Publications by authors named "Nataliya Mar"

19 Publications

  • Page 1 of 1

Adjuvant pembrolizumab in genomically selected high-risk patients with muscle-invasive bladder cancer.

J Oncol Pharm Pract 2021 May 20:10781552211016526. Epub 2021 May 20.

Division of Hematology/Oncology, 8788University of California Irvine, Irvine, CA, USA.

Introduction: Patients with muscle-invasive urothelial bladder cancer post neoadjuvant cisplatin-based chemotherapy with pathologic advanced disease (ypT3, ypT4, ypN+) at radical cystectomy have a significantly worse five-year overall survival. There is currently no preferred adjuvant therapy to reduce risk of cancer recurrence in this high-risk patient cohort and surveillance remains the standard-of-care.

Case Report: We present a case series of two patients who received cisplatin-based neoadjuvant chemotherapy and had pathologic node-positive urothelial carcinoma at the time of radical cystectomy. Tumor next generation sequencing revealed high mutational burden in both patients and positive PD-L1 in one patient.Management and outcome: Patients were treated with adjuvant pembrolizumab and experienced long-term disease free intervals.

Discussion: Use of adjuvant checkpoint inhibitors in patients post neoadjuvant cisplatin-based chemotherapy with pathologic advanced disease at the time of radical cystectomy at high-risk of cancer recurrence sounds appealing. Careful patient selection based on tumor-specific genomic alterations may be key. Large trials addressing this question are ongoing.
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http://dx.doi.org/10.1177/10781552211016526DOI Listing
May 2021

Thromboembolic events in metastatic testicular cancer treated with cisplatin-based chemotherapy.

World J Clin Oncol 2021 Mar;12(3):183-194

Division of Hematology/Oncology, Department of Medicine, UCI Medical Center, Orange, CA 92868, United States.

Background: Testicular germ cell tumor (TGCT) is the most curable solid tumor and most common cancer among men 18-39 years. While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT, it is associated with a high rate of thromboembolic events (TEE).

Aim: To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy, with special attention to those patients who suffered a TEE.

Methods: A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinum-based chemotherapy at our Institution in a metropolitan community between January 1, 2014 and December 31, 2019.

Results: A total of 19 (28%) patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13 (68%) of these patients. Patients with a higher pathologic stage (stage III) were significantly ( = 0.023) more likely to experience a TEE compared to patients who had a lower stage. Additionally, patients who were treated with 3 cycles of bleomycine, etoposide, and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5 ( = 0.02) times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine, etoposide, and cisplatin.

Conclusion: Due to numerous factors that predispose to a TEE such as large retroperitoneal disease, higher clinical stage, greater number of chemotherapy cycle, central venous catheter, cigarette smoking, and possible cannabis use, high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation. Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.
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http://dx.doi.org/10.5306/wjco.v12.i3.183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968108PMC
March 2021

Management of Advanced Prostate Cancer in Clinical Practice: Real-World Answers to Challenging Dilemmas.

JCO Oncol Pract 2020 12;16(12):783-789

Division of Urology, University of California Irvine, Orange, CA.

Advanced prostate cancer is a continuum of states distinguished by the presence or absence of metastasis and sensitivity or resistance to androgen deprivation therapy (ADT). Therapeutic options for this disease continue to rapidly evolve, making it a challenge to apply results of clinical trial data to daily patient management. One question relevant to providers is whether molecular biomarkers predictive of response or resistance to therapies are available to guide clinical treatment decisions. Other salient topics include the timing of therapy initiation in patients with biochemical recurrence, treatment approach in low-volume versus high-volume metastatic castrate-sensitive prostate cancer, types of agents available beyond ADT, and timing of their use in men with nonmetastatic castrate-resistant prostate cancer as well as whether sequencing of therapies in metastatic castrate-resistant prostate cancer matters. Additionally, familiarity with emerging treatment strategies is important. This review addresses the gray areas and challenging questions in advanced prostate cancer management that frequently arise in clinical practice.
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http://dx.doi.org/10.1200/OP.20.00445DOI Listing
December 2020

Development of carpal tunnel syndrome in association with checkpoint inhibitors.

J Oncol Pharm Pract 2021 Apr 20;27(3):764-765. Epub 2020 Aug 20.

Department of Medicine, Division of Hematology Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Irvine, CA, USA.

Introduction: The incidence of neuropathy with checkpoint inhibitors is 0.3-1%, typically occurring 2-12 weeks after treatment initiation. Common neuropathy phenotypes include inflammatory myopathies, myasthenia gravis, acute and chronic demyelinating polyradiculopathies, vasculitic neuropathies, isolated cranial neuropathies, aseptic meningitis, autoimmune encephalitis, multiple sclerosis and hypophysitis. Carpal tunnel syndrome is the most common entrapment neuropathy in the general population; however, the association of carpal tunnel syndrome with checkpoint inhibitors is exceedingly rare.

Case Report: We report two cases of patients with no prior history of carpal tunnel syndrome treated with checkpoint inhibitors that developed de novo bilateral carpal tunnel syndrome. For both patients, the neurologic symptoms improved with cessation of the checkpoint inhibitor and initiation of corticosteroids.

Discussion: Given the prevalence of carpal tunnel syndrome in the general population, a high index of suspicion for carpal tunnel in patients receiving checkpoint inhibitors and prompt treatment with corticosteroids is essential.
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http://dx.doi.org/10.1177/1078155220950430DOI Listing
April 2021

Metastatic penile squamous cell carcinoma with dramatic response to combined checkpoint blockade with ipilimumab and nivolumab.

J Oncol Pharm Pract 2021 Jan 7;27(1):212-215. Epub 2020 May 7.

Division of Hematology/Oncology, 8788University of California Irvine, CA, USA.

Introduction: Prognosis for patients with lymph node positive or metastatic penile squamous cell carcinoma remains poor. Chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP regimen) is recommended as a first-line option in this cohort of patients. No standard preferred subsequent-line therapy exists for patients with relapsed or refractory penile carcinoma following TIP chemotherapy. Molecular pathogenesis of penile cancer can be subdivided into human papilloma virus-dependent and human papilloma virus-independent pathways. Recent studies have demonstrated increased expression of programmed death ligand-1 in some penile tumors, commonly those that are human papilloma virus-negative. Given the rarity of penile carcinoma in industrialized countries and lack of effective therapies, checkpoint inhibitors may be an attractive treatment option for this subset of patients.

Case Report: We report a case of metastatic penile cancer refractory to TIP chemotherapy, with a dramatic treatment response to ipilimumab and nivolumab. Molecular profiling of this tumor showed a high programmed death ligand-1 expression, high tumor mutational burden, high microsatellite instability, and alterations in DNA mismatch repair genes.

Discussion: This case highlights another dimension of information that may be gained with molecular genomic profiling of penile tumors, providing insight into the biologic behavior of this neoplasm and assessing for predictive biomarkers of response to immune checkpoint inhibitors.
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http://dx.doi.org/10.1177/1078155220922602DOI Listing
January 2021

Management of Urothelial Bladder Cancer in Clinical Practice: Real-World Answers to Difficult Questions.

J Oncol Pract 2019 08;15(8):421-428

1University of California Irvine, Orange, CA.

Management of urothelial bladder cancer has historically been challenging as a result of a limited grasp of disease biology and few available systemic therapy options, mainly consisting of platinum-based chemotherapy. Improved understanding of molecular mechanisms underlying pathogenesis of muscle-invasive bladder cancer as well as their correlation with tumor behavior and response to treatment has emerged over the past few years. Remarkable therapeutic advances have been made with the introduction of checkpoint inhibitors, which have changed the course of this disease. Multiple agents with novel mechanisms of action are also actively being explored in ongoing clinical trials. These advances are exciting but may prove challenging in terms of how to apply this constantly evolving plethora of data to actual patients. This review addresses the gray areas and challenging questions that frequently arise in clinical practice.
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http://dx.doi.org/10.1200/JOP.19.00215DOI Listing
August 2019

Use of Neoadjuvant Sunitinib in Renal Cell Carcinoma of a Transplanted Kidney.

J Oncol Pract 2018 10 22;14(10):632-634. Epub 2018 Aug 22.

University of California Irvine, Irvine, CA.

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http://dx.doi.org/10.1200/JOP.18.00292DOI Listing
October 2018

Rubinstein-Taybi syndrome - a window into follicular lymphoma biology.

Leuk Lymphoma 2016 12 18;57(12):2908-2910. Epub 2016 Apr 18.

c Department of Hematology/Oncology , Hartford Hospital , Hartford , CT , USA.

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http://dx.doi.org/10.3109/10428194.2016.1165816DOI Listing
December 2016

Dual HER2 Blockade in Non-Small Cell Lung Cancer Harboring a HER2 Mutation.

Conn Med 2015 Oct;79(9):531-5

Identification of targetable oncogenic mutations in non-small cell lung cancer (NSCLC) has been a major advance in cancer treatment. Laboratory techniques to assess human epidermal growth factor receptor 2 (HER2) positivity in NSCLC include immunohistochemistry (IHC) for protein overexpression, fluorescent in situ hybridization (FISH) for gene amplification, and next generation sequencing (NGS) for HER2 gene mutations. These tests have a controversial prognostic and predictive value, with an emerging association between HER2 gene mutations and treatment response to HER2 targeted therapy. We present a case of a woman with metastatic lung adenocarcinoma with HER2 positivity assessed by IHC and FISH, as well as a high gene copy number noted on NGS. She was observed to have significant disease progression following standard first-line platinum doublet chemotherapy. She was started on dual HER2 blockade in the second-line setting, which yielded a great response in the liver with stable disease elsewhere. To our knowledge, this is the first report describing successful use of dual HER2 blockade in metastatic HER2 positive NSCLC. We also review common laboratory techniques for determining HER2 positivity in NSCLC and their clinical applications.
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October 2015

CCR 20th Anniversary Commentary: Bevacizumab in the Treatment of Glioblastoma--The Progress and the Limitations.

Clin Cancer Res 2015 Oct;21(19):4248-50

Department of Hematology/Oncology, Saint Francis Hospital, Hartford, Connecticut.

Vredenburgh and colleagues conducted the first phase II study of bevacizumab plus irinotecan in recurrent malignant glioma, confirming the safety and efficacy of bevacizumab. This study, which was published in the February 15, 2007, issue of Clinical Cancer Research, was a stepping stone for subsequent research, leading to regulatory approval of bevacizumab for recurrent glioblastoma.
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http://dx.doi.org/10.1158/1078-0432.CCR-15-1381DOI Listing
October 2015

Targeting HER2 in the treatment of non-small cell lung cancer.

Lung Cancer 2015 Mar 8;87(3):220-5. Epub 2015 Jan 8.

University of Connecticut Health Center, Department of Hematology/Oncology, United States.

Oncogenic driver mutations have emerged as major treatment targets for molecular therapies in a variety of cancers. HER2 positivity has been well-studied in breast cancer, but its importance is still being explored in non-small cell lung cancer (NSCLC). Laboratory methods for assessment of HER2 positivity in NSCLC include immunohistochemistry (IHC) for protein overexpression, fluorescent in situ hybridization (FISH) for gene amplification, and next generation sequencing (NGS) for gene mutations. The prognostic and predictive significance of these tests remain to be validated, with an emerging association between HER2 gene mutations and response to HER2 targeted therapies. Despite the assay used to determine the HER2 status of lung tumors, all patients with advanced HER2 positive lung adenocarcinoma should be evaluated for treatment with targeted agents. Several clinical approaches for inclusion of these drugs into patient treatment plans exist, but there is no defined algorithm specific to NSCLC.
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http://dx.doi.org/10.1016/j.lungcan.2014.12.018DOI Listing
March 2015

Recurrent thrombosis prevention with intravenous immunoglobulin and hydroxychloroquine during pregnancy in a patient with history of catastrophic antiphospholipid syndrome and pregnancy loss.

J Thromb Thrombolysis 2014 ;38(2):196-200

Department of Hematology/Oncology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA,

We report a case of a 36-year old patient with prior history of thrombosis in a setting of antiphospholipid antibody syndrome (APS) as well as pregnancy-associated catastrophic antiphospholipid syndrome (CAPS), resulting in multi-organ infarction and pregnancy loss. The episode of CAPS occurred while she was receiving antepartum low-dose aspirin and therapeutic-dose enoxaparin. This patient presented again at 6 weeks gestation and ultrasounds were consistent with fetal growth restriction, concerning for placental insufficiency and thrombosis. This time, hydroxychloroquine and monthly intravenous immunoglobulin (IVIG) infusions were added to her prophylaxis regimen, resulting in a successful delivery. Platelet count and antiphospholipid antibody titers were routinely monitored throughout pregnancy as markers of disease activity for APS. Current thromboprophylaxis guidelines do not address therapeutic options to prevent further pregnancy morbidity in women who develop recurrent episodes of thrombosis or CAPS despite receiving adequate anti-thrombotic treatment. Use of hydroxychloroquine and IVIG has been associated with good outcomes in this subset of patients.
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http://dx.doi.org/10.1007/s11239-014-1061-xDOI Listing
February 2015

Potential costs of inappropriate use of proton pump inhibitors.

Am J Med Sci 2014 Jun;347(6):446-51

Division of Gastroenterology (AML), Department of Medicine (JC, NM, RG), Department of Internal Medicine, Lenox Hill Hospital (GP), New York, New York.

Background: Proton pump inhibitors (PPIs) are commonly overused in hospitalized patients. The objectives of this study were to determine the extent of their inappropriate initiation in patients with low risk for gastrointestinal hemorrhage, factors associated with their continuation on discharge and potential cost of this trend.

Methods: Retrospective examination of patients with low risk for gastrointestinal hemorrhage admitted to a tertiary-care teaching hospital over a 3-month period who received esomeprazole. The following information was collected: age, gender, PPI status (de novo or continued) and admitting diagnoses. Additional information collected from the de novo subgroup included indication for PPI, number of days on PPI and continuation of the drug on discharge. The cost of the medication was obtained from pharmacy records.

Results: Four hundred nine patients were admitted during the study period and 204 (49.9%) received PPI de novo. Among these, 155 patients (76%) had an inappropriate indication for PPI. Of these, 62 (40%) patients were continued on PPI on discharge. Older age was a significant predictor of continuation of PPI at discharge. The estimated cost of the inpatient and outpatient inappropriate use of PPI was $12,272 and $59,272, respectively.

Conclusions: PPIs are overused in the majority of hospitalized patients with low risk for gastrointestinal bleeding and this practice gets perpetuated at discharge, especially in older patients. The cost of this phenomenon is alarming.
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http://dx.doi.org/10.1097/MAJ.0b013e31829f87d5DOI Listing
June 2014

Blue toes and a new pair of shoes--challenges in diagnosis and treatment of acute myelogenous leukemia.

Am J Hematol 2013 Dec 22;88(12):1090-3. Epub 2013 Oct 22.

Department of Hematology/Oncology, Hartford Hospital, Hartford, Connecticut.

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http://dx.doi.org/10.1002/ajh.23563DOI Listing
December 2013

Lung abscess, esophageal dilation, and bulimia--six degrees of separation from adjustable gastric banding.

Surg Obes Relat Dis 2012 Mar-Apr;8(2):e11-3. Epub 2011 Jan 23.

Department of Internal Medicine, Lenox Hill Hospital, New York, New York, USA.

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http://dx.doi.org/10.1016/j.soard.2011.01.001DOI Listing
May 2012

Acquired thrombotic thrombocytopenic purpura: puzzles, curiosities and conundrums.

J Thromb Thrombolysis 2011 Jan;31(1):119-21

Department of Medicine, Lenox Hill Hospital, 50 East 76th Street, Apt 4D, New York, NY 10021, USA.

We report a case of acquired thrombotic thrombocytopenic purpura (TTP) in a 34-year old patient with a prior diagnosis of systemic lupus erythematosis (SLE) who was recently started on hydroxychloroquine. Presenting symptoms included fevers, sore throat and productive cough with progressive weakness, dyspnea on exertion, hemoptysis and dark urine. Initial laboratory abnormalities were consistent with an acute microangiopathic hemolytic anemia and severe thrombocytopenia. At the time of admission, the patient's lupus was highly active as evident by his high SLE Disease Activity Index (SLEDAI) score. He was later also found to have severely reduced ADAMTS-13 levels and a positive antibody assay. This case highlights the occasional difficulty in pinpointing the exact etiology of TTP as well as establishes a possible novel drug association between hydroxychloroquine and TTP development.
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http://dx.doi.org/10.1007/s11239-010-0517-xDOI Listing
January 2011

Skin rash secondary to bevacizumab in a patient with advanced colorectal cancer and relation to response.

Anticancer Drugs 2006 Nov;17(10):1227-9

The Brooklyn Hospital Center of Cornell Medical College, Brooklyn, New York, USA.

Bevacizumab (Avastin) in combination with intravenous 5-fluorouracil-based chemotherapy as first-line as well as second-line treatment of metastatic colorectal cancer improves survival. Although skin rash (type unspecified) has been described in some patients following infusion of bevacizumab, it is not a common toxicity of bevacizumab, while acneiform rash occurs in more than 90% of patients who receive cetuximab (Erbitux), the severity of which appears to be predictive of response. We report a patient with colorectal cancer who developed a rash secondary to bevacizumab that correlated with response. A 40-year-old patient with stage IV colorectal cancer received FOLFOX-4 and bevacizumab, which he tolerated very well except for a skin rash related to bevacizumab. The rash cleared every time bevacizumab was eliminated from the chemotherapy regimen. When use of bevacizumab was resumed, similar rash reappeared. Therefore, we believe that this observation of the rash emergence was linked to bevacizumab administration. The most common toxicities associated with bevacizumab include hypertension, hemorrhage, gastrointestinal perforation, arterial thromboembolism, wound healing and proteinuria. Exfoliative dermatitis and a nonspecific rash have been reported with bevacizumab. This case report, we believe, is the first report of a possible correlation between a rash and a positive drug response associated with bevacizumab, and may initiate further investigation of similar observation.
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http://dx.doi.org/10.1097/01.cad.0000231481.07654.fcDOI Listing
November 2006
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