ML Peters’ Publications

@article{pmid38086003,

title = {Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations},

author = {Mary Linton B Peters and Andrew Eckel and Claudia L Seguin and Barak Davidi and David H Howard and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1200/OP.23.00495},

issn = {2688-1535},

year  = {2024},

date = {2024-02-01},

urldate = {2024-02-01},

journal = {JCO Oncol Pract},

volume = {20},

issue = {2},

pages = {278-290},

abstract = {PURPOSE: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease.nnMETHODS: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including  and , , , Lynch syndrome, , , and . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency. Screening included MRI with follow-up EUS in a subset of patients. Costs of tests were based on Medicare reimbursement for MRI, EUS, fine-needle aspiration biopsy, and pancreatectomy. Cancer-related cost by stage of disease and phase of treatment was based on the literature. For each high-risk population, we performed an incremental cost-effectiveness analysis, assuming a willingness-to-pay (WTP) threshold of $100,000 US dollars (USD) per quality-adjusted life year (QALY) gained.nnRESULTS: For men with relative risk (RR) 12.33 () and RR 28 (), annual screening was cost-effective, starting at age 55 and 40 years, respectively. For women, screening was only cost-effective for those with RR 28 (), with annual screening starting at age 45 years.nnCONCLUSION: Combined MRI/EUS screening may be a cost-effective approach for the highest-risk populations (among mutations considered, those with RR \>12). However, for those with moderate risk (RR, 5-12), screening would only be cost-effective at higher WTP thresholds (eg, $200K USD/QALY) or with once-only screening.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37302445,

title = {Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals},

author = {Jagpreet Chhatwal and Ali Hajjar and Peter P Mueller and Gizem Nemutlu and Neeti Kulkarni and Mary Linton B Peters and Fasiha Kanwal},

doi = {10.1016/j.cgh.2023.05.024},

issn = {1542-7714},

year  = {2024},

date = {2024-01-01},

urldate = {2024-01-01},

journal = {Clin Gastroenterol Hepatol},

volume = {22},

issue = {1},

pages = {91-101},

abstract = {BACKGROUND \& AIMS: Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis.nnMETHODS: We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used published data on the natural history of hepatitis C, competing risk post virologic cure, HCC tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options and associated costs, and utilities of different health states. We estimated the HCC incidence above which biannual HCC surveillance using ultrasound and alpha-fetoprotein would be cost-effective.nnRESULTS: In virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis, HCC surveillance is cost-effective if HCC incidence exceeds 0.7 per 100 PY using $100,000 per quality-adjusted life year willingness-to-pay. At this HCC incidence, routine HCC surveillance would result in 2650 and 5700 additional life years per 100,000 cirrhosis and advanced fibrosis persons, respectively, compared with no surveillance. At $150,000 willingness-to-pay, surveillance is cost-effective if HCC incidence exceeds 0.4 per 100 PY. Sensitivity analysis showed that the threshold mostly remained below 1.5 per 100 PY.nnCONCLUSIONS: The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37406750c,

title = {Ultrasound Surveillance of Small, Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},

author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1016/j.jacr.2023.05.015},

issn = {1558-349X},

year  = {2023},

date = {2023-10-01},

urldate = {2023-10-01},

journal = {J Am Coll Radiol},

volume = {20},

number = {10},

pages = {1031-1041},

abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to 5 years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \<3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With 10 years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37561981,

title = {The Cholangiocarcinoma in the Young (CITY) Study: Tumor Biology, Treatment Patterns, and Survival Outcomes in Adolescent Young Adults With Cholangiocarcinoma},

author = {Leontios Pappas and Islam Baiev and Stephanie Reyes and Andrea Grace Bocobo and Apurva Jain and Kristen Spencer and Tri Minh Le and Osama E Rahma and Jordan Maurer and Jen Stanton and Karen Zhang and Anaemy Danner De Armas and Thomas T Deleon and Marc Roth and Mary Linton B Peters and Andrew X Zhu and Kylie Boyhen and Christine VanCott and Tushar Patel and Lewis R Roberts and Stacie Lindsey and Nora Horick and Jochen K Lennerz and A John Iafrate and Laura Williams Goff and Kabir Mody and Mitesh J Borad and Rachna T Shroff and Milind M Javle and R Katie Kelley and Lipika Goyal},

doi = {10.1200/PO.22.00594},

issn = {2473-4284},

year  = {2023},

date = {2023-08-01},

journal = {JCO Precis Oncol},

volume = {7},

pages = {e2200594},

abstract = {PURPOSE: Increased awareness of the distinct tumor biology for adolescents and young adults (AYAs) with cancer has led to improvement in outcomes for this population. However, in cholangiocarcinoma (CCA), a paucity of data exist on the AYA population. To our knowledge, we present the largest study to date on AYA disease biology, treatment patterns, and survival outcomes in CCA.nnMETHODS: A multi-institutional cohort of patients with CCA diagnosed with intrahepatic cholangiocarcinoma (ICC) or extrahepatic cholangiocarcinoma (ECC) was used for analysis. Retrospective chart review was conducted on patients who were 50 years old and younger (young; n = 124) and older than 50 years (older; n = 723).nnRESULTS: Among 1,039 patients screened, 847 patients met eligibility (72% ICC, 28% ECC). Young patients had a larger median tumor size at resection compared with older patients (4.2  3.6 cm;  .048), more commonly had N1 disease (65%  43%;  .040), and were more likely to receive adjuvant therapy (odds ratio, 4.0; 95% CI, 1.64 to 9.74). Tumors of young patients were more likely to harbor an  fusion,  mutation, or  mutation ( .05 for each). Young patients were more likely to receive palliative systemic therapy (96%  69%;  .001), targeted therapy (23%  8%;  .001), and treatment on a clinical trial (31%  19%;  .004). Among patients who presented with advanced disease, young patients had a higher median overall survival compared with their older counterparts (17.7  13.5 months; 95% CI, 12.6 to 22.6  11.4 to 14.8;  .049).nnCONCLUSION: Young patients with CCA had more advanced disease at resection, more commonly received both adjuvant and palliative therapies, and demonstrated improved survival compared with older patients. Given the low clinical trial enrollment and poor outcomes among some AYA cancer populations, data to the contrary in CCA are highly encouraging.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37392171,

title = {Updated COVID-19 clearance time among patients with cancer in the Delta and Omicron waves},

author = {Zachary M Avigan and Rodrigo Paredes and Leora S Boussi and Barbara D Lam and Meghan E Shea and Matthew J Weinstock and Mary Linton B Peters},

doi = {10.1002/cam4.6311},

issn = {2045-7634},

year  = {2023},

date = {2023-07-01},

journal = {Cancer Med},

abstract = {BACKGROUND: COVID-19 infection delays therapy and in-person evaluation for oncology patients, but clinic clearance criteria are not clearly defined.nnMETHODS: We conducted a retrospective review of oncology patients with COVID-19 at a tertiary care center during the Delta and Omicron waves and compared clearance strategies.nnRESULTS: Median clearance by two consecutive negative tests was 32.0 days (Interquartile Range [IQR] 22.0-42.5, n = 153) and was prolonged in hematologic malignancy versus solid tumors (35.0 days for hematologic malignancy, 27.5 days for solid tumors, p = 0.01) and in patients receiving B-cell depletion versus other therapies. Median clearance by single negative test was reduced to 23.0 days (IQR 16.0-33.0), with recurrent positive rate 25.4% in hematologic malignancy versus 10.6% in solid tumors (p = 0.02). Clearance by a predefined waiting period required 41 days until an 80% negative rate.nnCONCLUSIONS: COVID-19 clearance remains prolonged in oncology patients. Single-negative test clearance can balance delays in care with risk of infection in patients with solid tumors.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37406750,

title = {Ultrasound Surveillance of Small Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},

author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1016/j.jacr.2023.05.015},

issn = {1558-349X},

year  = {2023},

date = {2023-07-01},

urldate = {2023-07-01},

journal = {J Am Coll Radiol},

volume = {S1546-1440},

issue = {23},

pages = {00475-1},

abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to five years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \< 3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With ten years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37040087,

title = {Molecular Profiling and Treatment Pattern Differences between Intrahepatic and Extrahepatic Cholangiocarcinoma},

author = {Kristen Spencer and Leontios Pappas and Islam Baiev and Jordan Maurer and Andrea Grace Bocobo and Karen Zhang and Apurva Jain and Anaemy Danner De Armas and Stephanie Reyes and Tri Minh Le and Osama E Rahma and Jennifer Stanton and Thomas T DeLeon and Marc Roth and Mary Linton B Peters and Andrew X Zhu and Jochen K Lennerz and A John Iafrate and Kylie Boyhen and Christine VanCott and Lewis R Roberts and Stacie Lindsey and Nora Horick and Laura Williams Goff and Kabir Mody and Mitesh J Borad and Rachna T Shroff and R Katie Kelley and Milind M Javle and Lipika Goyal},

doi = {10.1093/jnci/djad046},

issn = {1460-2105},

year  = {2023},

date = {2023-04-11},

urldate = {2023-04-01},

journal = {J Natl Cancer Inst},

abstract = {BACKGROUND: Treatment patterns for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) differ, but limited studies exist comparing them. This study examines differences in molecular profiling rates and treatment patterns in these populations, focusing on use of adjuvant, liver-directed, targeted, and investigational therapies.nnMETHODS: This multi-center collaboration included patients with ICC or ECC treated at one of eight participating institutions. Retrospective data were collected on risk factors, pathology, treatments, and survival. Comparative statistical tests were two-sided.nnRESULTS: Among 1,039 patients screened, 847 patients met eligibility (ICC = 611, ECC = 236). Patients with ECC were more likely than those with ICC to present with early-stage disease (53.8% vs 28.0%), undergo surgical resection (55.1% vs 29.8%), and receive adjuvant chemoradiation (36.5% vs 4.2%), (all p \< 0.00001). However, they were less likely to undergo molecular profiling (50.3% vs 64.3%) or receive liver directed therapy (17.9% vs 35.7%), targeted therapy (4.7% vs 18.9%), and clinical trial therapy (10.6% vs 24.8%), (all p \< 0.001). In patients with recurrent ECC after surgery, the molecular profiling rate was 64.5%. Patients with advanced ECC had a shorter median overall survival than those with advanced ICC (11.8 vs 15.1 months, p \< 0.001).nnCONCLUSIONS: Patients with advanced ECC have low rates of molecular profiling, possibly in part due to insufficient tissue. They also have low rates of targeted therapy use and clinical trial enrollment. While these rates are higher in advanced ICC, the prognosis for both subtypes of cholangiocarcinoma remains poor, and a pressing need exists for new effective targeted therapies and broader access to clinical trials.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36746516,

title = {Partial response in non-resectable adenosquamous carcinoma of the pancreas with high tumour mutation burden treated with gemcitabine, nab-paclitaxel and pembrolizumab},

author = {Rodrigo Paredes de la Fuente and James W Doolin and Mary Linton Peters},

doi = {10.1136/bcr-2022-251936},

issn = {1757-790X},

year  = {2023},

date = {2023-02-01},

journal = {BMJ Case Rep},

volume = {16},

number = {2},

abstract = {A previously healthy man in his 60s was diagnosed with a rare histological subtype of pancreatic cancer, adenosquamous carcinoma. After somatic mutation profiling, it was found that the tumour had microsatellite instability status high and a high tumour mutational burden. The patient was started on combination therapy with gemcitabine, nab-paclitaxel and pembrolizumab. Tumour size and biomarkers showed a dramatic response eventually leading to the patient being transitioned to maintenance therapy with pembrolizumab. The patient has demonstrated continued response since the start of the treatment. This is the first report in the literature showing a sustained response in this type of neoplasm that was treated with a checkpoint inhibitor, and thus adds to the evidence supporting universal somatic testing in all pancreatic cancers for a tailored approach to therapy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38239822,

title = {Primary Undifferentiated Neoplasm of the Left Arm with Characteristics of Extragonadal Germ Cell Tumor and High-Grade Sarcoma},

author = {Rodrigo Paredes de la Fuente and Megan E Anderson and Mary Linton B Peters},

year  = {2023},

date = {2023-02-01},

journal = {Clin Oncol Case Rep},

volume = {6},

number = {2},

abstract = {A previously healthy man in his late 20s was diagnosed with a primary undifferentiated non- metastatic tumor of the left arm. After a biopsy, a clear pathological diagnosis could not be established. The tumor had positive immunohistological markers for both an extragonadal germ cell tumor and a high-grade sarcoma. Given the presumed germ cell etiology, he was started on empiric chemotherapy with etoposide and cisplatin. After a few cycles, the tumor showed dramatic response. However, due to poor patient follow- up, it progressed to massive size with severe compromise of the joint and critical neurovascular structures, which led to the decision for limb amputation. Post-surgical checkups showed no recurrence of the primary tumor or metastasis. This is the first report in the literature showing a tumor with these histological characteristics that responded to platinum-based therapy. It provides evidence for the need of more specific markers for the pathological evaluation of undifferentiated neoplasms.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{PETERS2022,

title = {‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Genetic testing to guide screening for pancreatic ductal adenocarcinoma: Results of a microsimulation model},

author = {Mary Linton B. Peters and Andrew Eckel and Anna Lietz and Claudia Seguin and Peter Mueller and Chin Hur and Pari V. Pandharipande},

url = {https://www.sciencedirect.com/science/article/pii/S1424390322001703},

doi = {https://doi.org/10.1016/j.pan.2022.05.003},

issn = {1424-3903},

year  = {2022},

date = {2022-09-22},

urldate = {2022-05-31},

journal = {Pancreatology},

volume = {22},

issue = {6},

pages = {760-769},

abstract = {Background 

First-degree relatives (FDRs) of patients with pancreatic ductal adenocarcinoma (PDAC) have elevated PDAC risk, partially due to germline genetic variants. We evaluated the potential effectiveness of genetic testing to target MRI-based screening among FDRs. 

Methods 

We used a microsimulation model of PDAC, calibrated to Surveillance, Epidemiology, and End Results (SEER) data, to estimate the potential life expectancy (LE) gain of screening for each of the following groups of FDRs: indviduals who test positive for each of eight variants associated with elevated PDAC risk (e.g., BRCA2, CDKN2A); individuals who test negative; and individuals who do not test. Screening was assumed to take place if LE gains were achievable. We simulated multiple screening approaches, defined by starting age and frequency. Sensitivity analysis evaluated changes in results given varying model assumptions. 

Results 

For women, 92% of mutation carriers had projected LE gains from screening for PDAC, if screening strategies (start age, frequency) were optimized. Among carriers, LE gains ranged from 0.1 days (ATM + women screened once at age 70) to 510 days (STK11+ women screened annually from age 40). For men, LE gains were projected for all mutation carriers, ranging from 0.2 days (BRCA1+ men screened once at age 70) to 620 days (STK11+ men screened annually from age 40). For men and women who did not undergo genetic testing, or for whom testing showed no variant, screening yielded small LE benefit (0\textendash2.1 days). 

Conclusions 

Genetic testing of FDRs can inform targeted PDAC screening by identifying which FDRs may benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Mueller2022,

title = {Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication.},

author = {Peter P. Mueller and Qiushi Chen and Turgay Ayer and Gizem Nemutlu and Ali Hajjar and Emily D. Bethea and Mary Linton B. Peters and Brian P. Lee and Naveed Z. Janjua and Fasiha Kanwal and Jagpreet Chhatwal},

url = {https://pubmed.ncbi.nlm.nih.gov/35157959/},

doi = {10.1016/j.jhep.2022.01.027},

issn = {1600-0641},

year  = {2022},

date = {2022-07-01},

urldate = {2022-02-01},

journal = {Journal of hepatology},

volume = {77},

issue = {1},

pages = {55-62},

abstract = {Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. We developed a microsimulation model of the natural history of HCC in hepatitis C individuals with advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance. In virologically-cured patients with cirrhosis, the ICER of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the start age (40-65). Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs. In virologically-cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the start age (40-50). Compared with no surveillance, surveillance per 1000 advanced fibrosis patients detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs. Biannual surveillance for HCC in virologically-cured hepatitis C patients is cost-effective until the age of 70 for cirrhosis patients, and until the age of 60 for patients with stable advanced fibrosis. Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual screening for liver cancer is cost-effective up to age 70 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Santoro2021a,

title = {K Awards: The Journey of a Thousand Steps.},

author = {Stephanie L. Santoro and Mary Linton B. Peters},

url = {https://pubmed.ncbi.nlm.nih.gov/34781710/},

doi = {10.7326/M21-2692},

issn = {1539-3704},

year  = {2021},

date = {2021-11-01},

journal = {Annals of internal medicine},

keywords = {},

pubstate = {aheadofprint},

tppubtype = {article}

}

@article{Grossman2021,

title = {Organoid Sensitivity Correlates with Therapeutic Response in Patients with Pancreatic Cancer.},

author = {Joseph E. Grossman and Lakshmi Muthuswamy and Ling Huang and Dipikaa Akshinthala and Sofia Perea and Raul S. Gonzalez and Leo L. Tsai and Jonah Cohen and Bruno Bockorny and Andrea J. Bullock and Benjamin Schlechter and Mary Linton B. Peters and Catherine Conahan and Supraja Narasimhan and Christine Lim and Roger B. Davis and Robert Besaw and Mandeep S. Sawhney and Douglas Pleskow and Tyler M. Berzin and Martin Smith and Tara S. Kent and Mark Callery and Senthil K. Muthuswamy and Manuel Hidalgo},

url = {https://pubmed.ncbi.nlm.nih.gov/34789479/},

doi = {10.1158/1078-0432.CCR-20-4116},

issn = {1557-3265},

year  = {2021},

date = {2021-11-01},

journal = {Clinical cancer research : an official journal of the American Association for Cancer Research},

abstract = {Pancreatic ductal adenocarcinoma (PDAC) remains a significant health issue. For most patients there are no options for targeted therapy and existing treatments are limited by toxicity. The HOPE trial (Harnessing Organoids for PErsonalized Therapy) was a pilot feasibility trial aiming to prospectively generate patient derived organoids (PDOs) from patients with PDAC and test their drug sensitivity and correlation with clinical outcomes. PDOs were established from a heterogeneous population of patients with PDAC including both basal and classical PDAC subtypes. A method for classifying PDOs as sensitive or resistant to chemotherapy regimens was developed to predict the clinical outcome of study subjects. Drug sensitivity testing on PDOs correlated with clinical responses to treatment in individual patients. These data support the investigation of PDOs to guide treatment in prospective interventional trials in PDAC.},

keywords = {},

pubstate = {aheadofprint},

tppubtype = {article}

}

@article{Chamberlain2021,

title = {Burden of illness for patients with cholangiocarcinoma in the United States: a retrospective claims analysis.},

author = {Christina X Chamberlain and Elizabeth Faust and Debbie Goldschmidt and Nathan Webster and Audra N Boscoe and Dendy Macaulay and Mary Linton B. Peters},

url = {https://pubmed.ncbi.nlm.nih.gov/34012657/},

doi = {10.21037/jgo-20-544},

issn = {2078-6891},

year  = {2021},

date = {2021-04-01},

journal = {Journal of gastrointestinal oncology},

volume = {12},

pages = {658--668},

abstract = {Advanced cholangiocarcinoma (CCA) is associated with considerable morbidity and mortality. Novel second-line treatments for advanced CCA underscore the need to understand treatment patterns and economic burden of illness in clinical practice. This retrospective, claims-based study using Optum's de-identified Clinformatics Data Mart Database [2007-2019] selected patients with CCA who experienced failure of a line of therapy containing either gemcitabine or fluorouracil. The index date was defined based on evidence of treatment failure: date of last administration of the gemcitabine- or fluorouracil-based regimen plus 28 days, or initiation date of the next-line systemic therapy. Treatment patterns, healthcare resource use (HRU), costs, and survival were assessed during the follow-up period (index until death or end of eligibility). A total of 1,298 patients met inclusion criteria and had a mean age of 69.1 years. There were 958 patients (73.8%) with intrahepatic and 275 patients (21.2%) with extrahepatic CCA. Average follow-up was 7.5 months. Almost 40% of patients did not receive another line of therapy after the index date. Among the 784 patients who received another line of therapy, 40.3% used fluorouracil-based therapy, 30.7% used gemcitabine-based therapy, and 29.3% used capecitabine-based therapy. Total mean per patient per month CCA-related healthcare costs were $7,743, with medical services ($6,685) a larger driver of monthly costs relative to treatment costs ($1,058). Median overall survival (OS) was 5.3 months among all patients. Many patients with advanced CCA do not initiate additional therapy after failure of gemcitabine or fluorouracil treatment, and there is considerable variation in treatments among those who do. This study highlights the high costs and unmet need for a standard of care in this patient population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Xu2021,

title = {Time to SARS-CoV-2 clearance among patients with cancer and COVID-19.},

author = {Wenxin Xu and Andrew J Piper-Vallillo and Poorva Bindal and Jonathan Wischhusen and Jaymin M Patel and Daniel B Costa and Mary Linton B. Peters},

url = {https://pubmed.ncbi.nlm.nih.gov/33560590/},

doi = {10.1002/cam4.3708},

issn = {2045-7634},

year  = {2021},

date = {2021-03-01},

journal = {Cancer Medicine},

volume = {10},

number = {5},

pages = {1545-1549},

abstract = {For cancer patients, coronavirus disease 19 (COVID-19) infection can lead to delays in cancer therapy both due to the infection itself and due to the need to minimize exposure to other patients and to staff. Clearance guidelines have been proposed, but expected time to clearance has not been established. We identified all patients at a tertiary care hospital cancer center between 25 March 2020 and 6 June 2020 with a positive nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a cancer-related visit within 3 years, and at least one follow-up assay. We determined the time to clearance using American Society of Clinical Oncology (ASCO), the UK National Institute for Health and Care Excellence (UK-NICE), and Centers for Disease Control and Prevention (CDC) criteria. A matched non-cancer comparison cohort was also identified. Thirty-two cancer patients were identified. Nineteen were cleared by ASCO criteria, with estimated median time to clearance of 50 days. Fourteen patients resumed chemotherapy prior to clearance. Using UK-NICE criteria, median time to clearance would have been 31 days, and using CDC criteria, it would have been 13 days. The matched non-cancer cohort had similar clearance time, but with less frequent testing. SARS-CoV-2 clearance times differ substantially depending on the criteria used and may be prolonged in cancer patients. This could lead to a delay in cancer care, increased use of clearance testing, and extension of infection control precautions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Raber2020a,

title = {In Reply.},

author = {Inbar Raber and Mary Linton B. Peters and Aarti Asnani},

url = {https://pubmed.ncbi.nlm.nih.gov/32436313/},

doi = {10.1634/theoncologist.2020-0119},

issn = {1549-490X},

year  = {2020},

date = {2020-08-01},

urldate = {2020-08-01},

journal = {The oncologist},

volume = {25},

pages = {e1255--e1256},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Raber2020,

title = {Fluoropyrimidine-Associated Cardiotoxicity: A Retrospective Case-Control Study.},

author = {Inbar Raber and Sarah Warack and Jaya Kanduri and Abby Pribish and Anuradha Godishala and Arielle Abovich and Anna Orbite and Sujithraj Dommaraju and Morgan Frazer and Mary Linton B. Peters and Aarti Asnani},

url = {https://pubmed.ncbi.nlm.nih.gov/32162823/},

doi = {10.1634/theoncologist.2019-0762},

issn = {1549-490X},

year  = {2020},

date = {2020-03-01},

journal = {The oncologist},

volume = {25},

pages = {e606--e609},

abstract = {The fluoropyrimidines, 5-fluorouracil (5-FU) and capecitabine, are commonly used chemotherapeutic agents that have been associated with coronary vasospasm. In this retrospective case-control study, we identified patients at our institution who received 5-FU or capecitabine in 2018. We compared characteristics of patients who experienced cardiotoxicity with controls. We described phenotypes and outcomes of cardiotoxic cases. We identified 177 patients who received fluoropyrimidines. After adjudication, 4.5% of the cohort met the criteria for cardiovascular toxicity. Coronary artery disease was more common among cases than controls (38% vs. 7%, p \< .05). There was also a trend toward increased prevalence of cardiovascular risk factors in cases compared with controls. Most cardiotoxic cases had chest pain, although a minority of cases presented with nonischemic cardiomyopathy. Cardiotoxicity phenotypes associated with fluoropyrimidine use are not limited to coronary vasospasm. Cardiac risk factors and ischemic heart disease were highly prevalent among patients with cardiotoxicity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Tramontano2019a,

title = {Pancreatic cancer treatment costs, including patient liability, by phase of care and treatment modality, 2000-2013.},

author = {Angela Tramontano and Yufan Chen and Tina Watson and Andrew Eckel and Deirdre Sheehan and Mary Linton B. Peters and Pari Pandharipande and Chin Hur and Chung Yin Kong},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31804317},

doi = {10.1097/MD.0000000000018082},

issn = {1536-5964},

year  = {2019},

date = {2019-12-01},

journal = {Medicine},

volume = {98},

number = {49},

pages = {e18082},

abstract = {Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2019,

title = {Family communication and patient distress after germline genetic testing in individuals with pancreatic ductal adenocarcinoma.},

author = {Mary Linton B. Peters and Lindsey Stobie and Beth Dudley and Eve Karloski and Kyle Allen and Virginia Speare and Jill S Dolinsky and Yuan Tian and Kim DeLeonardis and Jill Krejdovsky and Arlene Button and Cynthia Lim and Erkut Borazanci and Randall Brand and Nadine Tung},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30980401},

doi = {10.1002/cncr.32077},

issn = {1097-0142},

year  = {2019},

date = {2019-04-01},

journal = {Cancer},

abstract = {Germline genetic testing currently is recommended for patients with pancreatic ductal adenocarcinoma (PDAC). In the current study, the authors assessed how often results are communicated to first-degree relatives within 3 months and the emotional impact of testing on patients. A total of 148 patients who were newly diagnosed with PDAC and who had undergone testing of 32 cancer susceptibility genes at 3 academic centers were selected; 71% participated. Subjects completed the Multidimensional Impact of Cancer Risk Assessment (MICRA) and a family communication survey. The results of both surveys were assessed at 3 months according to the genetic test result (positive, negative, or variant of unknown significance [VUS]) and whether a patient met criteria for genetic testing. A total of 99 patients completed the MICRA survey and 104 completed the family communication survey. The average age of the patients was 67 years, 47% were female, 29% had stage III/IV (AJCC 8th edition) disease, and 42% met genetic testing criteria. Approximately 80% of patients told at least 1 first-degree relative about their result. There was a trend toward greater disclosure among patients who tested positive (93% vs 77% for those with a VUS result [P = .149] and 74% for those who tested negative [P = .069]). Patients not meeting genetic testing criteria were less likely to disclose results (69% vs 93%; P = .003). MICRA scores did not differ by test result, age, stage of disease, or sex. The rate of result communication was high, although it was lower among patients who did not meet genetic testing criteria, those who tested negative, or those who had a VUS result. Testing-associated distress was similar across patient groups, and was comparable to that reported by other patients with cancer. Improved communication for all patients is crucial given the prognosis of PDAC, which limits time for disclosure.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Weaver2019,

title = {Testing for Verification Bias in Reported Malignancy Risks for Side-Branch Intraductal Papillary Mucinous Neoplasms: A Simulation Modeling Approach.},

author = {Davis Weaver and Anna Lietz and Sarah Fletcher Mercaldo and Mary Linton B. Peters and Chin Hur and Chung Yin Kong and Brian M Wolpin and Alec J Megibow and Lincoln L Berland and Amy Knudsen and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30620679},

doi = {10.2214/AJR.18.20180},

issn = {1546-3141},

year  = {2019},

date = {2019-03-01},

urldate = {2019-03-01},

journal = {AJR. American journal of roentgenology},

volume = {212},

number = {3},

pages = {596-601},

abstract = {The objective of our study was to test for the possibility that published malignancy risks for side-branch intraductal papillary mucinous neoplasms (IPMNs) are overestimates, likely due to verification bias. We tested for possible verification bias using simulation modeling techniques. First, in age-defined hypothetical cohorts of 10 million persons, we projected the frequency of pancreatic ductal adenocarcinoma (PDAC) arising from side-branch IPMNs over 5 years using published estimates of their prevalence (4.4%) and rate of malignant transformation (1.9%). Second, we projected the total number of PDAC cases in corresponding cohorts over the same time horizon using national cancer registry data. For each cohort, we determined whether the percentage of all PDAC cases that arose from side-branch IPMNs (i.e., side-branch IPMN-associated PDAC cases) was clinically plausible using an upper limit of 10% to define plausibility, as estimated from the literature. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. Across all cohorts, percentages of side-branch IPMN-associated PDACs greatly exceeded 10%. In the base case (mean age = 55.7 years), 80% of PDAC cases arose from side-branch IPMNs (7877/9786). In the oldest cohort evaluated (mean age = 75 years), this estimate was 76% (14,227/18,714). In a secondary analysis, we found that if an upper limit threshold of 10% for side-branch IPMN-associated PDAC was imposed, the model-predicted rate of malignancy for side-branch IPMNs would be less than 0.24% over a 5-year time horizon, substantially lower than most literature-based estimates. Our results suggest that reported malignancy risks associated with side-branch IPMNs are likely to be overestimates and imply the presence of verification bias.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Sehgal2019,

title = {Activity of Brigatinib in the Setting of Alectinib Resistance Mediated by ALK I1171S in ALK-Rearranged Lung Cancer},

author = {Kartik Sehgal and Mary Linton B. Peters and Paul A VanderLaan and Deepa Rangachari and Susumu S Kobayashi and Daniel B Costa},

url = {https://pubmed.ncbi.nlm.nih.gov/29981924/},

doi = {10.1016/j.jtho.2018.06.020},

issn = {1556-1380},

year  = {2019},

date = {2019-01-01},

urldate = {2019-01-01},

journal = {Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer},

volume = {14},

pages = {e1--e3},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2018,

title = {Progression to pancreatic ductal adenocarcinoma from pancreatic intraepithelial neoplasia: Results of a simulation model.},

author = {Mary Linton B. Peters and Andrew Eckel and Peter P. Mueller and Angela Tramontano and Davis Weaver and Anna Lietz and Chin Hur and Chung Yin Kong and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30143405},

doi = {10.1016/j.pan.2018.07.009},

issn = {1424-3911},

year  = {2018},

date = {2018-12-01},

urldate = {2018-12-01},

journal = {Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]},

volume = {18},

number = {8},

pages = {928-934},

abstract = {To gain insight into the natural history and carcinogenesis pathway of Pancreatic Intraepithelial Neoplasia (PanIN) lesions by building a calibrated simulation model of PanIN progression to pancreatic ductal adenocarcinoma (PDAC) METHODS: We revised a previously validated simulation model of solid PDAC, calibrating the model to fit data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program and published literature on PanIN prevalence by age. We estimated the likelihood of progression from PanIN states (1, 2, and 3) to PDAC and the time between PanIN onset and PDAC (dwell time). We evaluated a hypothetical intervention to test for and treat PanIN 3 lesions to estimate the potential benefits from PanIN detection. We estimated the lifetime probability of progressing from PanIN 1 to PDAC to be 1.5% (men), 1.3% (women). Progression from PanIN 1 to PDAC took 33.6 years and 35.3 years, respectively, and from PanIN 3 to PDAC took 11.3 years and 12.3 years. A hypothetical test for PanIN 3 detection and treatment could provide a maximum, average life expectancy gain of 40 days. Our modeling analysis estimates PanINs have a relatively indolent course to PDAC, supporting the feasibility of potential future early detection strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Brand2018,

title = {Prospective study of germline genetic testing in incident cases of pancreatic adenocarcinoma.},

author = {Randall Brand and Erkut Borazanci and Virginia Speare and Beth Dudley and Eve Karloski and Mary Linton B. Peters and Lindsey Stobie and Nathan Bahary and Herbert Zeh and Amer Zureikat and Melissa Hogg and Kenneth Lee and Allan Tsung and John Rhee and James Ohr and Weijing Sun and Janie Lee and A James Moser and Kim DeLeonardis and Jill Krejdovsky and Emily Dalton and Holly LaDuca and Jill Dolinsky and Arlene Colvin and Cynthia Lim and Mary Helen Black and Nadine Tung},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30067863},

doi = {10.1002/cncr.31628},

issn = {1097-0142},

year  = {2018},

date = {2018-09-01},

journal = {Cancer},

volume = {124},

pages = {3520--3527},

abstract = {The objective of this study was to investigate the prevalence of pathogenic germline variants (PGVs) in 32 cancer susceptibility genes in individuals with newly diagnosed pancreatic ductal adenocarcinoma (PDAC). A key secondary objective was to evaluate how often PGVs would have been undetected with existing genetic testing criteria. From May 2016 through May 2017, this multicenter cohort study enrolled consecutive patients aged 18 to 89 years with histologically confirmed PDAC diagnosed within the previous 12 weeks. Demographics, medical histories, and 3-generation pedigrees were collected from participants who provided samples for germline DNA analysis. Four hundred nineteen patients were deemed eligible, 302 were enrolled, and 298 were included in the final cohort. Clinically actionable variants were reported in 29 PDAC patients (9.7%), with 23 (7.7%) having a PGV associated with an increased risk for PDAC. Six of 23 individuals (26%) with PDAC-associated gene mutations did not meet currently established genetic testing criteria. According to guideline-based genetic testing, only 11 of the 23 PGVs (48%) in known PDAC genes would have been detected. Six additional patients (2%) had PGVs associated with an increased risk for other cancers. These findings support the significant prevalence of PGVs associated with PDAC and the limitations of current paradigms for selecting patients for genetic testing, and they thereby lend support for universal germline multigene genetic testing in this population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2017,

title = {Managing hereditary breast cancer risk in women with and without ovarian cancer.},

author = {Mary Linton B. Peters and Judy E Garber and Nadine Tung},

url = {https://pubmed.ncbi.nlm.nih.gov/28454658/},

doi = {10.1016/j.ygyno.2017.04.013},

issn = {1095-6859},

year  = {2017},

date = {2017-07-01},

journal = {Gynecologic oncology},

volume = {146},

pages = {205--214},

abstract = {Current guidelines recommend that all women with ovarian cancer undergo germline genetic testing for BRCA1/2. Increasingly, genetic testing is being performed via panels that include other genes that confer a high or moderate risk of breast cancer. In addition, many women with a family history of breast or ovarian cancer are not found to have a mutation, but may have increased risk of breast cancer for which surveillance and risk reduction strategies are indicated. This review discusses how to assess and manage an increased risk of breast cancer through surveillance, preventive medications, and risk-reducing surgery. Assessing and managing the increased risk of breast cancer in BRCA1/2 mutation carriers after a diagnosis of ovarian cancer can be challenging. For the first few years after an ovarian cancer diagnosis, BRCA1/2 mutation carriers have a relatively low risk of breast cancer, and their prognosis is largely determined by the ovarian cancer. However, if these women remain in remission after two years, the risk of breast cancer becomes comparable with, and in some cases exceeds, their risk of ovarian cancer recurrence. For these women, breast cancer surveillance and risk reduction becomes important to their overall health. Specifically, for BRCA1/2 carriers who are diagnosed with early-stage ovarian cancer, we recommend regular breast cancer surveillance and consideration of risk reduction with medication and/or prophylactic mastectomy. For women with advanced ovarian cancer who do not achieve remission, breast cancer surveillance or prophylaxis is not of value. However, among carriers with more favorable advanced disease, it is reasonable to initiate breast cancer surveillance. Patients with less favorable advanced stage disease who achieve sustained remission (\>2-5years) should also consider more aggressive strategies for breast cancer screening and prevention. For mutation carriers who remain in remission after five years, prophylactic mastectomy can be considered.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{BPeters2017,

title = {Cabozantinib in the treatment of hepatocellular carcinoma},

author = {Mary Linton B. Peters and Rebecca Miksad},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28703624},

doi = {10.2217/fon-2017-0169},

issn = {1744-8301},

year  = {2017},

date = {2017-07-01},

journal = {Future oncology (London, England)},

abstract = {Despite clinical studies with different mechanisms of action, no new systemic therapies were approved for hepatocellular carcinoma (HCC) between sorafenib in 2007 and regorafenib in 2017. This is an area of interest to improve outcomes and quality of life. Cabozantinib is oral, small-molecule tyrosine kinase inhibitor that primarily targets MET, VEGFR2, AXL and RET, with additional effect on KIT and FLT3. Cabozantinib is approved for progressive metastatic medullary thyroid cancer and previously treated renal cell carcinoma, and is in development for multiple solid tumors. Given positive results from a Phase II study, cabozantinib is under evaluation in a Phase III randomized controlled trial for patients with advanced HCC previously treated with sorafenib. It has been granted orphan drug status in the USA for this indication. This review summarizes the development of cabozantinib in HCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2017a,

title = {Compound Uncommon EGFR Mutations in a Patient with Advanced NSCLC and Durable Response to Sequential EGFR Targeted Therapies},

author = {Mary Linton B. Peters and Daniel B Costa and Deepa Rangachari},

url = {https://www.ncbi.nlm.nih.gov/pubmed/28343545},

doi = {10.1016/j.jtho.2016.12.018},

issn = {1556-1380},

year  = {2017},

date = {2017-04-01},

journal = {Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer},

volume = {12},

pages = {e35--e36},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2016,

title = {Genetic Testing in Pancreatic Ductal Adenocarcinoma: Implications for Prevention and Treatment},

author = {Mary Linton B. Peters and Jennifer F Tseng and Rebecca Miksad},

url = {http://www.ncbi.nlm.nih.gov/pubmed/27041411},

doi = {10.1016/j.clinthera.2016.03.006},

issn = {1879-114X},

year  = {2016},

date = {2016-07-01},

urldate = {2016-07-01},

journal = {Clinical therapeutics},

volume = {38},

pages = {1622--1635},

abstract = {This article reviews the progress to date and future directions for investigation of germline and somatic genetic testing to inform pancreatic adenocarcinoma (PDAC) treatment, screening, and prevention strategies. We searched PubMed to identify recent articles regarding genetic testing in pancreatic cancer, including both germline and somatic testing, and recent genome-wide association studies. References were specifically hand searched as relevant. Guidelines for testing and screening high-risk individuals were included. We searched clinicaltrials.gov to review the current landscape of active clinical trials. Approximately 10% of PDACs are associated with an identified germline mutation. Although germline mutations may inform treatment options and identify high-risk individuals for screening in other cancers, the data on PDAC are only now emerging. For example, poly adenosine diphosphate ribose polymerase (PARP) inhibitors are under investigation for BRCA-associated PDAC. Somatic mutations have also been identified in PDAC. However, current data are limited regarding treatment for potential PDAC somatic driver mutations. Although erlotinib is used in PDAC, its use is not targeted based on a tumor marker. Many tyrosine kinase inhibitors targeted toward potential driver mutations and critical pathways are in development, including BRAF/MEK, ALK, and CDK4/6. A consensus on screening strategies for individuals at high risk for PDAC is still evolving because of the relatively low prevalence of the disease, the relative invasiveness of endoscopic procedures often used as part of screening, and the lack of a clear survival benefit. Pancreatic cancer has been slower to move toward genomic testing, partially because of a lower prevalence of mutations and partially because of a limited effect of results on treatment choices outside a clinical trial. This is an area of active investigation, and we anticipate that there will be both preventive and therapeutic implications of driver mutations in the coming decade.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Burrows2012,

title = {Limbic and motor function comparison of deep brain stimulation of the zona incerta and subthalamic nucleus},

author = {Anthony M Burrows and Paula D Ravin and Peter Novak and Mary Linton B. Peters and Brian Dessureau and Joan Swearer and Julie G Pilitsis},

url = {https://www.ncbi.nlm.nih.gov/pubmed/21869721},

doi = {10.1227/NEU.0b013e318232fdac},

issn = {1524-4040},

year  = {2012},

date = {2012-03-01},

journal = {Neurosurgery},

volume = {70},

pages = {125--30; discussion},

abstract = {Psychiatric and neuropsychological side effects of subthalamic nucleus (STN) stimulation have been increasingly recognized. Most programming regimens focus on contacts 0 and 1, whereas contact 3, which often is located near or in the zona incerta (ZI), is usually not used. The question of whether ZI stimulation may limit limbic effects has not been answered. To examine the effects of short-term stimulation near or in the ZI (contact 3) compared with stimulation of the STN using standard trajectories and targeting as measured by limbic and motor functions. Motor and limbic functions of 11 patients with STN DBS were assessed with the Unified Parkinson Disease Rating Scale-3, structured gait video analysis, Visual Analog Scale mood scales, task testing of impulsivity, and facial recognition under routine STN programming and under stimulation in or near the ZI. Postoperative magnetic resonance imaging confirmed the location of contact 3 near or in the ZI. Data analysis with repeated-measures analysis of variance revealed that motor scores remained stable with both stimulation settings, with specific improvements in finger taps (P = .02) and rapid alternating movements (P = .03) in ZI stimulation. Stimulation near or in the ZI led to a decrease in self- reported anxiety and depression (P = .03 for both) and an improvement in fear recognition (P = .02). We provide preliminary evidence that stimulation in or near the ZI results in maintained motor function while improving self-reported depression and anxiety in patients with bilateral STN DBS. Stimulation in or near the ZI may provide a useful programming setting for patients prone to psychiatric side effects.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Pilitsis2012,

title = {Changing practice patterns of deep brain stimulation in Parkinson's disease and essential tremor in the USA.},

author = {Julie G Pilitsis and Anthony Burrows and Mary Linton B. Peters and Julie Sargent and Sing Chau Ng and Jennifer F Tseng},

url = {https://pubmed.ncbi.nlm.nih.gov/22190124/},

doi = {10.1159/000333834},

issn = {1423-0372},

year  = {2012},

date = {2012-01-01},

journal = {Stereotactic and functional neurosurgery},

volume = {90},

pages = {25--29},

abstract = {Randomized controlled studies have shown deep brain stimulation (DBS) to be an effective treatment for Parkinson's disease (PD). Outside of large-center studies, little is known about trends in DBS use in the USA. We employ the Nationwide Inpatient Sample to look at changes in DBS utilization over time. We identified all individuals with PD (332.0) and essential tremor (ET) (333.1) who underwent DBS (02.93) from 1998 to 2007. We examined demographics, hospital status, comorbidities, and in-hospital systemic/technical complications. DBS patients from 2000 and 2007 were compared using χ(2) tests. PD patients from the 2007 sample who underwent DBS were older (p = 0.01). Both ET and PD patients had significantly more comorbidities in 2007 (p \< 0.001). In-hospital complications decreased from 3.8 to 2.8%. DBS was performed in medium- or high-volume centers in 70% of cases in 2000 and in 50% in 2007. In all groups, a majority of cases (range 65-71%) underwent DBS at hospitals in the western and southern USA. Patients who underwent DBS in the 2007 sample were older and had more comorbidities than those in the 2000 sample; in-hospital complications remained low. Understanding trends in DBS is helpful in assessing how the technology is adopted and what relationships should be further explored.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}