Publications by authors named "Aa Gupta"

Background: Dual inhibition of cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed death ligand 1 (PD-L1) has been shown to be an effective treatment strategy in many cancers. We sought to determine the objective response rate of combination durvalumab (D) plus tremelimumab (TM) in parallel cohorts of patients with carefully selected rare cancer types in which these agents had not previously been evaluated in phase II trials and for which there was clinical or biological rationale for dual immune checkpoint inhibitor therapy to be active.

Methods: We designed a multi-centre, non-blinded, open-label phase II basket trial with each of the following 8 rare cancers considered a separate phase II trial: salivary carcinoma, carcinoma of unknown primary (CUP) with tumour infiltrating lymphocytes and/or expressing PD-L1, mucosal melanoma, acral melanoma, osteosarcoma, undifferentiated pleomorphic sarcoma, clear cell carcinoma of the ovary (CCCO) or squamous cell carcinoma of the anal canal (SCCA).

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Background: Patients with relapsed rhabdomyosarcoma (RMS) are treated with varying approaches and have a poor overall survival (OS). We performed an observational comparison of salvage regimens exploring whether high-dose alkylator combinations were associated with longer OS.

Procedure: We categorized 110 patients with relapsed RMS from five institutions into two groups, those treated with regimens including a high-dose alkylator (Group A) and those treated without a high-dose alkylator (Group B).

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Living donor liver transplantation (LDLT) employing right-lobe (RL) grafts has become indispensable amid limited deceased donor graft availability. RL grafts, while smaller, offer outcomes comparable with deceased donor grafts, prompting a surge in global RL LDLT. However, bench surgery in LDLT requires meticulous preparation to minimize warm ischaemia time and ensure optimal inflow and outflow reconstruction.

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  • Neck lumps in the anterior neck can signal issues with the thyroid and parathyroid glands, and some may be indicative of follicular thyroid cancer, a type of malignant tumor with specific characteristics.
  • Follicular thyroid cancer is more common in iodine-deficient areas and has seen a decline in incidence, though prior radiation therapy increases its risk.
  • A case study of a 60-year-old woman revealed her long-standing neck mass as metastatic follicular thyroid carcinoma, confirmed through ultrasound, which had spread to her ribs and vertebrae, yet she was followed up without complications.
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Background: The Children's Oncology Group defines intermediate-risk rhabdomyosarcoma as unresected FOXO1 fusion-negative disease arising at an unfavourable site or non-metastatic FOXO1 fusion-positive disease. Temsirolimus in combination with chemotherapy has shown promising activity in patients with relapsed or refractory rhabdomyosarcoma. We aimed to compare event-free survival in patients with intermediate-risk rhabdomyosarcoma treated with vincristine, actinomycin, and cyclophosphamide alternating with vincristine and irinotecan (VAC/VI) combined with temsirolimus followed by maintenance therapy versus VAC/VI alone with maintenance therapy.

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Background/objectives: The purpose of the study was to describe the ocular manifestations of rhabdomyosarcoma in a large cohort of children.

Subject/methods: This was a retrospective observational cohort study. The medical records of all pediatric patients with head and neck rhabdomyosarcoma diagnosed between 1997 and 2021 at a tertiary-care pediatric hospital were analyzed.

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  • The phase 1b METSSAR trial evaluated a split-dose schedule of selinexor for advanced soft tissue sarcoma patients, aiming to reduce toxicity while maintaining efficacy.
  • The new dosing regimen showed no grade ≥ 3 treatment-related adverse events (TRAEs), and only mild toxicities like nausea and fatigue were reported, with some patients needing dose reductions.
  • Patients experienced a median progression-free survival of 4 months, indicating that the new schedule was tolerable and potentially more beneficial than the standard dosing.
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  • Living donor liver transplantation (LDLT) using an upper midline incision (UMI) shows advantages over the traditional J-shaped incision, including shorter recovery times and fewer complications.
  • A study comparing 115 UMI recipients to 140 J-shaped incision recipients found significant differences in ambulation time, ICU stay, and lower rates of pleural effusion and postoperative ileus.
  • Overall, UMI-LDLT is considered a safe and effective technique, providing similar long-term outcomes with less post-operative discomfort and complications.
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  • Sorafenib and pazopanib, two tyrosine kinase inhibitors, are commonly used to treat patients with progressive desmoid tumors (DT), but real-world long-term outcome data is limited.
  • A study involving 142 DT patients analyzed treatment history and outcomes from 2011 to 2022, showing an overall response rate of 26% and a disease control rate of 95%, with median treatment duration of 10.8 months.
  • Results indicated that discontinuation of treatment in responders was generally safe, but further research is needed to determine the best treatment duration for patients with stable disease.
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Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access.

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With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context.

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Background: This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and clinically relevant donor classification.

Methods: Preoperative imaging and operative details of 3035 donors from 2005 to 2020 were reviewed.

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Introduction: Adolescents and young adults diagnosed with cancer (AYAs) are under-represented in research. The Internet and social media could increase the reach of recruitment efforts but may impact sample characteristics. This study evaluated the characteristics of AYAs recruited in-person at an urban hospital versus the Internet in terms of their sociodemographic and medical characteristics, and psychosocial wellbeing, and offers recommendation for increasing the inclusivity and representativeness of research samples.

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  • Radiation-induced sarcomas (RIS) are rare and aggressive tumors that can complicate treatment decisions due to their unique characteristics and origins in previously irradiated tissues.
  • A retrospective study using the CanSaRCC database analyzed RIS cases from 1996 to 2021, looking specifically at patient demographics, treatment, and outcomes across different sarcoma types.
  • Among the 107 identified RIS tumors, breast angiosarcoma (BAS) was most common and associated with specific clinical trends, including a younger age for osteosarcoma patients and varying time intervals since initial cancer treatment.
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Objectives: We conducted a retrospective multi-centre study to assess the real-world outcome of regorafenib (REGO) and cabozantinib (CABO) in recurrent/refractory bone tumours (BTs) including osteosarcoma (OST), Ewing sarcoma (EWS) and chondrosarcoma (CS)/extra-skeletal mesenchymal CS (ESMC).

Methods: After regulatory approval, data from patients with recurrent BT (11 institutions) were extracted from CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration) database. Patient characteristics, treatment and outcomes were collected.

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Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma among children and adolescents. The management of RMS involves risk stratification of the patients based on various clinicopathological characteristics. The multimodality treatment approach requires chemotherapy, surgery, and/or radiation.

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Purpose: Non-inflamed (cold) tumors such as leiomyosarcoma do not benefit from immune checkpoint blockade (ICB) monotherapy. Combining ICB with angiogenesis or PARP inhibitors may increase tumor immunogenicity by altering the immune cell composition of the tumor microenvironment (TME). The DAPPER phase II study evaluated the safety, immunologic, and clinical activity of ICB-based combinations in pretreated patients with leiomyosarcoma.

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Primitive myxoid mesenchymal tumor of infancy (PMMTI), a rare soft tissue tumor with distinct characteristics. PMMTI tends to have an aggressive local course, with multiple relapses and poor response to treatment. Rare cases of distant metastases have been described before.

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Objective: The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status.

Methods: Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed.

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Background: Temsirolimus has shown in vivo activity against rhabdomyosarcoma (RMS). We aimed to determine the feasibility of incorporating temsirolimus within the standard Children's Oncology Group (COG) chemotherapy backbone of vincristine, actinomycin-D, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (VI) in children with intermediate-risk (IR) RMS.

Methods: The feasibility phase of the COG IR-RMS trial, ARST1431 (NCT02567435), assigned 10 patients to receive 15 mg/m /dose (dose level 1) of temsirolimus on days 1, 8, and 15 of each of three weekly VAC and VI cycles for the first 12 weeks of induction chemotherapy.

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Objective: In this study, we aimed to describe the clinical features, management, and outcomes of desmoid tumors (DTs) in familial adenomatous polyposis (FAP) patients at a high-volume sarcoma center.

Methods: Consecutive patients with FAP and DTs were identified from our institutional databases (1985-2021). Patient demographics, treatment, and outcomes were described.

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Background: Radiation-induced sarcoma (RIS) is a late toxicity of radiation therapy (RT) usually associated with poor prognosis. Due to ongoing improvements in childhood cancer treatment and patient outcomes, RIS may become more prevalent notwithstanding evolving indications for RT. Due to limited reported studies, we sought to review our experience with RIS in survivors of pediatric cancer.

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