4</b>), 6-(1-phenylvinyl)-2,2′-bipyridine (<b>L5</b>), and 6-(prop-1-en-2-yl)-2,2′-bipyridine (<b>L6</b>) were synthesized by the Negishi coupling of 6-bromo-2,2′-bipyridine with the corresponding organozinc reagents. The reaction of <b>L4</b> with K₂PtCl₄ produced only the cycloplatinated compound <b>4a</b> via sp² C–H bond activation. The reactions of <b>L5</b> and <b>L6</b> produced exclusively the cycloplatinated compounds <b>5b</b> and <b>6a</b>, respectively, via vinylic C–H bond activation. DFT calculations were performed on 12 possible cycloplatination products from the reaction of <i>N</i>-alkyl-<i>N</i>-phenyl-2,2′-bipyridin-6-amine (alkyl = methyl (<b>L1</b>), ethyl (<b>L2</b>), and isopropyl (<b>L3</b>)) and <b>L4</b>–<b>L6</b>. The results show that compounds <b>1b</b>–<b>3b</b> resulting from the sp³ C–H bond activation of <b>L1</b>–<b>L3</b> are thermodynamic products, and their relative stability is attributed to the planar geometry that allows for a better conjugation. Similar reasoning also applies to the stability of products from vinylic C–H bond activation of <b>L5</b> and <b>L6</b>. The relative stability of isomeric cycloplatinated compounds <b>4a</b> and <b>4b</b> may be due to the different strengths of C–Pt bonds. The steric interaction is the major cause of severe distortion from a planar coordination geometry in the cycloplatinated compounds, which leads to instability of the corresponding cyclometalated products and a higher kinetic barrier for C–H bond activation