Publications by authors named "Jason Starr"

Purpose: This phase II study evaluated the efficacy and tolerability of onvansertib, a polo-like kinase 1 (PLK1) inhibitor, in combination with fluorouracil, leucovorin, and irinotecan (FOLFIRI) + bevacizumab for the second-line treatment of -mutant metastatic colorectal cancer (mCRC).

Patients And Methods: This multicenter, open-label, single-arm study enrolled patients with -mutated mCRC previously treated with oxaliplatin and fluorouracil with or without bevacizumab. Patients received onvansertib (15 mg/m once daily on days 1-5 and 15-19 of a 28-day cycle) and FOLFIRI + bevacizumab (days 1 and 15).

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Purpose: Thrombocytopenia is a relatively common dose-limiting toxicity during peptide receptor radionuclide therapy (PRRT) in patients with NET. Although uncommon, some patients develop persistent cytopenia and eventually therapy-related myeloid neoplasm (t-MN), which has a dismal prognosis. As the indications for PRRT are expanding, it is important to investigate factors that may predict cytopenias during/after PRRT.

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Purpose: Guidelines recommend germline genetic testing (GT) for patients with pancreatic ductal adenocarcinoma (PDAC). This study aims to evaluate the utilization and outcomes of multigene panel GT in patients with PDAC.

Methods: This retrospective, multisite study included patients with PDAC diagnosed between May 2018 and August 2020 at Mayo Clinic Arizona, Florida, and Minnesota.

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We present a 54-year-old White male with a diagnosis of stage IV pancreatic neuroendocrine carcinoma. Next-generation sequencing of the tumor/blood identified a complex tumor genome, which included a rearranged during transfection (RET) gene fusion. The patient initially received cytotoxic chemotherapy with a significant radiographic response.

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Purpose: Immune checkpoint inhibitors are approved for advanced solid tumors with microsatellite instability-high (MSI-H). Although several technologies can assess MSI-H status, detection and outcomes with circulating tumor DNA (ctDNA)-detected MSI-H are lacking. As such, we examined pan-cancer MSI-H prevalence across 21 cancers and outcomes after ctDNA-detected MSI-H.

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Article Synopsis
  • Pancreatic cancer is really tough to treat, with only about 11.5% of patients living for 5 years after diagnosis.
  • A common mutation called KRAS is found in most pancreatic cancer patients, and it helps cancer cells grow and survive, making it a key focus for new treatments.
  • Researchers are trying to find ways to target this mutation, but it's been really hard, though there are some promising new tests happening right now.
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Introduction: The CYP2D6 enzyme metabolizes opioids commonly prescribed for cancer-related pain, and CYP2D6 polymorphisms may contribute to variability in opioid response. We evaluated the feasibility of implementing CYP2D6-guided opioid prescribing for patients with cancer and reported pilot outcome data.

Methods: Adult patients from two cancer centers were prospectively enrolled into a hybrid implementation-effectiveness clinical trial and randomized to CYP2D6-genotype-guided opioid selection, with clinical recommendations, or usual care.

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  • The study investigates pancreatic cancer (PC) with deficient mismatch repair (dMMR) and high microsatellite instability (MSI-H), which show poor outcomes and few treatment options, particularly focusing on responses to immune checkpoint inhibitors (ICIs).
  • Researchers reviewed records of 32 patients diagnosed with dMMR/MSI-H PC, observing favorable outcomes with ICIs, including a 75% overall response rate in palliative care, compared to only 30% with conventional chemotherapy.
  • The findings suggest that ICIs should be prioritized over cytotoxic chemotherapy for patients with dMMR/MSI-H PC in need of systemic therapy, highlighting discrepancies in testing methods used for MMR and MSI.
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Article Synopsis
  • Extrapulmonary neuroendocrine carcinoma (EP-NEC) is a rare and aggressive cancer with a poor prognosis, as most patients survive less than a year despite receiving therapy.
  • Current treatment typically follows the protocols used for small cell lung cancer, starting with first-line therapies like etoposide and platinum drugs, but options for second-line therapies are limited.
  • Recent advancements include the use of new drug combinations and checkpoint inhibitors, which show promise for improving patient outcomes, along with better understanding of disease biology that may lead to more targeted treatments in the future.
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Large duct adenocarcinoma (LDA) is a rare histopathological variant of pancreatic ductal adenocarcinoma (PDAC) that closely mimics intraductal papillary mucinous neoplasm (IPMN). We present a 74-year-old female diagnosed with LDA in 2017. She was initially managed with chemotherapy and laparoscopic distal pancreatectomy.

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Introduction: Neuroendocrine tumors (NETs) are a diverse group of tumors with origins from different primary sites such as gastro-entero-pancreatic, lung and endocrine tissue. Worldwide, their incidence has increased in recent decades. Advances in imaging and better clinical awareness are traditionally attributed to this trend; however, other factors such as genetic and environmental contributors are appreciated as well.

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Neuroendocrine tumors (NETs) represent a heterogeneous group of malignancies that arise from neuroendocrine cells dispersed throughout the organs/tissues of the body. Treatment of advanced/metastatic disease varies depending on tumor origin and grade. Somatostatin analogs (SSA) have been the mainstay first-line treatment in the advanced/metastatic setting for tumor control and managing hormonal syndromes.

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Article Synopsis
  • Poorly differentiated extrapulmonary neuroendocrine carcinomas (EP NECs) are a form of aggressive cancer with high growth rates, divided into small and large cell types, and have low survival rates.
  • Small cell lung carcinoma, a type of pulmonary neuroendocrine carcinoma, typically benefits from a treatment combination of chemotherapy and a checkpoint inhibitor, which is considered better than chemotherapy alone.
  • In a study involving 57 patients with EP NECs, the results showed that adding a checkpoint inhibitor to standard chemotherapy did not provide any additional benefits.
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The role of circulating tumor DNA (ctDNA) is expanding in oncology practices, and it is increasingly being used for targeted therapies and disease monitoring. It is minimally invasive and provides data from both primary and secondary sites of disease. Herein, we report a unique case of a patient with microsatellite instability-high (MSI-H) pancreatic adenocarcinoma (PDAC) treated with neoadjuvant chemotherapy and pembrolizumab who achieved a pathologically confirmed complete resolution of the tumor.

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Introduction: The Leukemia Inhibitory Factor (LIF) is a member of the interleukin-6 (IL-6) cytokine family. Known to induce differentiation of myeloid leukemia cells, evidence has accumulated supporting its role in cancer evolution through regulating cell differentiation, renewal, and survival. LIF has recently emerged as a biomarker and therapeutic target for pancreatic ductal adenocarcinoma (PDAC).

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The aim of the current study was to describe the risk of hepatotoxicity for patients with gastroenteropancreatic neuroendocrine tumors undergoing peptide receptor radionuclide therapy (PRRT) with a very high liver tumor burden, defined as tumor involving more than 75% of the liver. We conducted a retrospective analysis of 371 patients who received at least 1 cycle of Lu-DOTATATE at Mayo Clinic for advanced gastroenteropancreatic neuroendocrine tumors. We identified 15 total patients with more than 75% liver involvement on Ga-DOTATATE PET/CT and with either a contrast-enhanced abdominal MRI or dual-phase abdominal CT examination.

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Purpose: When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery.

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Grade 3 neuroendocrine neoplasms (NEN G3) are high-grade (Ki-67 index >20%) neuroendocrine malignancies that comprise both rapidly proliferating, well-differentiated neuroendocrine tumors (NET G3) and poorly differentiated neuroendocrine carcinomas (NEC). The phenotypic differences between NET G3 and NEC stem from differences in their underlying genomic alterations. As a result of these differences, NET G3 is molecularly, radiologically, and prognostically distinct from NEC.

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Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy projected to be the 2 leading cause of cancer related death in the USA by 2030. This manuscript discusses current and evolving treatment approaches in patients with pancreatic cancer.

Areas Covered: PDAC is classified as: a) resectable, b) borderline resectable, c) unresectable (locally advanced and metastatic).

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  • The study investigates the effectiveness of perioperative chemotherapy in patients with colorectal cancer liver metastasis (CRLM), as its role remains unclear despite previous trials.
  • After analyzing data from seven randomized controlled trials involving 1,504 patients, the results indicated that adding perioperative therapy leads to better disease-free survival (DFS) but does not significantly improve overall survival (OS).
  • The review suggests that while perioperative systemic treatments can enhance DFS, decisions about their use should consider individual patient risks and benefits.
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Clinical trials reporting the robust antitumor activity of immune checkpoint inhibitors (ICIs) in microsatellite instability-high (MSI-H) solid tumors have used tissue-based testing to determine the MSI-H status. This study assessed if MSI-H detected by a plasma-based circulating tumor DNA liquid biopsy test predicts robust response to ICI in patients with pancreatic ductal adenocarcinoma (PDAC). Retrospective analysis of patients with PDAC and MSI-H identified on Guardant360 from October 2018 to April 2021 was performed; clinical outcomes were submitted by treating providers.

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Article Synopsis
  • This study examined how circulating tumor DNA (ctDNA) levels before treatment can predict outcomes for patients with metastatic biliary tract cancers (BTCs) receiving platinum-based chemotherapy.
  • Researchers analyzed data from 67 patients, focusing on the dominant clone allele frequency (DCAF) of ctDNA and correlating it with patient demographics, progression-free survival (PFS), and overall survival (OS).
  • The findings suggest that higher DCAF levels (especially above 10%) are linked to significantly worse PFS and OS, indicating that ctDNA analysis could help identify patients at higher risk of poor outcomes from chemotherapy.
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