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Garst, Jennifer Lynn

Overview:

1. Non-small cell and small cell lung cancer - intervention, epidemiology and treatment.
2. Clinical trials of combined modality therapy, cancer drug development, and new treatment approaches and supportive care for lung cancer.
3. Lung cancer as a women's health issue.
4. Supportive care for lung cancer patients including management of taste alteration, weight loss and declining performance status.
5. Clinical research in the Duke Oncology Outreach (DOORS) & DOC affiliate setting.
6. Standardization of management for common oncologic problems.

Clinical Research:

1. Principal Investigator:
TOP 96-02, "A Phase I/II Dose Escalation Study of Concurrent Navelbine and Radiation Inoperable Stage III"
TOP 96-03, "A Phase I/II Study of Weekly Docetaxel and Vinorelbine in Advanced and Relapsed Non-Small Cell Lung Carcinoma"
TOP 97-01, "A Phase I/II Study: Sequential Topotecan and Carboplatin/VP-16 for the Treatment of Small Cell Lung Cancer"
TOP 98-01, "A Phase I/II Study: Weekly CPT-11 with Vinorelbine in Advanced Non-Small Cell Lung Carcinoma"
TOP 98-02, "A Phase I/II Trial of Concurrent Carboplatin and Vinorelbine Chemotherapy with Radiation Followed by Surgery in Patients with Non-Small Cell Lung Carcinoma"
TOP 99-01, "A Feasibility Trial of Filgrastim-SD/01 to Support Carboplatin/ Navelbine (SD/01-CaN) Chemotherapy for the Treatment of Thoracic Malignancies"
TOP 00-03, "Phase II Trial of Gemcitabine and Oxaliplatin in the Treatment of Non-Small Cell Lung Cancer (NSCLC)"
TOP 00-01, "A Pilot Study of the Relative Velocity of Serum Tumor Marker CYFRA 21-1 as an Indicator of Early Chemotherapeutic Response in Advanced Non-Small Cell Lung Cancer"
"Evaluation of Oral Antiemetic Regimens for Moderately-High to Highly Emetogenic Chemotherapy: Pilot Study of Oral Ondansetron in Acute Chemotherapy Inducted Emesis (CIE) and a Randomized Double Blind Comparison of Ondansetron versus Dexamethasone versus Procholorperazine in Delayed CIE"
2. Co-Principal Investigator:
"A Phase I/II Study of Active Immunotherapy with Dexosomes Loaded with
Mage3.A2 and Mage4.A2 Peptides in HLA A2+ Patients with Metastatic
Non-Small Cell Lung Cancer Expressing Mage3 or Mage4 (AP Cells,
Inc.)"
3D 97-01, "A Phase I Dose Escalation Research Study of Radiotherapy Using Three-Dimensional Treatment Planning Following Neoadjuvant Chemotherapy for Stage IIB/III Non-Small Cell Lung Cancer"
"Phase IV Pharmacokinetic Study in Chemonaive Patients with Stage IIIB or IV
Non-Small Cell Lung Cancer (NSCLC) Receiving Gemcitabine and
Cisplatin (Eli Lilly B9E-MC-JHQK)"
3. Initiation, organization and development of the Multidisciplinary Thoracic Oncology clinic
with clinical research at DVAMC, 1996
4. Development of four oncology clinical pathways at Duke University Medical Center, 1997
5. Implementation of 3 clinical research trials at DOORS Asheboro site, Randolph Hospital,
1997

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

M.D. — Medical College of Georgia School of Medicine

News:

Grants:

Quit-smoking program for lung cancer patients' families

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
May 10, 2003
End Date
April 30, 2010

Caregiver-Assisting Coping Skills Training for Lung Cancer

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
June 06, 2002
End Date
May 31, 2008

Dexasome Based Immunotherapy of Lung Cancer

Administered By
Medicine, Medical Oncology
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
March 01, 2001
End Date
February 28, 2004

Publications:

Safety and effectiveness of bevacizumab-containing treatment for non-small-cell lung cancer: final results of the ARIES observational cohort study.

INTRODUCTION: Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor, was approved by the US Food and Drug Administration for the treatment of advanced non-small-cell lung cancer (NSCLC) in combination with carboplatin and paclitaxel. ARIES (Avastin Regimens: Investigation of Effectiveness and Safety), a prospective observational cohort study, evaluated outcomes in a large, community-based population of patients with first-line NSCLC. METHODS: From 2006 to 2009, ARIES enrolled patients with locally advanced or metastatic NSCLC who were eligible for bevacizumab, excluding those with predominantly squamous histology. Patients were required to provide informed consent and to have initiated bevacizumab with chemotherapy within 4 months before enrollment. There were no protocol-defined treatments or assessments. The dosing of bevacizumab and chemotherapy, and the choice of chemotherapy regimen, was at the discretion of the treating physician. RESULTS: ARIES enrolled 1967 patients with first-line NSCLC. At study closure, median follow-up was 12.5 months (range, 0.2-65.5). Median age was 65 years (range, 31-93), and 252 patients (12.8%) identified as never smokers. Median progression-free survival was 6.6 months (95% confidence interval, 6.3-6.9), and median overall survival was 13.0 months (95% confidence interval, 12.2-13.8) with first-line bevacizumab plus chemotherapy. Incidences of bevacizumab-associated adverse events (19.7% overall) were consistent with those in randomized controlled trials of bevacizumab in NSCLC. CONCLUSION: Results from ARIES demonstrate similar outcomes to randomized controlled trials of bevacizumab when added to standard chemotherapy in a real-world patient population with advanced NSCLC.

Authors
Lynch, TJ; Spigel, DR; Brahmer, J; Fischbach, N; Garst, J; Jahanzeb, M; Kumar, P; Vidaver, RM; Wozniak, AJ; Fish, S; Flick, ED; Leon, L; Hazard, SJ; Kosty, MP
MLA Citation
Lynch, TJ, Spigel, DR, Brahmer, J, Fischbach, N, Garst, J, Jahanzeb, M, Kumar, P, Vidaver, RM, Wozniak, AJ, Fish, S, Flick, ED, Leon, L, Hazard, SJ, and Kosty, MP. "Safety and effectiveness of bevacizumab-containing treatment for non-small-cell lung cancer: final results of the ARIES observational cohort study." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 9.9 (September 2014): 1332-1339.
PMID
25122429
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
9
Issue
9
Publish Date
2014
Start Page
1332
End Page
1339
DOI
10.1097/jto.0000000000000257

Assessment of the Impact of Adjunctive Proactive Telephone Counseling to Promote Smoking Cessation Among Lung Cancer Patients' Social Networks

Authors
Bastian, LA; Fish, LJ; Peterson, BL; Biddle, AK; Garst, J; Lyna, P; Molner, S; Bepler, G; Kelley, M; Keefe, FJ; McBride, CM
MLA Citation
Bastian, LA, Fish, LJ, Peterson, BL, Biddle, AK, Garst, J, Lyna, P, Molner, S, Bepler, G, Kelley, M, Keefe, FJ, and McBride, CM. "Assessment of the Impact of Adjunctive Proactive Telephone Counseling to Promote Smoking Cessation Among Lung Cancer Patients' Social Networks." AMERICAN JOURNAL OF HEALTH PROMOTION 27.3 (2013): 181-190.
PMID
23286595
Source
wos-lite
Published In
American journal of health promotion : AJHP
Volume
27
Issue
3
Publish Date
2013
Start Page
181
End Page
190
DOI
10.4278/ajhp.101122-QUAN-387

Attachment styles in patients with lung cancer and their spouses: Associations with patient and spouse adjustment

Purpose This study examined attachment styles in patients with lung cancer and their spouses and associations between attachment styles and patient and spouse adjustment. Methods One hundred twenty-seven patients with early stage lung cancer completed measures of attachment style, marital quality, self-efficacy, pain, depression, anxiety, and quality of life. Their spouses completedmeasures of attachment style, marital quality, self-efficacy, caregiver strain, and mood. Results Analyses indicated that, among patients, those high in either attachment anxiety or avoidance had significantly higher levels of anxiety and poorer social well-being. Attachment avoidance was also significantly associated with higher levels of depression and poorer marital quality and functional well-being. Spouse avoidant attachment was significantly associated with patient reports of increased pain and poorer functional well-being, and spouse anxious attachment was associated with poorer patient marital quality. Among spouses, those high in attachment avoidance reported significantly higher levels of caregiver strain, anger, depressed mood, and poorer marital quality; those high in attachment anxiety reported higher anxious mood. Dyads in which both partners were insecurely attached had significantly poorer adjustment compared to dyads in which both partners reported secure attachment. Conclusions These preliminary findings raise the possibility that attachment styles of cancer patients and their spouses as individuals and as a dyad may be important factors affecting adjustment in multiple domains. © 2011 Springer-Verlag .

Authors
Porter, LS; Keefe, FJ; Davis, D; Rumble, M; Scipio, C; Garst, J
MLA Citation
Porter, LS, Keefe, FJ, Davis, D, Rumble, M, Scipio, C, and Garst, J. "Attachment styles in patients with lung cancer and their spouses: Associations with patient and spouse adjustment." Supportive Care in Cancer 20.10 (2012): 2459-2466.
PMID
22246596
Source
scival
Published In
Supportive Care in Cancer
Volume
20
Issue
10
Publish Date
2012
Start Page
2459
End Page
2466
DOI
10.1007/s00520-011-1367-6

Proactive recruitment of cancer patients' social networks into a smoking cessation trial.

BACKGROUND: This report describes the characteristics associated with successful enrollment of smokers in the social networks (i.e., family and close friends) of patients with lung cancer into a smoking cessation intervention. METHODS: Lung cancer patients from four clinical sites were asked to complete a survey enumerating their family members and close friends who smoke, and provide permission to contact these potential participants. Family members and close friends identified as smokers were interviewed and offered participation in a smoking cessation intervention. Repeated measures logistic regression model examined characteristics associated with enrollment. RESULTS: A total of 1062 eligible lung cancer patients were identified and 516 patients consented and completed the survey. These patients identified 1325 potentially eligible family and close friends. Of these, 496 consented and enrolled in the smoking cessation program. Network enrollment was highest among patients who were white and had late-stage disease. Social network members enrolled were most likely to be female, a birth family, immediate family, or close friend, and live in close geographic proximity to the patient. CONCLUSIONS: Proactive recruitment of smokers in the social networks of lung cancer patients is challenging. In this study, the majority of family members and friends declined to participate. Enlisting immediate female family members and friends, who live close to the patient as agents to proactively recruit other network members into smoking cessation trials could be used to extend reach of cessation interventions to patients' social networks. Moreover, further consideration should be given to the appropriate timing of approaching network smokers to consider cessation.

Authors
Bastian, LA; Fish, LJ; Peterson, BL; Biddle, AK; Garst, J; Lyna, P; Molner, S; Bepler, G; Kelley, M; Keefe, FJ; McBride, CM
MLA Citation
Bastian, LA, Fish, LJ, Peterson, BL, Biddle, AK, Garst, J, Lyna, P, Molner, S, Bepler, G, Kelley, M, Keefe, FJ, and McBride, CM. "Proactive recruitment of cancer patients' social networks into a smoking cessation trial." Contemporary clinical trials 32.4 (July 2011): 498-504. (Academic Article)
PMID
21382509
Source
manual
Published In
Contemporary Clinical Trials
Volume
32
Issue
4
Publish Date
2011
Start Page
498
End Page
504
DOI
10.1016/j.cct.2011.03.006

Caregiver-assisted coping skills training for lung cancer: Results of a randomized clinical trial

Context: Lung cancer is one of the most common cancers in the United States and is associated with high levels of symptoms, including pain, fatigue, shortness of breath, and psychological distress. Caregivers and patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor have systematically included caregivers. Objectives: This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer. Methods: Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, quality of life (QOL), and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms. Results: Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy, and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer. Conclusion: Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the use of three-group designs (e.g., comparing two active interventions with a standard-care control) and examining mechanisms of change. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
Porter, LS; Keefe, FJ; Garst, J; Baucom, DH; McBride, CM; McKee, DC; Sutton, L; Carson, K; Knowles, V; Rumble, M; Scipio, C
MLA Citation
Porter, LS, Keefe, FJ, Garst, J, Baucom, DH, McBride, CM, McKee, DC, Sutton, L, Carson, K, Knowles, V, Rumble, M, and Scipio, C. "Caregiver-assisted coping skills training for lung cancer: Results of a randomized clinical trial." Journal of Pain and Symptom Management 41.1 (2011): 1-13.
PMID
20832982
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
41
Issue
1
Publish Date
2011
Start Page
1
End Page
13
DOI
10.1016/j.jpainsymman.2010.04.014

Randomized phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small-cell lung cancer: Cancer and leukemia group B trial 30407

Purpose: Cancer and Leukemia Group B conducted a randomized phase II trial to investigate two novel chemotherapy regimens in combination with concurrent thoracic radiation therapy (TRT). Patients and Methods: Patients with unresectable stage III non-small-cell lung cancer (NSCLC) were randomly assigned to carboplatin (area under the curve, 5) and pemetrexed (500 mg/m2) every 21 days for four cycles and TRT (70 Gy; arm A) or the same treatment with cetuximab administered concurrent only with TRT (arm B). Patients in both arms received up to four cycles of pemetrexed as consolidation therapy. The primary end point was the 18-month overall survival (OS) rate; if the 18-month OS rate was ≥ 55%, the regimen(s) would be considered for further study. Results: Of the 101 eligible patients enrolled (48 in arm A and 53 in arm B), 60% were male; the median age was 66 years (range, 32 to 81 years); 44% and 35% had adenocarcinoma and squamous carcinoma, respectively; and more patients enrolled onto arm A compared with arm B had a performance status of 0 (58% v 34%, respectively; P = .04). The 18-month OS rate was 58% (95% CI, 46% to 74%) in arm A and 54% (95% CI, 42% to 70%) in arm B. No significant difference in OS between patients with squamous and nonsquamous NSCLC was observed (P = .667). The toxicities observed were consistent with toxicities associated with concurrent chemoradiotherapy. Conclusion: The combination of pemetrexed, carboplatin, and TRT met the prespecified criteria for further evaluation. This regimen should be studied further in patients with locally advanced unresectable nonsquamous NSCLC. © 2011 by American Society of Clinical Oncology.

Authors
Govindan, R; Bogart, J; Stinchcombe, T; Wang, X; Hodgson, L; Kratzke, R; Garst, J; Brotherton, T; Vokes, EE
MLA Citation
Govindan, R, Bogart, J, Stinchcombe, T, Wang, X, Hodgson, L, Kratzke, R, Garst, J, Brotherton, T, and Vokes, EE. "Randomized phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small-cell lung cancer: Cancer and leukemia group B trial 30407." Journal of Clinical Oncology 29.23 (2011): 3120-3125.
PMID
21747084
Source
scival
Published In
Journal of Clinical Oncology
Volume
29
Issue
23
Publish Date
2011
Start Page
3120
End Page
3125
DOI
10.1200/JCO.2010.33.4979

Chemoradiotherapy and gefitinib in stage III non-small cell lung cancer with epidermal growth factor receptor and KRAS mutation analysis: Cancer and Leukemia Group B (CALEB) 30106, a CALGB-Stratified Phase II Trial

Introduction: This study evaluated the addition of gefitinib to sequential or concurrent chemoradiotherapy (CRT) in unresectable stage III non-small cell lung cancer. Methods: Between May 2002 and April 2005, 63 patients were entered before the study closing early. All received two cycles paclitaxel 200 mg/m and carboplatin area under the curve 6 intravenous plus gefitinib 250 mg daily. Poor risk stratum 1 (â‰15% weight loss and/or performance status 2) received radiotherapy 200 cGy for 33 fractions (6600 cGy) and gefitinib 250 mg daily. Good-risk stratum 2 (performance status: 0-1weight loss and <5%) received the same RT with gefitinib 250 mg daily and weekly paclitaxel 50 mg/m plus carboplatin AUC 2. Consolidation gefitinib until progression was started after all toxicities were grade ≤2. Results: Acute high-grade infield toxicities were not clearly increased compared with historical CRT data. Poor-risk (N = 21) median progression-free survival was 13.4 months (95% confidence interval [CI]: 6.4-25.2) and median overall survival 19.0 months (95% CI: 9.9-28.4). Good-risk (N = 39) median progression-free survival was 9.2 months (95% CI: 6.7-12.2), and median overall survival was 13 months (95% CI: 8.5-17.2). Thirteen of 45 tumors analyzed had activating epidermal growth factor receptor (EGFR) mutations, and 2 of 13 also had T790M mutations. Seven tumors of 45 had KRAS mutations. There was no apparent survival difference with EGFR-activating mutations versus wild type or KRAS mutation versus wild type. Conclusions: Survival of poor-risk patients with wild type or mutated EGFR receiving sequential CRT with gefitinib was promising. Survival for good-risk patients receiving concurrent CRT plus gefitinib was disappointing even for tumors with activating EGFR mutations. © 2010 by the International Association for the Study of Lung Cancer.

Authors
Ready, N; Jänne, PA; Bogart, J; Dipetrillo, T; Garst, J; Graziano, S; Gu, L; Wang, X; Green, MR; Vokes, EE
MLA Citation
Ready, N, Jänne, PA, Bogart, J, Dipetrillo, T, Garst, J, Graziano, S, Gu, L, Wang, X, Green, MR, and Vokes, EE. "Chemoradiotherapy and gefitinib in stage III non-small cell lung cancer with epidermal growth factor receptor and KRAS mutation analysis: Cancer and Leukemia Group B (CALEB) 30106, a CALGB-Stratified Phase II Trial." Journal of Thoracic Oncology 5.9 (2010): 1382-1390.
PMID
20686428
Source
scival
Published In
Journal of Thoracic Oncology
Volume
5
Issue
9
Publish Date
2010
Start Page
1382
End Page
1390
DOI
10.1097/JTO.0b013e3181eba657

Randomized phase II multicenter trial of two schedules of lapatinib as first- or second-line monotherapy in patients with advanced or metastatic non-small cell lung cancer

Purpose: This randomized phase II study was initially designed to test the activity of two dose schedules of lapatinib (GW572016H), an oral, reversible, dual tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR) and human EGFR-2 (HER2/neu; HER2), in chemotherapy-naive patients with non-small cell lung cancer (NSCLC); it was later amended to target patients with bronchioloalveolar carcinoma or no smoking history. Experimental Design: Patients with good performance status and recurrent or metastatic NSCLC were randomized to lapatinib (orally, 1,500 mg once daily or 500 mg twice daily) until progression or intolerance. Patients could have had a maximum of one prior systemic therapy (chemotherapy or biological therapy) for NSCLC. Safety and activity were assessed every 4 and 8 weeks, respectively. Tumors were analyzed for EGFR and HER2 mutations and/or amplifications. Results: Of 75 patients in the nontargeted population, 1 (1.3%) had partial response and 16 (21%) had stable disease of ≥24 weeks. No complete or partial responses were observed in 56 patients in the targeted population; 14 (25%) had stable disease of ≥24 weeks. No responses were seen in three patients with EGFR mutations and five with EGFR gene amplification. No mutations in HER2 were found. One of two patients with HER2 amplification had a 51% decrease in tumor size; however, this response was unconfirmed. The most common adverse events were grade 1 or 2 diarrhea, rash, fatigue, nausea, and anorexia. Adverse events were similar across dosing regimens. Conclusions: Lapatinib was well tolerated, with no notable difference in toxicity between treatment groups. Lapatinib monotherapy did not induce a significant number of tumor regressions in NSCLC. Further studies may be warranted to determine whether lapatinib is active in combination with other agents in the treatment of NSCLC. ©2010 AACR.

Authors
Ross, HJ; Jr, GRB; Aisner, J; Damjanov, N; Dowlati, A; Garst, J; Rigas, JR; Smylie, M; Hassani, H; Allen, KE; Leopold, L; Zaks, TZ; Shepherd, FA
MLA Citation
Ross, HJ, Jr, GRB, Aisner, J, Damjanov, N, Dowlati, A, Garst, J, Rigas, JR, Smylie, M, Hassani, H, Allen, KE, Leopold, L, Zaks, TZ, and Shepherd, FA. "Randomized phase II multicenter trial of two schedules of lapatinib as first- or second-line monotherapy in patients with advanced or metastatic non-small cell lung cancer." Clinical Cancer Research 16.6 (2010): 1938-1949.
PMID
20215545
Source
scival
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
16
Issue
6
Publish Date
2010
Start Page
1938
End Page
1949
DOI
10.1158/1078-0432.CCR-08-3328

Persistent Smoking After a Diagnosis of Lung Cancer Is Associated With Higher Reported Pain Levels

The purpose of this study was to evaluate the impact of smoking status after a diagnosis of lung cancer on reported pain levels. We conducted a telephone survey of patients with lung cancer identified from 4 participating sites between September 2004 and July 2006. Patients were asked to rate their usual pain level over the past week on a 0 to 10 rating scale on which 0 was "no pain" and 10 "pain as bad as you can imagine." We operationally defined persistent smokers as patients who reported continuing to smoke after their lung cancer diagnosis. A logistic regression analysis was used to test the hypothesis that persistent smokers report higher usual pain levels than nonsmokers. Overall, 893 patients completed the survey. The majority (76%) was found to have advanced cancer (stages IIIb and IV). The mean age was 63 years (SD = 10). Seventeen percent of the patients studied were categorized as persistent smokers. The mean pain score for the study sample was 3.1 (SD = 2.7) and 41% reported moderate (4 to 6) or severe pain (7 to 10). A greater proportion of persistent smokers reported moderate or severe pain than nonsmokers or former smokers (P < .001). Logistic regression analysis revealed that smoking status was associated with the usual pain even after adjusting for age, perceived health status, and other lung cancer symptoms such as dyspnea, fatigue, and trouble eating. In conclusion, patients who continue to smoke after a diagnosis of lung cancer report higher levels of usual pain than nonsmokers or former smokers. More research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression in late-stage lung cancer. Perspective: This article examines the relationship between pain and persistent smoking in patients with lung cancer. Although more research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression, physicians can promote smoking cessation in patients with lung cancer to improve health and quality of life. © 2009 American Pain Society.

Authors
Daniel, M; Keefe, FJ; Lyna, P; Peterson, B; Garst, J; Kelley, M; Bepler, G; Bastian, LA
MLA Citation
Daniel, M, Keefe, FJ, Lyna, P, Peterson, B, Garst, J, Kelley, M, Bepler, G, and Bastian, LA. "Persistent Smoking After a Diagnosis of Lung Cancer Is Associated With Higher Reported Pain Levels." Journal of Pain 10.3 (2009): 323-328.
PMID
19254679
Source
scival
Published In
The Journal of Pain
Volume
10
Issue
3
Publish Date
2009
Start Page
323
End Page
328
DOI
10.1016/j.jpain.2008.10.006

Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study.

BACKGROUND: A feasibility study examining the effects of supervised aerobic exercise training on cardiopulmonary and quality of life (QOL) endpoints among postsurgical nonsmall cell lung cancer (NSCLC) patients was conducted. METHODS: Using a single-group design, 20 patients with stage I-IIIB NSCLC performed 3 aerobic cycle ergometry sessions per week at 60% to 100% of peak workload for 14 weeks. Peak oxygen consumption (VO(2peak)) was assessed using an incremental exercise test. QOL and fatigue were assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. RESULTS: Nineteen patients completed the study. Intention-to-treat analysis indicated that VO(2peak) increased 1.1 mL/kg(-1)/min(-1) (95% confidence interval [CI], -0.3-2.5; P = .109) and peak workload increased 9 W (95% CI, 3-14; P = .003), whereas FACT-L increased 10 points (95% CI, -1-22; P = .071) and fatigue decreased 7 points (95% CI; -1 to -17; P = .029) from baseline to postintervention. Per protocol analyses indicated greater improvements in cardiopulmonary and QOL endpoints among patients not receiving adjuvant chemotherapy. CONCLUSIONS: This pilot study provided proof of principle that supervised aerobic training is safe and feasible for postsurgical NSCLC patients. Aerobic exercise training is also associated with significant improvements in QOL and select cardiopulmonary endpoints, particularly among patients not receiving chemotherapy. Larger randomized trials are warranted.

Authors
Jones, LW; Eves, ND; Peterson, BL; Garst, J; Crawford, J; West, MJ; Mabe, S; Harpole, D; Kraus, WE; Douglas, PS
MLA Citation
Jones, LW, Eves, ND, Peterson, BL, Garst, J, Crawford, J, West, MJ, Mabe, S, Harpole, D, Kraus, WE, and Douglas, PS. "Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study." Cancer 113.12 (December 2008): 3430-3439. (Academic Article)
PMID
18988290
Source
manual
Published In
Cancer
Volume
113
Issue
12
Publish Date
2008
Start Page
3430
End Page
3439
DOI
10.1002/cncr.23967

Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress

This study examined self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their caregivers, and associations between self-efficacy and patient and caregiver adjustment. One hundred and fifty-two patients with early stage lung cancer completed measures of self-efficacy, pain, fatigue, quality of life, depression, and anxiety. Their caregivers completed a measure assessing their self-efficacy for helping the patient manage symptoms and measures of psychological distress and caregiver strain. Analyses indicated that, overall, patients and caregivers were relatively low in self-efficacy for managing pain, symptoms, and function, and that there were significant associations between self-efficacy and adjustment. Patients low in self-efficacy reported significantly higher levels of pain, fatigue, lung cancer symptoms, depression, and anxiety, and significantly worse physical and functional well being, as did patients whose caregivers were low in self-efficacy. When patients and caregivers both had low self-efficacy, patients reported higher levels of anxiety and poorer quality of life than when both were high in self-efficacy. There were also significant associations between patient and caregiver self-efficacy and caregiver adjustment, with lower levels of self-efficacy associated with higher levels of caregiver strain and psychological distress. These preliminary findings raise the possibility that patient and caregiver self-efficacy for managing pain, symptoms, and function may be important factors affecting adjustment, and that interventions targeted at increasing self-efficacy may be useful in this population. © 2007 International Association for the Study of Pain.

Authors
Porter, LS; Keefe, FJ; Garst, J; McBride, CM; Baucom, D
MLA Citation
Porter, LS, Keefe, FJ, Garst, J, McBride, CM, and Baucom, D. "Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress." Pain 137.2 (2008): 306-315.
PMID
17942229
Source
scival
Published In
PAIN
Volume
137
Issue
2
Publish Date
2008
Start Page
306
End Page
315
DOI
10.1016/j.pain.2007.09.010

Cancer- and chemotherapy-induced anemia

Authors
III, GMR; Becker, PS; Bennett, CL; Cella, D; Chanan-Khan, A; Chesney, C; Cleeland, C; Coccia, PF; Djulbegovic, B; Garst, JL; Gilreath, JA; Kraut, EH; Lin, W-C; Matulonis, U; Millenson, M; Reinke, D; Rosenthal, J; Sabbatini, P; Schwartz, RN; Stein, RS; Vij, R
MLA Citation
III, GMR, Becker, PS, Bennett, CL, Cella, D, Chanan-Khan, A, Chesney, C, Cleeland, C, Coccia, PF, Djulbegovic, B, Garst, JL, Gilreath, JA, Kraut, EH, Lin, W-C, Matulonis, U, Millenson, M, Reinke, D, Rosenthal, J, Sabbatini, P, Schwartz, RN, Stein, RS, and Vij, R. "Cancer- and chemotherapy-induced anemia." JNCCN Journal of the National Comprehensive Cancer Network 6.6 (2008): 536-564.
PMID
18597709
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
6
Issue
6
Publish Date
2008
Start Page
536
End Page
564

Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients.

BACKGROUND: Abnormalities in taste and smell functioning occur with elevated frequency in both older adults and patients with cancer. With the predicted increase in both of these populations in the coming decades, it is imperative to evaluate potential interventions that are designed to help older cancer patients compensate for the additive burden of this disease and its treatment on age-related taste and smell losses. OBJECTIVE: The purpose of the current study was to determine if providing instruction and products for flavor enhancement of foods to elderly cancer patients in addition to nutritional information would improve their nutritional status, and, by extension, functional and immune status as well as quality of life. DESIGN: One hundred and seven subjects enrolled in the study. Fifty-four subjects were in the experimental group that received flavor enhancement plus nutritional information; fifty-three control subjects received only nutritional information. Subjects were evaluated 1 month, 3 months, and 8 months after beginning chemotherapy. At every session, subjects completed taste and smell assessments as well as questionnaires related to nutritional status, activities of daily living, and quality of life. Blood samples were also obtained to determine immune parameters. RESULTS: At the eight-month time point, experimental subjects had better scores on the mini nutritional assessment (MNA) and the physical function assessment of the quality of life questionnaire. Also at eight months, self-reported taste and smell perception for experimental subjects was better than that of controls as well as better than at earlier time points. Tests that assessed quantity and quality of food intake, as well as a number of immune parameters declined over time and did not differ significantly between groups. CONCLUSION: The combination of flavor enhancement, chemosensory education, and nutritional information for elderly cancer patients improved their nutritional assessment on the MNA and physical function over time. On the whole, experimental subjects perceived themselves to be better functioning at eight months than did their control counterparts.

Authors
Schiffman, SS; Sattely-Miller, EA; Taylor, EL; Graham, BG; Landerman, LR; Zervakis, J; Campagna, LK; Cohen, HJ; Blackwell, S; Garst, JL
MLA Citation
Schiffman, SS, Sattely-Miller, EA, Taylor, EL, Graham, BG, Landerman, LR, Zervakis, J, Campagna, LK, Cohen, HJ, Blackwell, S, and Garst, JL. "Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients." J Nutr Health Aging 11.5 (September 2007): 439-454.
PMID
17657366
Source
pubmed
Published In
The Journal of Nutrition Health and Aging
Volume
11
Issue
5
Publish Date
2007
Start Page
439
End Page
454

A phase II trial of carboplatin/vinorelbine with pegfilgrastim support for the treatment of patients with advanced non-small cell lung cancer.

INTRODUCTION: The impact of chemotherapy dose delivery has not been well studied in patients with non-small cell lung cancer (NSCLC). Overlapping hematologic toxicities commonly limit planned dose intensity of combination chemotherapy regimens. A phase II study investigating carboplatin and vinorelbine, supported by pegfilgrastim, in the treatment of patients with advanced NSCLC was performed. METHODS: Chemotherapy-naïve patients with locally advanced or metastatic NSCLC were treated with carboplatin area under the curve (AUC) 6 mg/ml per minute intravenously on day 1 and vinorelbine 30 mg/m2 intravenously on days 1 and 8 every 3 weeks for four planned cycles. Pegfilgrastim was administered on day 9 of each cycle as a 6-mg subcutaneous injection. The primary endpoint was incidence of cycle 1 febrile neutropenia. Secondary endpoints included incidence of grade 3/4 hematologic and nonhematologic toxicities, delivered dose intensity, and overall survival. RESULTS: Thirty patients (21 men, 9 women) with a median age of 61 years (range, 43-79) were enrolled. Of 120 planned patient cycles, 101 (84%) were completed. There was one episode of cycle 1 febrile neutropenia. Overall response rate was 27%. Median dose delivered for vinorelbine was 17.2 mg/m2 per week, representing a delivered dose intensity of 86%. Median survival was 9.4 months (95% confidence interval: 6.1-18.0) with a 3-year survival rate of 20%. CONCLUSIONS: This regimen of carboplatin and vinorelbine with pegfilgrastim support was associated with a low rate of febrile neutropenia and good maintenance of planned dose intensity. Although response and survival are similar to other chemotherapy regimens in advanced NSCLC, studies optimizing chemotherapy delivery in this setting may help inform treatment approaches in patients with earlier stage disease.

Authors
Riedel, RF; Andrews, C; Garst, J; Dunphy, F; Herndon, JE; Blackwell, S; Barbour, S; Crawford, J
MLA Citation
Riedel, RF, Andrews, C, Garst, J, Dunphy, F, Herndon, JE, Blackwell, S, Barbour, S, and Crawford, J. "A phase II trial of carboplatin/vinorelbine with pegfilgrastim support for the treatment of patients with advanced non-small cell lung cancer." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2.6 (June 2007): 520-525. (Academic Article)
PMID
17545847
Source
manual
Published In
Journal of Thoracic Oncology
Volume
2
Issue
6
Publish Date
2007
Start Page
520
End Page
525

The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response

Purpose: To assess the impact of induction chemotherapy, and associated tumor shrinkage, on the subsequent radiation-related changes in pulmonary function and tumor response. Methods and Materials: As part of a prospective institutional review board-approved study, 91 evaluable patients treated definitively with thoracic radiation therapy (RT) for unresectable lung cancer were analyzed. The rates of RT-associated pulmonary toxicity and tumor response were compared in the patients with and without pre-RT chemotherapy. In the patients receiving induction chemotherapy, the rates of RT-associated pulmonary toxicity and tumor response were compared in the patients with and without a response (modified Response Evaluation Criteria in Solid Tumor criteria) to the pre-RT chemotherapy. Comparisons of the rates of improvements in pulmonary function tests (PFTs) post-RT, dyspnea requiring steroids, and percent declines in PFTs post-RT were compared in patient subgroups using Fisher's exact test, analysis of variance, and linear or logistic regression. Results: The use of pre-RT chemotherapy appears to increase the rate of radiation-induced pneumonitis (p = 0.009-0.07), but has no consistent impact on changes in PFTs. The degree of induction chemotherapy-associated tumor shrinkage is not associated with the rate of subsequent RT-associated pulmonary toxicity. The degree of tumor response to chemotherapy is not related to the degree of tumor response to RT. Conclusions: Additional study is needed to better clarify the impact of chemotherapy on radiation-associated disfunction. © 2007 Elsevier Inc. All rights reserved.

Authors
Mao, J; Kocak, Z; Zhou, S; Garst, J; Evans, ES; Zhang, J; Larrier, NA; Hollis, DR; Folz, RJ; Marks, LB
MLA Citation
Mao, J, Kocak, Z, Zhou, S, Garst, J, Evans, ES, Zhang, J, Larrier, NA, Hollis, DR, Folz, RJ, and Marks, LB. "The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response." International Journal of Radiation Oncology Biology Physics 67.5 (2007): 1360-1369.
PMID
17276621
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
67
Issue
5
Publish Date
2007
Start Page
1360
End Page
1369
DOI
10.1016/j.ijrobp.2006.11.003

Vaccine therapy in non-small-cell lung cancer

Lung cancer is the leading cause of death from cancer worldwide. First-line therapy is based on stage at diagnosis and can include chemotherapy, radiation, and surgery. Despite advances, the prognosis for advanced-stage lung cancer is very poor. Vaccines with the capability to activate the host immune system may have a role in second-line therapy. Advances in the understanding of cellular and molecular immunology are forming the basis for improving vaccine therapy. Most trials to date have demonstrated safety but inconsistent efficacy. Further research is needed to enhance this potential. Copyright © 2007 by Current Medicine Group LLC.

Authors
Albright, C; Garst, J
MLA Citation
Albright, C, and Garst, J. "Vaccine therapy in non-small-cell lung cancer." Current Oncology Reports 9.4 (2007): 241-246.
PMID
17588347
Source
scival
Published In
Current Oncology Reports
Volume
9
Issue
4
Publish Date
2007
Start Page
241
End Page
246
DOI
10.1007/s11912-007-0029-9

Safety of topotecan in the treatment of recurrent small-cell lung cancer and ovarian cancer

The topoisomerase I inhibitor, topotecan, is approved for the treatment of recurrent small-cell lung cancer (SCLC) and ovarian cancer (OC). Patients with recurrent SCLC and OC typically experience multiple relapses and receive multiple rounds of chemotherapy. In these settings, disease stabilisation is considered a treatment benefit, and quality-of-life effects and cumulative toxicities of treatments should be considered. Many patients with recurrent cancer may be predisposed to treatment-related adverse events because of advanced age, renal impairment or extensive prior therapy. The standard regimen of topotecan, 1.5 mg/m2 on days 1 - 5 of a 21-day cycle, has generally mild nonhaematological toxicity and a well-defined haematological toxicity profile characterised by reversible and noncumulative neutropenia. Alternative regimens may lower the incidence of haematological toxicities and maintain antitumour efficacy. Topotecan may provide physicians with a versatile therapeutic option for the treatment of patients with relapsed SCLC or OC. © 2007 Informa UK Ltd.

Authors
Garst, J
MLA Citation
Garst, J. "Safety of topotecan in the treatment of recurrent small-cell lung cancer and ovarian cancer." Expert Opinion on Drug Safety 6.1 (2007): 53-62.
PMID
17181452
Source
scival
Published In
Expert Opinion on Drug Safety
Volume
6
Issue
1
Publish Date
2007
Start Page
53
End Page
62
DOI
10.1517/14740338.6.1.53

Topotecan: An evolving option in the treatment of relapsed small cell lung cancer

The topoisomerase I inhibitor topotecan is the only single-agent therapy approved for the treatment of recurrent small cell lung cancer (SCLC). Many patients with recurrent SCLC may be predisposed to treatment-related adverse events because of the presence of comorbidities such as advanced age, renal impairment, or extensive prior therapy. In this setting, disease stabilization is considered a treatment benefit, and quality-of-life effects and toxicity profiles of treatments should be considered. The approved regimen of topotecan 1.5 mg/m2 on days 1 to 5 of a 21-day cycle is active and has generally mild nonhematologic toxicity and a well-established hematologic toxicity profile characterized by reversible, manageable, and noncumulative neutropenia. Alternative dosing and treatment schedules may lower the incidence of hematologic toxicities while maintaining antitumor efficacy in this patient population. Therefore, topotecan may provide physicians with an effective and versatile therapeutic option for the treatment of patients with relapsed SCLCT. © 2007 Dove Medical Press Limited. All rights reserved.

Authors
Garst, J
MLA Citation
Garst, J. "Topotecan: An evolving option in the treatment of relapsed small cell lung cancer." Therapeutics and Clinical Risk Management 3.6 (2007): 1087-1095.
Source
scival
Published In
Therapeutics and clinical risk management
Volume
3
Issue
6
Publish Date
2007
Start Page
1087
End Page
1095

Phase II study of carboplatin, irinotecan, and thalidomide combination in patients with extensive stage small-cell lung cancer.

Authors
Riedel, RF; Crawford, J; Dunphy, F; Herndon, JE; Garst, J; Kelley, MJ
MLA Citation
Riedel, RF, Crawford, J, Dunphy, F, Herndon, JE, Garst, J, and Kelley, MJ. "Phase II study of carboplatin, irinotecan, and thalidomide combination in patients with extensive stage small-cell lung cancer." Lung cancer (Amsterdam, Netherlands) 54.3 (December 2006): 431-432. (Academic Article)
PMID
17005294
Source
manual
Published In
Lung Cancer
Volume
54
Issue
3
Publish Date
2006
Start Page
431
End Page
432

A phase I study of dose-dense topotecan given upfront to standard therapy in patients with small cell lung cancer.

OBJECTIVE: To determine the feasibility and maximum tolerated dose of dose-dense topotecan as induction chemotherapy before standard therapy (carboplatin plus etoposide alone or in combination with radiotherapy) in patients with small cell lung cancer (SCLC). PATIENTS AND METHODS: Chemotherapy-naive patients with SCLC and good performance status were eligible. Three 2-week cycles of dose-dense topotecan administered on days 1-3 with granulocyte colony-stimulating factor support were followed by four cycles of standard carboplatin plus etoposide therapy alone (extensive-stage SCLC) or with radiotherapy (limited-stage SCLC). The dose of topotecan was escalated from 1.5 mg/m2/day to 2.5 mg/m2/day in increments of 0.25 mg/m2/day within cohorts of 3-5 patients each. Dose-limiting toxicity was defined as any grade 3 or 4 toxicity resulting in a treatment reduction or a delay of >3 days. RESULTS: Twenty-two patients with SCLC (5 limited-stage, 17 extensive-stage) were enrolled. Treatment was well tolerated. The dose-limiting toxicities were thrombocytopenia and neutropenia, and the maximum tolerated dose of dose-dense topotecan induction therapy was 2.25 mg/m2/day. Overall, topotecan-related grade 3/4 haematological toxicities included neutropenia (n = 4), thrombocytopenia (n = 3) and febrile neutropenia (n = 1). No grade 4 non-haematological toxicities occurred. Grade 3 adverse events included nausea (n = 2), renal toxicity (n = 1) and anorexia (n = 1). Toxicity during the carboplatin plus etoposide +/- radiotherapy phase of therapy was consistent with that reported in previous trials. The overall response rate was 80% for limited-stage and 76% for extensive-stage SCLC. Median survival was 8 months in patients with limited-stage SCLC and 13.5 months for patients with extensive-stage SCLC. CONCLUSION: The results of this phase I study suggest that a regimen of sequential dose-dense topotecan and carboplatin plus etoposide is feasible, and the preliminary activity observed in patients with SCLC warrants further investigation at a starting dose of topotecan 2.25 mg/m2/day.

Authors
Garst, J; Herndon, JE; Shafman, T; Campagna, L; Blackwell, S; Padilla, K; Bjurstrom, T; Andrews, C; Maravich May, D; Anderson, E; Crawford, J
MLA Citation
Garst, J, Herndon, JE, Shafman, T, Campagna, L, Blackwell, S, Padilla, K, Bjurstrom, T, Andrews, C, Maravich May, D, Anderson, E, and Crawford, J. "A phase I study of dose-dense topotecan given upfront to standard therapy in patients with small cell lung cancer." Clinical drug investigation 26.5 (2006): 257-266. (Academic Article)
PMID
17163259
Source
manual
Published In
Clinical drug investigation
Volume
26
Issue
5
Publish Date
2006
Start Page
257
End Page
266

Assessing the ability of the antiangiogenic and anticytokine agent thalidomide to modulate radiation-induced lung injury

Purpose: Thalidomide has broad anticytokine properties, which might protect normal tissues in patients undergoing chemoradiotherapy. The purpose of this study was to determine the maximal tolerated dose of thalidomide when used in combination with vinorelbine plus thoracic radiotherapy. Methods and Materials: Eligible patients had inoperable Stage III non-small-cell lung cancer, a Karnofsky Performance Status ⩾70, and life expectancy ⩾6 months. Patients underwent pretreatment evaluation of lung function. Radiotherapy consisted of 66 Gy in 6.5 weeks. Vinorelbine was administered i.v. (5 mg/m2) 3 times per week just before radiotherapy. Thalidomide was begun at 50 mg, p.o., on day 1 of chemoradiotherapy and continued once daily for 6 months. Side effects were scored using National Cancer Institute Common Toxicity Criteria. Results: Ten patients were enrolled. Of the first 6 patients, 2 developed major thrombotic events that were believed to be possibly related to thalidomide. The study was suspended and modified to require prophylactic anticoagulation. Of the last 4 patients, 2 developed dose-limiting toxicity attributable to thalidomide; both patients required a dose reduction of thalidomide to <50 mg/day. Because the drug is not available in an oral product providing <50 mg/day, the study was closed. Conclusions: The combination of thalidomide concurrently with thoracic radiotherapy and vinorelbine resulted in excessive toxicity. [All rights reserved Elsevier]

Authors
Anscher, MS; Garst, J; Marks, LB; Larrier, N; Dunphy, F; II, HJE; Clough, R; Marino, C; Vujaskovic, Z; Zhou, S; Dewhirst, MW; Shafman, TD; Crawford, J
MLA Citation
Anscher, MS, Garst, J, Marks, LB, Larrier, N, Dunphy, F, II, HJE, Clough, R, Marino, C, Vujaskovic, Z, Zhou, S, Dewhirst, MW, Shafman, TD, and Crawford, J. "Assessing the ability of the antiangiogenic and anticytokine agent thalidomide to modulate radiation-induced lung injury." Int. J. Radiat. Oncol. Biol. Phys. (USA) 66.2 (2006): 477-482. (Academic Article)
PMID
16904841
Source
manual
Published In
Int. J. Radiat. Oncol. Biol. Phys. (USA)
Volume
66
Issue
2
Publish Date
2006
Start Page
477
End Page
482
DOI
10.1016/j.ijrobp.2006.05.031

Genomic signatures in non-small-cell lung cancer: Targeting the targeted therapies

Despite major developments in targeted biologic agents, patients with advanced non-small-cell lung cancer have a poor prognosis. Recent development of targeted biologic agents have given us insight into possibilities of matching therapy with disease; however, the success of these agents has been marginal. In this article, we discuss the use of genomic signatures that have been developed to identify unique aspects of individual lung tumors and provide insight on how novel strategies can be used to identify populations susceptible to specific targeted agents. Copyright © 2006 by Current Science Inc.

Authors
Dressman, HK; Bild, A; Garst, J; Jr, DH; Potti, A
MLA Citation
Dressman, HK, Bild, A, Garst, J, Jr, DH, and Potti, A. "Genomic signatures in non-small-cell lung cancer: Targeting the targeted therapies." Current Oncology Reports 8.4 (2006): 252-257.
PMID
17254524
Source
scival
Published In
Current Oncology Reports
Volume
8
Issue
4
Publish Date
2006
Start Page
252
End Page
257
DOI
10.1007/s11912-006-0029-1

Lung cancer in women

Lung cancer is the most common cancer in both men and women; however, there are some clear gender-based differences. As the incidence of lung cancer is declining in men, the incidence of lung cancer is increasing in women. Women are more likely than men to have adenocarcinoma, a histologic subtype that correlates with worsened prognosis, but women have improved survival compared with men. Genetic predisposition and the presence of estrogen receptors in lung cancer cells may predispose women to developing lung cancer. Further studies are needed to understand the mechanism and significance of these findings. Copyright © 2006 by Current Science Inc.

Authors
Coscio, AM; Garst, J
MLA Citation
Coscio, AM, and Garst, J. "Lung cancer in women." Current Oncology Reports 8.4 (2006): 248-251.
PMID
17254523
Source
scival
Published In
Current Oncology Reports
Volume
8
Issue
4
Publish Date
2006
Start Page
248
End Page
251
DOI
10.1007/s11912-006-0028-2

A pilot study investigating the utility of the cognitive-behavioral model of insomnia in early-stage lung cancer patients.

This pilot study investigated the utility of a cognitive-behavioral model in understanding insomnia in early-stage lung cancer patients. Nineteen patients meeting criteria for insomnia and a comparison group of 13 patients not meeting these criteria completed questionnaires assessing dysfunctional sleep-related thoughts, poor sleep hygiene, lung cancer symptoms, mood, quality of life, and insomnia symptoms. Participants also completed standard sleep logs and wore an Actiwatch while sleeping each day for 7 days. Findings indicated that the insomnia group reported significantly more dysfunctional sleep-related thoughts, higher levels of pain and anxiety, and lower quality of life than those in the comparison group. Men in the insomnia group reported significantly higher levels of fatigue than men in the comparison group, whereas women demonstrated no group differences. These pilot findings support the utility of the cognitive-behavioral model in understanding insomnia in early-stage lung cancer patients and the hypothesis that insomnia is related to poor clinical status.

Authors
Rumble, ME; Keefe, FJ; Edinger, JD; Porter, LS; Garst, JL
MLA Citation
Rumble, ME, Keefe, FJ, Edinger, JD, Porter, LS, and Garst, JL. "A pilot study investigating the utility of the cognitive-behavioral model of insomnia in early-stage lung cancer patients." J Pain Symptom Manage 30.2 (August 2005): 160-169.
PMID
16125031
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
30
Issue
2
Publish Date
2005
Start Page
160
End Page
169
DOI
10.1016/j.jpainsymman.2005.02.013

Lack of trastuzumab activity in nonsmall cell lung carcinoma with overexpression of erb-B2: 39810: a phase II trial of Cancer and Leukemia Group B.

BACKGROUND: The overexpression of HER-2 occurs in a minority of patients with nonsmall cell lung carcinoma. Trastuzumab, which is a monoclonal antibody to HER-2, is an effective treatment in some women with breast carcinomas that overexpress HER-2, as demonstrated by immunohistochemistry. The objective of this Phase II study was to determine whether trastuzumab would effect responses in patients with nonsmall cell lung carcinoma who had tumors that overexpressed HER-2. METHODS: Patients were required to have Stage IIIB or Stage IV nonsmall cell lung carcinoma and tumors with 2+ or 3+ expression of HER-2, as determined with immunohistochemistry, and they may have received up to 1 prior chemotherapy regimen. Trastuzumab at a dose of 4 mg/kg was given intravenously on Week 1; then, weekly doses of 2 mg/kg were given. Response revaluation was performed every 8 weeks. RESULTS: Among 209 screened patients, 24 patients (11%) had tumors with 2+ or 3+ expression of HER-2. One patient achieved a partial response, and one patient experienced a treatment-related death due to pulmonary toxicity. CONCLUSIONS: Single-agent trastuzumab did not exhibit significant clinical activity against nonsmall cell lung carcinoma when HER-2 expression levels were measured by immunohistochemistry.

Authors
Clamon, G; Herndon, J; Kern, J; Govindan, R; Garst, J; Watson, D; Green Cancer, M; Leukemia Group, B
MLA Citation
Clamon, G, Herndon, J, Kern, J, Govindan, R, Garst, J, Watson, D, Green Cancer, M, and Leukemia Group, B. "Lack of trastuzumab activity in nonsmall cell lung carcinoma with overexpression of erb-B2: 39810: a phase II trial of Cancer and Leukemia Group B." Cancer 103.8 (April 2005): 1670-1675. (Academic Article)
PMID
15751020
Source
manual
Published In
Cancer
Volume
103
Issue
8
Publish Date
2005
Start Page
1670
End Page
1675

A phase I study of dexosome immunotherapy in patients with advanced non-small cell lung cancer.

BACKGROUND: There is a continued need to develop more effective cancer immunotherapy strategies. Exosomes, cell-derived lipid vesicles that express high levels of a narrow spectrum of cell proteins represent a novel platform for delivering high levels of antigen in conjunction with costimulatory molecules. We performed this study to test the safety, feasibility and efficacy of autologous dendritic cell (DC)-derived exosomes (DEX) loaded with the MAGE tumor antigens in patients with non-small cell lung cancer (NSCLC). METHODS: This Phase I study enrolled HLA A2+ patients with pre-treated Stage IIIb (N = 4) and IV (N = 9) NSCLC with tumor expression of MAGE-A3 or A4. Patients underwent leukapheresis to generate DC from which DEX were produced and loaded with MAGE-A3, -A4, -A10, and MAGE-3DPO4 peptides. Patients received 4 doses of DEX at weekly intervals. RESULTS: Thirteen patients were enrolled and 9 completed therapy. Three formulations of DEX were evaluated; all were well tolerated with only grade 1-2 adverse events related to the use of DEX (injection site reactions (N = 8), flu like illness (N = 1), and peripheral arm pain (N = 1)). The time from the first dose of DEX until disease progression was 30 to 429+ days. Three patients had disease progression before the first DEX dose. Survival of patients after the first DEX dose was 52-665+ days. DTH reactivity against MAGE peptides was detected in 3/9 patients. Immune responses were detected in patients as follows: MAGE-specific T cell responses in 1/3, increased NK lytic activity in 2/4. CONCLUSION: Production of the DEX vaccine was feasible and DEX therapy was well tolerated in patients with advanced NSCLC. Some patients experienced long term stability of disease and activation of immune effectors.

Authors
Morse, MA; Garst, J; Osada, T; Khan, S; Hobeika, A; Clay, TM; Valente, N; Shreeniwas, R; Sutton, MA; Delcayre, A; Hsu, DH; Le Pecq, JB; Lyerly, HK
MLA Citation
Morse, MA, Garst, J, Osada, T, Khan, S, Hobeika, A, Clay, TM, Valente, N, Shreeniwas, R, Sutton, MA, Delcayre, A, Hsu, DH, Le Pecq, JB, and Lyerly, HK. "A phase I study of dexosome immunotherapy in patients with advanced non-small cell lung cancer." Journal of translational medicine [electronic resource]. 3.1 (February 2005): 9-. (Academic Article)
PMID
15723705
Source
manual
Published In
Journal of Translational Medicine
Volume
3
Issue
1
Publish Date
2005
Start Page
9

Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?

PURPOSE: To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). METHODS AND MATERIALS: The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. RESULTS: Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7% and 38%, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4% and 25% at a dose of approximately 74 Gy and 86 Gy, respectively. CONCLUSION: Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.

Authors
Miller, KL; Shafman, TD; Anscher, MS; Zhou, S-M; Clough, RW; Garst, JL; Crawford, J; Rosenman, J; Socinski, MA; Blackstock, W; Sibley, GS; Marks, LB
MLA Citation
Miller, KL, Shafman, TD, Anscher, MS, Zhou, S-M, Clough, RW, Garst, JL, Crawford, J, Rosenman, J, Socinski, MA, Blackstock, W, Sibley, GS, and Marks, LB. "Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?." Int J Radiat Oncol Biol Phys 61.1 (January 1, 2005): 64-69.
PMID
15629595
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
61
Issue
1
Publish Date
2005
Start Page
64
End Page
69
DOI
10.1016/j.ijrobp.2004.02.066

Topotecan in the treatment of elderly patients with relapsed small-cell lung cancer

Background: Almost 70% of all patients with lung cancer in the United States are > 65 years of age, and the incidence of small-cell lung cancer (SCLC) increases with age until the eighth decade of life. However, elderly patients are underrepresented in clinical trials and are often suboptimally treated. The validity of age as a prognostic factor for toxicity or survival remains controversial. Patients and Methods: To investigate the safety and efficacy of topotecan (an approved treatment for relapsed SCLC) in older patients, we performed a retrospective analysis in patients ≥ 65 years of age versus patients < 65 years of age from 5 large topotecan trials. In all 5 trials, patients received topotecan 1.5 Mg/M2 per day via a 30-minute intravenous infusion on days 1 through 5 of a 21-day cycle. Efficacy and tolerability outcomes were assessed for both age groups. Results: Topot ecan was similarly tolerated in both age groups, with generally manageable hematologic toxicity. The incidence, duration, and onset of severe hematologic toxicities did not vary significantly with age. In the < 65 age group, grade 4 neutropenia and leukopenia were reported in 72% and 32% of patients, respectively; in the ≥ 65 age group, grade 4 neutropenia and leukopenia were reported in 77% and 31% of patients, respectively. Grade 4 thrombocytopenia was less common in the < 65 age group. Nonhematologic toxicities, median time to progression, and overall survival were comparable between groups. Colclusion: This is the first demonstration of the safety and efficacy of topotecan in older patients with recurrent SCLC. Future studies are needed to fully characterize the role of topotecan in the treatment of older patients.

Authors
Garst, J; Buller, R; Lane, S; Crawford, J
MLA Citation
Garst, J, Buller, R, Lane, S, and Crawford, J. "Topotecan in the treatment of elderly patients with relapsed small-cell lung cancer." Clinical Lung Cancer 7.3 (2005): 190-196.
PMID
16354314
Source
scival
Published In
Clinical lung cancer
Volume
7
Issue
3
Publish Date
2005
Start Page
190
End Page
196

Cancer- and treatment-related anemia: Clinical Practice Guidelines in Oncology

Cancer- and treatment-related anemia has received increasing attention, particularly because relationships between anemia and quality of life (QOL) or treatment outcomes are under investigation. This guideline recognizes the multiple etiologies of cancer- and treatment-related anemia, but specifically addresses the treatment of anemia caused by the myelosuppressive effects of chemotherapy and the anemia associated with chronic disease. It provides guidelines for the use of erythropoietic agents in patients with cancer who are receiving chemotherapy. © Journal of the National Comprehensive Cancer Network.

Authors
III, GMR; Cella, D; Chanan-Khan, A; Chesney, C; Cleeland, C; Coccia, PF; Demetri, GD; Djulbegovic, B; Garst, JL; Gore, M; Kraut, EH; Lin, W-C; Millenson, M; Mock, V; Reinke, D; Rosenthal, J; Sabbatini, P
MLA Citation
III, GMR, Cella, D, Chanan-Khan, A, Chesney, C, Cleeland, C, Coccia, PF, Demetri, GD, Djulbegovic, B, Garst, JL, Gore, M, Kraut, EH, Lin, W-C, Millenson, M, Mock, V, Reinke, D, Rosenthal, J, and Sabbatini, P. "Cancer- and treatment-related anemia: Clinical Practice Guidelines in Oncology." JNCCN Journal of the National Comprehensive Cancer Network 3.6 (2005): 772-789.
PMID
16316613
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
3
Issue
6
Publish Date
2005
Start Page
772
End Page
789

Epidermal growth factor receptor inhibitors and their role in non-small-cell lung cancer

The epidermal growth factor receptor (EGFR) is a promising target in the treatment of advanced stage non-small-cell lung cancer (NSCLC). Currently erlotinib and gefitinib are approved by the US Food and Drug Administration, whereas cetuximab is being studied for use in NSCLC. Erlotinib has shown a survival advantage in patients with advanced NSCLC. Further studies have identified female sex, non-smokers, Asian race, good performance status, and adenocarcinoma histology as predictors of patient response to these agents. A genetic mutation in EGFR has also been correlated with an increase in response. Copyright © 2005 by Current Science Inc.

Authors
Byrne, BJ; Garst, J
MLA Citation
Byrne, BJ, and Garst, J. "Epidermal growth factor receptor inhibitors and their role in non-small-cell lung cancer." Current Oncology Reports 7.4 (2005): 241-247.
PMID
15946581
Source
scival
Published In
Current Oncology Reports
Volume
7
Issue
4
Publish Date
2005
Start Page
241
End Page
247

Carboplatin/paclitaxel or carboplatin/vinorelbine followed by accelerated hyperfractionated conformal radiation therapy: report of a prospective phase I dose escalation trial from the Carolina Conformal Therapy Consortium.

PURPOSE: To prospectively determine the maximum-tolerated dose of accelerated hyperfractionated conformal radiotherapy (RT; 1.6 Gy bid) for unresectable locally advanced lung cancer (IIB to IIIA/B) following induction carboplatin/paclitaxel (C/T) or carboplatin/vinorelbine (C/N). METHODS: Induction chemotherapy, C/T or C/N, was followed by escalating doses of conformally-planned RT (73.6 to 86.4 Gy in 6.4-Gy increments). Concurrent boost methods delivered 1.6 and 1.25 Gy bid to the gross and clinical target volumes, respectively. RESULTS: Between November 1997 and February 2002, 44 patients were enrolled (median age, 59 years; 59% male; stage III, 98%; median tumor size, 4 cm). Thirty-nine patients completed induction chemotherapy: 19 had a partial response, seven progressed, 15 had no response, and three were not assessable. Chemotherapy-associated toxicities were similar in the two chemotherapy groups. The incidence of grade > or = 3 RT-induced toxicity was 1/13, 2/14, and 4/12 at 73.6, 80, and 86.4 Gy, respectively, thus defining the maximum tolerated dose at approximately 80 Gy. Toxicities were in both lung and esophagus and were similar in the two chemotherapy arms. With a median followup of 34 months in the survivors, the actuarial 2-year survival was 47%, the median survival was 18 months. Fifteen patients had tumor relapse: 5 local failures in the high-dose volume, 2 regional failures outside of the high-dose volume, and 8 distant metastases. CONCLUSION: High-dose conformal twice-daily radiation therapy to approximately 80 Gy appears tolerable in well-selected patients with unresectable lung cancer following either C/T or C/N. Dose-limiting toxicities are mainly pulmonary and esophageal.

Authors
Marks, LB; Garst, J; Socinski, MA; Sibley, G; Blackstock, AW; Herndon, JE; Zhou, S; Shafman, T; Tisch, A; Clough, R; Yu, X; Turrisi, A; Anscher, M; Crawford, J; Rosenman, J; Consortium, CCT
MLA Citation
Marks, LB, Garst, J, Socinski, MA, Sibley, G, Blackstock, AW, Herndon, JE, Zhou, S, Shafman, T, Tisch, A, Clough, R, Yu, X, Turrisi, A, Anscher, M, Crawford, J, Rosenman, J, and Consortium, CCT. "Carboplatin/paclitaxel or carboplatin/vinorelbine followed by accelerated hyperfractionated conformal radiation therapy: report of a prospective phase I dose escalation trial from the Carolina Conformal Therapy Consortium." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 22.21 (November 2004): 4329-4340. (Academic Article)
PMID
15514374
Source
manual
Published In
Journal of Clinical Oncology
Volume
22
Issue
21
Publish Date
2004
Start Page
4329
End Page
4340

How does the immune system attack cancer?

Authors
Morse, MA; Lyerly, HK; Clay, TM; Abdel-Wahab, O; Chui, SY; Garst, J; Gollob, J; Grossi, PM; Kalady, M; Mosca, PJ; Onaitis, M; Sampson, JH; Seigler, HF; Toloza, EM; Tyler, D; Vieweg, J; Yang, Y
MLA Citation
Morse, MA, Lyerly, HK, Clay, TM, Abdel-Wahab, O, Chui, SY, Garst, J, Gollob, J, Grossi, PM, Kalady, M, Mosca, PJ, Onaitis, M, Sampson, JH, Seigler, HF, Toloza, EM, Tyler, D, Vieweg, J, and Yang, Y. "How does the immune system attack cancer?." Current Problems in Surgery 41.1 (2004): 15-132.
Source
scival
Published In
Current Problems in Surgery
Volume
41
Issue
1
Publish Date
2004
Start Page
15
End Page
132
DOI
10.1016/j.cpsurg.2003.08.001

Risk of long-term complications after TFG-beta1-guided very-high-dose thoracic radiotherapy.

PURPOSE: To report the incidence of late complications in long-term survivors of very-high-dose thoracic radiotherapy (RT) treated on a prospective clinical trial. METHODS AND MATERIALS: Patients with locally advanced or medically inoperable non-small-cell lung cancer received three-dimensional conformal RT to the primary tumor and radiographically involved lymph nodes to a dose of 73.6 Gy at 1.6 Gy twice daily. If the plasma transforming growth factor-beta1 (TGF-beta1) level was normal after 73.6 Gy, additional twice-daily RT was delivered to successively higher total doses until the maximal tolerated dose was reached. Patients within a given dose level were followed for 6 months before escalation to the next dose level was permitted. Late complications were defined according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. RESULTS: Thirty-eight patients were enrolled between 1996 and 1999. Twenty-four patients were not eligible for radiation dose escalation beyond 73.6 Gy because of persistently abnormal TGF-beta1 levels. Fourteen patients received dose escalation (80 Gy in 8; 86.4 Gy in 6). Grade 3 or greater late complications occurred in 4 of 24, 1 of 8, and 2 of 6 patients treated to 73.6, 80, and 86.4 Gy, respectively. The corresponding patient numbers with late Grade 4-5 toxicity were 3 of 24, 0 of 6, and 0 of 8. Overall, 7 (18%) of the 38 patients developed Grade 3-5 late toxicity. Nonpulmonary complications predominated (4 of 7). Five (71%) of seven serious complications developed within 11 months after RT; however, the remaining two complications (29%) occurred very late (at 43 and 62 months). The 5-year actuarial risk of late Grade 3-5 complications was 33%. CONCLUSION: Long-term survivors of very-high-dose RT for non-small-cell lung cancer have a significant risk of severe treatment-related complications. At these high dose levels, the predominant toxicity may no longer be pulmonary. All Grade 4-5 complications occurred in patients whose dose was limited to 73.6 Gy because of a persistently elevated TGF-beta1. Thus, persistently elevated plasma TGF-beta1 levels toward the end of RT may identify patients at greatest risk of severe complications.

Authors
Anscher, MS; Marks, LB; Shafman, TD; Clough, R; Huang, H; Tisch, A; Munley, M; Herndon, JE; Garst, J; Crawford, J; Jirtle, RL
MLA Citation
Anscher, MS, Marks, LB, Shafman, TD, Clough, R, Huang, H, Tisch, A, Munley, M, Herndon, JE, Garst, J, Crawford, J, and Jirtle, RL. "Risk of long-term complications after TFG-beta1-guided very-high-dose thoracic radiotherapy." International journal of radiation oncology, biology, physics 56.4 (July 2003): 988-995. (Academic Article)
PMID
12829134
Source
manual
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
56
Issue
4
Publish Date
2003
Start Page
988
End Page
995

Routine use of approximately 60 Gy once-daily thoracic irradiation for patients with limited-stage small-cell lung cancer.

PURPOSE: To review the outcome of patients with limited-stage small-cell lung cancer receiving daily thoracic irradiation (RT) to approximately 60 Gy. METHODS AND MATERIALS: The records of patients treated with RT for limited-stage small-cell lung cancer between 1991 and 1999 at Duke University were retrospectively reviewed. Sixty-five patients were identified who had received continuous course once-daily 1.8-2 Gy fractions to approximately 60 Gy (range 58-66). All patients received chemotherapy (CHT); 32 received concurrent RT/CHT and 33 sequential CHT and then RT. Prophylactic cranial RT was administered to 17 patients. The time from diagnosis to local failure, tumor progression, and death was assessed using actuarial methods. The median follow-up for all patients was 16.7 months and for surviving patients was 29.6 months. The median age was 64 years (range 36-83), and the median Karnofsky performance status was 80 (range 50-100). RESULTS: The 3-year actuarial rate of local failure, progression-free survival, and overall survival was 40%, 25%, and 23%, respectively. One case of acute Grade 3 esophagitis developed. Ten late complications occurred: four pulmonary, two esophageal, two infectious, one leukemia, and one retinal toxicity with prophylactic cranial RT. Six were mild and resolved with treatment. CONCLUSION: CHT plus approximately 60 Gy of once-daily RT for limited-stage small-cell lung cancer was generally well tolerated. The survival rates were less than have been reported using 45 Gy in 1.5-Gy twice-daily fractions (2-year overall survival rate 47% compared with 30% in this study), but may be comparable because fewer than one-half our patients received concurrent CHT/RT and only 26% received prophylactic cranial RT. The relatively low rate of normal tissue morbidity in our patients supports the use of conventional once-daily fractionation to > or = 60 Gy. A randomized trial would be required to compare the outcomes after maximally tolerated dose twice-daily RT vs. maximally tolerated dose daily RT.

Authors
Miller, KL; Marks, LB; Sibley, GS; Clough, RW; Garst, JL; Crawford, J; Shafman, TD
MLA Citation
Miller, KL, Marks, LB, Sibley, GS, Clough, RW, Garst, JL, Crawford, J, and Shafman, TD. "Routine use of approximately 60 Gy once-daily thoracic irradiation for patients with limited-stage small-cell lung cancer." Int J Radiat Oncol Biol Phys 56.2 (June 1, 2003): 355-359.
PMID
12738309
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
56
Issue
2
Publish Date
2003
Start Page
355
End Page
359

Serum CYFRA 21-1 in advanced stage non-small cell lung cancer: an early measure of response.

OBJECTIVES: Our objective was to test the prognostic importance of both the pretreatment level and change in serum CYFRA 21-1 after one cycle of chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) and to compare these two CYFRA variables to routine clinical stage and response as measured by imaging. PATIENTS AND METHODS: Our patients consisted of 58 with advanced NSCLC who were treated with chemotherapy. Fourteen were stage IIIa, 8 stage IIIb, and 36 stage IV, and none had received previous treatment. The choice of chemotherapy was left to the discretion of the treating physicians. We collected two serum samples, one before the first cycle of chemotherapy and the second before the second cycle, and analyzed these for serum CYFRA 21-1 using an electrochemiluminescence immunoassay and the ElecSys 2010 system (Roche Diagnostics Corp., Indianapolis, IN). We expressed changes in CYFRA in terms of the natural ratio logarithm of post-treatment to pretreatment CYFRA, and we used the Cox proportional hazards model to analyze survival time. RESULTS: Patients experienced an average drop of 27% in serum CYFRA after the first cycle of chemotherapy. Furthermore, the Cox model demonstrated that both the initial natural logarithm of serum CYFRA and presence of >27% drop in CYFRA were significantly related to subsequent survival (model P 0.1). CONCLUSION: In advanced stage NSCLC, the initial level of serum CYFRA appears to provide more prognostic information than clinical stage. Furthermore, a drop of >27% in CYFRA after one cycle of therapy adds prognostic information, so that this threshold appears to be an early measure of response to chemotherapy.

Authors
Vollmer, RT; Govindan, R; Graziano, SL; Gamble, G; Garst, J; Kelley, MJ; Christenson, RH
MLA Citation
Vollmer, RT, Govindan, R, Graziano, SL, Gamble, G, Garst, J, Kelley, MJ, and Christenson, RH. "Serum CYFRA 21-1 in advanced stage non-small cell lung cancer: an early measure of response." Clinical cancer research : an official journal of the American Association for Cancer Research 9.5 (May 2003): 1728-1733. (Academic Article)
PMID
12738727
Source
manual
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
9
Issue
5
Publish Date
2003
Start Page
1728
End Page
1733

Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke.

BACKGROUND: Heightened distress at the time of a loved one's lung cancer diagnosis may motivate relatives to quit smoking or could undermine cessation. METHODS: Relatives of new lung cancer patients at Duke were surveyed by telephone to assess diagnosis-related depression, distress, and motivation for smoking cessation. RESULTS: Relatives who reported above average avoidant and intrusive thinking patterns, depressive symptoms or worry were more likely to report that the patient's diagnosis increased their intentions to quit than the less distressed. CONCLUSIONS: Interventions are needed that encourage smoking cessation as a strategy for adaptively coping with a loved ones' lung cancer diagnosis.

Authors
McBride, CM; Pollak, KI; Garst, J; Keefe, F; Lyna, P; Fish, L; Hood, L
MLA Citation
McBride, CM, Pollak, KI, Garst, J, Keefe, F, Lyna, P, Fish, L, and Hood, L. "Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke." Journal of cancer education : the official journal of the American Association for Cancer Education 18.3 (2003): 150-156. (Academic Article)
PMID
14512262
Source
manual
Published In
Journal of Cancer Education
Volume
18
Issue
3
Publish Date
2003
Start Page
150
End Page
156

Perceptions of patients’ self-efficacy for managing pain and lung cancer symptoms: Correspondence between patients and family caregivers

Authors
Porter, LS; Keefe, FJ; McBride, CM; Pollak, K; Fish, L; Garst, J
MLA Citation
Porter, LS, Keefe, FJ, McBride, CM, Pollak, K, Fish, L, and Garst, J. "Perceptions of patients’ self-efficacy for managing pain and lung cancer symptoms: Correspondence between patients and family caregivers." Pain 98 (2002): 169-178. (Academic Article)
PMID
12098629
Source
manual
Published In
Pain
Volume
98
Publish Date
2002
Start Page
169
End Page
178

Using plasma transforming growth factor beta-1 during radiotherapy to select patients for dose escalation.

PURPOSE: The ability to prescribe treatment based on relative risks for normal tissue injury has important implications for oncologists. In non-small-cell lung cancer, increasing the dose of radiation may improve local control and survival. Changes in plasma transforming growth factor beta (TGFbeta) levels during radiotherapy (RT) may identify patients at low risk for complications in whom higher doses of radiation could be safely delivered. PATIENT AND METHODS: Patients with locally advanced or medically inoperable non-small-cell lung cancer received three-dimensional conformal RT to the primary tumor and radiographically involved nodes to a dose of 73.6 Gy (1.6 Gy twice daily). If the plasma TGFbeta level was normal after 73.6 Gy, additional twice daily RT was delivered to successively higher total doses. The maximum-tolerated dose was defined as the highest radiation dose at which

Authors
Anscher, MS; Marks, LB; Shafman, TD; Clough, R; Huang, H; Tisch, A; Munley, M; Herndon, JE; Garst, J; Crawford, J; Jirtle, RL
MLA Citation
Anscher, MS, Marks, LB, Shafman, TD, Clough, R, Huang, H, Tisch, A, Munley, M, Herndon, JE, Garst, J, Crawford, J, and Jirtle, RL. "Using plasma transforming growth factor beta-1 during radiotherapy to select patients for dose escalation." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 19.17 (September 2001): 3758-3765. (Academic Article)
PMID
11533099
Source
manual
Published In
Journal of Clinical Oncology
Volume
19
Issue
17
Publish Date
2001
Start Page
3758
End Page
3765

Carboplatin/paclitaxel or carboplatin/vinorelbine followed by accelerated hyperfractionated conformal radiation therapy: a preliminary report of a phase I dose escalation trial from the Carolina Conformal Therapy Consortium.

The maximum tolerated dose of conformal radiation therapy delivered at 1.6 Gy bid is being assessed in patients with unresectable stage IIB-IIIB non-small cell lung cancer who have been treated with induction regimens consisting of carboplatin plus paclitaxel or carboplatin plus vinorelbine. Data from the early stages of this parallel phase I study show that the two induction regimens are similar in toxicity and that both induce partial responses in 45% of patients. Both regimens can be followed by conformal radiotherapy using an accelerated hyperfractionated schedule to a dose of at least 80 Gy without experiencing unacceptable toxicity. Key morbidity observed thus far has involved the esophagus. Further cohorts of patients will receive higher doses of conformal radiotherapy (in 6.4 Gy increments) until the maximum tolerated dose is reached.

Authors
Socinski, MA; Marks, LB; Garst, J; Sibley, GS; Blackstock, W; Turrisi, A; Herndon, J; Zhou, S; Anscher, M; Crawford, J; Shafman, T; Rosenman, J
MLA Citation
Socinski, MA, Marks, LB, Garst, J, Sibley, GS, Blackstock, W, Turrisi, A, Herndon, J, Zhou, S, Anscher, M, Crawford, J, Shafman, T, and Rosenman, J. "Carboplatin/paclitaxel or carboplatin/vinorelbine followed by accelerated hyperfractionated conformal radiation therapy: a preliminary report of a phase I dose escalation trial from the Carolina Conformal Therapy Consortium." The oncologist 6 Suppl 1 (2001): 20-24. (Academic Article)
PMID
11182001
Source
manual
Published In
The oncologist
Volume
6 Suppl 1
Publish Date
2001
Start Page
20
End Page
24

Randomized, dose-escalation study of SD/01 compared with daily filgrastim in patients receiving chemotherapy

Purpose: To explore the use of SD/01 (a polyethylene glycol-conjugated filgrastim shown in preclinical studies to have a prolonged half, life) in patients with chemotherapy-induced neutropenia. Patients and Methods: Thirteen patients with non-small-cell lung cancer were randomized to receive daily filgrastim (5 μg/kg/d) or a single injection of SD/01 (30, 100, or 300 μg/kg) 2 weeks before chemotherapy and again 24 hours after administration of carboplatin and paclitaxel. Pharmacodynamic. pharmacokinetic, and safety analyses were performed. Results: Peak serum concentrations of SD/01 and the duration of increased serum concentrations were dependent on the SD/01 dose. SD/01 concentrations remained increased longer in patients with chemotherapy- induced neutropenia. Prechemotherapy median absolute neutrophil counts (ANCs) in patients receiving SD/01 were increased in a dose-dependent fashion, with the duration of this effect also being dose dependent. After chemotherapy, median ANC nadirs were similar in the filgrastim cohort and the cohort receiving SD/01 30 μg/kg, with higher nadirs seen in the cohorts receiving SD/01 100 or 300 μg/kg. Dose-limiting toxicities were not noted. CD34+ cells were mobilized in all cohorts. Conclusion: A single dose of SD/01 increases the serum concentration of SD/01 for several days in a dose- dependent fashion and is not associated with significant toxicity. The effects of SD/01 on ANC and CD34+ cell mobilization are comparable or greater than those achieved with daily filgrastim. The self-regulation of this molecule provides a potential therapeutic advantage in a variety of clinical settings associated with neutropenia. (C) 2000 by American Society of Clinical Oncology.

Authors
Johnston, E; Crawford, J; Blackwell, S; Bjurstrom, T; Lockbaum, P; Roskos, L; Yang, B-B; Gardner, S; Miller-Messana, MA; Shoemaker, D; Garst, J; Schwab, G
MLA Citation
Johnston, E, Crawford, J, Blackwell, S, Bjurstrom, T, Lockbaum, P, Roskos, L, Yang, B-B, Gardner, S, Miller-Messana, MA, Shoemaker, D, Garst, J, and Schwab, G. "Randomized, dose-escalation study of SD/01 compared with daily filgrastim in patients receiving chemotherapy." Journal of Clinical Oncology 18.13 (2000): 2522-2528.
PMID
10893282
Source
scival
Published In
Journal of Clinical Oncology
Volume
18
Issue
13
Publish Date
2000
Start Page
2522
End Page
2528

Diagnosis of posttransplant granulocytic sarcoma by fine-needle aspiration cytology and flow cytometry.

We describe a patient who developed granulocytic sarcomas of the mesentery and breast approximately 4 yrs following an allogenic bone marrow transplantation for acute myeloblastic leukemia. The diagnosis was made by a combination of fine-needle aspiration cytology and flow cytometry. The differential diagnoses of localized masses in posttransplant patients and how the combination of fine-needle aspiration cytology and flow cytometry may be used are discussed.

Authors
Liu, K; Mann, KP; Garst, JL; Dodd, LG; Olatidoye, BA
MLA Citation
Liu, K, Mann, KP, Garst, JL, Dodd, LG, and Olatidoye, BA. "Diagnosis of posttransplant granulocytic sarcoma by fine-needle aspiration cytology and flow cytometry." Diagn Cytopathol 20.2 (February 1999): 85-89.
PMID
9951604
Source
pubmed
Published In
Diagnostic Cytopathology
Volume
20
Issue
2
Publish Date
1999
Start Page
85
End Page
89

Phase II study of irinotecan plus cisplatin in patients with advanced non-small-cell lung cancer

Purpose: To evaluate the antitumor efficacy and safety of a combination of irinotecan (CPT-11) and cisplatin in patients with inoperable non-small- cell lung cancer (NSCLC). A secondary objective was to characterize the pharmacokinetics and pharmacodynamics of CPT-11 and its active metabolite, SN-38. Patients and Methods: Patients with stage IIIB or IV NSCLC were treated with repeated 4-week courses comprising CPT-11 (60 mg/m2) administered on days 1, 8, and 15, and a single dose of cisplatin (80 mg/m2) after CPT-11 administration on day 1. Results: Fifty-two patients were enrolled, including 33 men and 19 women. The median age was 61 years (range, 29 to 79 years). Southwest Oncology Group performance status was 0 in 12 patients, 1 in 32 patients, and 2 in eight patients. Eleven and 41 patients had stage IIIB and IV disease, respectively. Objective responses occurred in 28.8% of patients (15 of 52; 95% confidence interval, 16.5% to 41.2%). The median survival duration was 9.9 months (range, 1.6 to 30.8 months). The 1- year survival rate was 37%. Grade 3/4 adverse events consisted primarily of nausea (32.7%) or vomiting (13.5%), late-onset diarrhea (17.3%), and neutropenia (46.1%). The study design led to preferential modification of CPT-11 doses, resulting in CPT-11 dose attenuations to ≤ 40 mg/m2 in the majority of patients (31 of 52; 60%), whereas dose reductions of cisplatin were uncommon. CPT-11 pharmacokinetic parameters were comparable to those reported previously in single-agent studies. Conclusion: CPT-11/cisplatin is an active combination regimen with manageable toxicity in the therapy of stage IIIB/IV NSCLC. Future studies should be designed with schedules and dose modification provisions that avoid unnecessary CPT-11 dose reductions to exploit more directly the therapeutic synergy of these agents.

Authors
DeVore, RF; Johnson, DH; Crawford, J; Garst, J; Dimery, IW; Eckardt, J; Eckhardt, SG; Elfring, GL; Schaaf, LJ; Hanover, CK; Miller, LL
MLA Citation
DeVore, RF, Johnson, DH, Crawford, J, Garst, J, Dimery, IW, Eckardt, J, Eckhardt, SG, Elfring, GL, Schaaf, LJ, Hanover, CK, and Miller, LL. "Phase II study of irinotecan plus cisplatin in patients with advanced non-small-cell lung cancer." Journal of Clinical Oncology 17.9 (1999): 2710-2720.
PMID
10561345
Source
scival
Published In
Journal of Clinical Oncology
Volume
17
Issue
9
Publish Date
1999
Start Page
2710
End Page
2720

Tumor lysis syndrome and acute renal failure after treatment of non- small-cell lung carcinoma with combination irinotecan and cisplatin

Tumor lysis syndrome, characterized by multiple metabolic abnormalities resulting from abrupt tumor cell death and release of intracellular constituents and metabolites, is most commonly associated with the treatment of highly chemotherapy-sensitive lymphoid and leukemic neoplasms. The authors report a case of tumor lysis syndrome accompanied by acute renal failure that occurred in a patient with stage IV non-small-cell lung cancer who was treated with topoisomerase I inhibitor, irinotecan, and cisplatin. Consistent with the rapid tumor lysis, an objective, marked, early clinical response was observed. Attention to adequate hydration, electrolytes, and renal function should be given to outpatients with non-small-cell lung cancer who receive newer chemotherapeutic agents that have greater efficacy toward this group of tumors.

Authors
Persons, DA; Garst, J; Vollmer, R; Crawford, J
MLA Citation
Persons, DA, Garst, J, Vollmer, R, and Crawford, J. "Tumor lysis syndrome and acute renal failure after treatment of non- small-cell lung carcinoma with combination irinotecan and cisplatin." American Journal of Clinical Oncology: Cancer Clinical Trials 21.4 (1998): 426-429.
PMID
9708649
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
21
Issue
4
Publish Date
1998
Start Page
426
End Page
429
DOI
10.1097/00000421-199808000-00024

Effects of polyethylene glycol-conjugated recombinant human megakaryocyte growth and development factor on platelet counts after chemotherapy for lung cancer

Background: Polyethylene glycol (PEG)-conjugated recombinant human megakaryocyte growth and development factor (MGDF, also known as PEG- rHuMGDF), a recombinant molecule related to thrombopoietin, specifically stimulates megakaryopoiesis and platelet production and reduces the severity of thrombocytopenia in animals receiving myelosuppressive chemotherapy. Methods: We conducted a randomized, double-blind, placebo-controlled dose- escalation study of MGDF in 53 patients with lung cancer who were treated with carboplatin and paclitaxel. The patients were randomly assigned in blocks of 4 in a 1:3 ratio to receive either placebo or MGDF (0.03, 0.1, 0.3, 1.0, 3.0, or 5.0 μg per kilogram of body weight per day), injected subcutaneously. No other marrow-active cytokines were given. Results: In the 38 patients who received MGDF after chemotherapy, the median nadir platelet count was 188,000 per cubic millimeter (range, 68,000 to 373,000), as compared with 111,000 per cubic millimeter (range, 21,000 to 307,000) in 12 patients receiving placebo (P = 0.013). The platelet count recovered to base- line levels in 14 days in the treated patients as compared with more than 21 days in those receiving placebo (P<0.001). Among all 40 patients treated with MGDF, 1 had deep venous thrombosis and pulmonary embolism, and another had superficial thrombophlebitis. Conclusions: MGDF has potent stimulatory effects on platelet production in patients with chemotherapy-induced thrombocytopenia.

Authors
Fanucchi, M; Glaspy, J; Crawford, J; Garst, J; Figlin, R; Sheridan, W; Menchaca, D; Tomita, D; Ozer, H; Harker, L
MLA Citation
Fanucchi, M, Glaspy, J, Crawford, J, Garst, J, Figlin, R, Sheridan, W, Menchaca, D, Tomita, D, Ozer, H, and Harker, L. "Effects of polyethylene glycol-conjugated recombinant human megakaryocyte growth and development factor on platelet counts after chemotherapy for lung cancer." New England Journal of Medicine 336.6 (1997): 404-409.
PMID
9010146
Source
scival
Published In
The New England journal of medicine
Volume
336
Issue
6
Publish Date
1997
Start Page
404
End Page
409
DOI
10.1056/NEJM199702063360603

Vinorelbine and carboplatin in the treatment of advanced non-small-cell lung cancer

Randomized trials in patients with advanced non-small-cell lung cancer (NSCLC) have demonstrated that the combination of vinorelbine (Navelbine) and cisplatin (Platinol), compared with vinorelbine alone, increases survival but also increases toxicity. In an effort to enhance survival and reduce toxicity, a phase I/II trial of vinorelbine and carboplatin was conducted. On the basis of the phase I experience in 22 patients, the regimen chosen for evaluation in phase II consisted of vinorelbine 30 mg/m2/week, carboplatin at an area under the concentration vs time curve of 7 (according to the Calvert formula) on a monthly basis, and granulocyte colony-stimulating factor (G-CSF) titrated according to the absolute neutrophil count. As in phase I, neutropenia was the major toxicity observed among the 42 patients in the phase II study. However, the use of G-CSF either in a reactive setting (after the development of neutropenia) or preemptively (prior to the development of neutropenia) limited the episodes of febrile neutropenia. The overall 1-year survival rate was comparable to results obtained with vinorelbine and cisplatin in large-scale trials, with a favorable toxicity profile. These results confirm the clinical activity of vinorelbine plus carboplatin in advanced non-small-cell lung cancer.

Authors
Crawford, J; Garst, J; O'Rourke, MA
MLA Citation
Crawford, J, Garst, J, and O'Rourke, MA. "Vinorelbine and carboplatin in the treatment of advanced non-small-cell lung cancer." ONCOLOGY 11.10 SUPPL. 12 (1997): 44-48.
Source
scival
Published In
ONCOLOGY
Volume
11
Issue
10 SUPPL. 12
Publish Date
1997
Start Page
44
End Page
48

Growth inhibition of a human lung adenocarcinoma cell line by genetic complementation with chromosome 11

Two regions on chromosome segment 11p15.5 have frequent allele loss in lung cancer. LOH11A is centromeric between loci D11S1758 and D11S12, and LOH11B is telomeric between HRAS and D11S1363. We studied the biological significance of this allele loss using microcell-mediated transfer of human chromosome 11, 11p, and two radiation-reduced fragments of 11p into human lung adenocarcinoma cell lines. Chromosome 12, which has not been implicated in lung carcinogenesis, was used as a control. All four chromosome 11-containing hybrid clones showed significant reduced tumorigenicity in nude mice and growth in liquid culture. These findings support the notion of a tumor suppressor gene located in the LOH11A region on chromosome segment 11p15.5.

Authors
O'Briant, K; Jolicoeur, E; Garst, J; Campa, M; Schreiber, G; Bepler, G
MLA Citation
O'Briant, K, Jolicoeur, E, Garst, J, Campa, M, Schreiber, G, and Bepler, G. "Growth inhibition of a human lung adenocarcinoma cell line by genetic complementation with chromosome 11." Anticancer Research 17.5 A (1997): 3243-3251.
PMID
9413155
Source
scival
Published In
Anticancer research
Volume
17
Issue
5 A
Publish Date
1997
Start Page
3243
End Page
3251

Tuberculous Osteomyelitis Complicating a Vertebral Fracture

Authors
Raj, G; Smith, J; Garst, J; Hollenberg, HG
MLA Citation
Raj, G, Smith, J, Garst, J, and Hollenberg, HG. "Tuberculous Osteomyelitis Complicating a Vertebral Fracture." Infectious Diseases in Clinical Practice 3.3 (May 1994): 201-203.
Source
crossref
Published In
Infectious Diseases in Clinical Practice
Volume
3
Issue
3
Publish Date
1994
Start Page
201
End Page
203
DOI
10.1097/00019048-199405000-00014
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