Research Spotlight

Li, W., J. A. O’Shaughnessy, D. F. Hayes, M. Campone, I. Bondarenko, I. Zbarskaya, E. Brain, M. Stenina, O. Ivanova, M. P. Graas, P. Neven, D. S. Ricci, T. W. Griffin, T. Kheoh, M. K. Yu, M. Gormley, J. Martin, M. Schaffer, K. Zelinsky, P. De Porre and S. R. Johnston (2016). “Biomarker associations with efficacy of abiraterone acetate and exemestane in postmenopausal patients with estrogen receptor-positive metastatic breast cancer.” Clin Cancer Res: 2016 June [Epub ahead of print].

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PURPOSE: Abiraterone may suppress androgens that stimulate breast cancer growth. We conducted a biomarker analysis of circulating tumor cells (CTCs), formalin-fixed paraffin-embedded tissues (FFPETs), and serum samples from postmenopausal estrogen receptor (ER)+ breast cancer patients to identify subgroups with differential abiraterone sensitivity. METHODS: Patients (randomized 1:1:1) were treated with 1,000 mg/d abiraterone acetate + 5 mg/d prednisone (AA), AA + 25 mg/d exemestane (AAE), or exemestane. The biomarker population included treated patients (n = 293). The CTC population included patients with {greater than or equal to} 3 baseline CTCs (n = 104). Biomarker (e.g., androgen receptor [AR], ER, Ki-67, CYP17) expression was evaluated. Cox regression stratified by prior therapies in the metastatic setting (0/1 vs. 2) and setting of letrozole/anastrozole (adjuvant vs. metastatic) was used to assess biomarker associations with progression-free survival (PFS). RESULTS: Serum testosterone and estrogen levels were lowered and progesterone increased with AA. Baseline AR or ER expression was not associated with PFS in CTCs or FFPETs for AAE versus exemestane but dual positivity of AR and ER expression was associated with improved PFS (HR 0.41 [95% confidence interval (CI), 0.16-1.07], P = 0.070). For AR expression in FFPETs obtained < 1 year prior to first dose (n = 67), a trend for improved PFS was noted for AAE versus exemestane (HR 0.56 [95% CI, 0.24-1.33], P = 0.19). CONCLUSIONS: An AA pharmacodynamic effect was shown by decreased serum androgen and estrogen levels and increased progesterone. AR and ER dual expression in CTCs and newly obtained FFPETs may predict AA sensitivity.

Glasgow, S. C., A. M. Morris, N. N. Baxter, J. W. Fleshman, K. S. Alavi, M. A. Luchtefeld, J. R. Monson, G. J. Chang and L. K. Temple (2016). “Development of the American Society of Colon and Rectal Surgeons’ rectal cancer surgery checklist.” Dis Colon Rectum 59(7): 601-606.

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BACKGROUND: There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality. OBJECTIVE: The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer. DESIGN: A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed. SETTINGS: The study was conducted through meetings and discussion to consensus. PATIENTS: Patient data were extracted from an initial literature review. MAIN OUTCOME MEASURES: The checklist was measured by its ability to improve care in complex rectal surgery cases by reducing the possibility of omission through the division of treatment into 3 distinct phases. RESULTS: The process generated a 25-item checklist covering the spectrum of care for patients with rectal cancer who were undergoing surgery. LIMITATIONS: The study was limited by its lack of prospective validation. CONCLUSIONS: The American Society of Colon and Rectal Surgeons rectal cancer surgery checklist is composed of the essential elements of preoperative, intraoperative, and postoperative care that must be addressed during the surgical treatment of patients with rectal cancer.

Dugas, C. M. and J. M. Schussler (2016). “Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions.” Trends Cardiovasc Med 26(5): 466-473.

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Several specific new technologies [high-resolution CT coronary imaging with fractional flow reserve (CTCA-FFR), virtual reality (VR), vascular robotic systems (VRS), and three-dimensional printing] are poised to improve the treatment of patients with cardiovascular disease and at the same time the safety of the physicians who care for them. This article focuses on the potential clinical impact each of these modalities will have, as well as speculating on synergies that use of them together may achieve.

Squiers, J. J., B. Lima and J. M. DiMaio (2016). “Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence.” J Thorac Cardiovasc Surg 152(1): 20-32.

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Extracorporeal membrane oxygenation (ECMO) provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure. Since ECMO was first reported in 1974, nearly 70,000 runs of ECMO have been implemented, and the use of ECMO in adults increased by more than 400% from 2006 to 2011 in the United States. A variety of factors, including the 2009 influenza A epidemic, results from recent clinical trials, and improvements in ECMO technology, have motivated this increased use in adults. Because ECMO is increasingly becoming available to a diverse population of critically ill patients, we provide an overview of its fundamental principles and a systematic review of the evidence basis of this treatment modality for a variety of indications in adults.

Rodriguez, E., L. W. Nifong, J. Bonatti, R. Casula, V. Falk, T. A. Folliguet, B. B. Kiaii, M. J. Mack, T. Mihaljevic, J. M. Smith, R. M. Suri, J. E. Bavaria, T. E. MacGillivray and W. R. Chitwood, Jr. (2016). “Pathway for surgeons and programs to establish and maintain a successful robot-assisted adult cardiac surgery program.” J Thorac Cardiovasc Surg 152(1): 9-13.

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Few education programs offer training in robotic-assisted cardiac surgery. This emerging field requires a new training paradigm, and we present a pathway and criteria to engage in robotic surgery.