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Rabin, Michael

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Rabin

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Michael

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Rabin, Michael
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    Tumoral cavitation in patients with non-small-cell lung cancer treated with antiangiogenic therapy using bevacizumab
    (E-MED LTD, 2012) Nishinoa, Mizuki; Cryer, Sarah K.; Okajim, Yuka; Sholl, Lynette; Hatabu, Hiroto; Rabin, Michael; Jackman, David M; Johnson, Bruce
    Rationale and objectives: To investigate the frequency and radiographic patterns of tumoral cavitation in patients with non-small cell lung cancer (NSCLC) treated with bevacizumab, and correlate the imaging findings with the pathology, clinical characteristics and outcome. Materials and methods: Seventy-two patients with NSCLC treated with bevacizumab therapy were identified retrospectively. Baseline and follow-up chest computed tomography scan were reviewed to identify tumoral cavitation and subsequent filling in of cavitation. Radiographic cavitation patterns were classified into 3 groups. The clinical and outcome data were correlated with cavity formation and patterns. Results: Out of 72 patients, 14 patients developed cavitation after the initiation of bevacizumab therapy (19%; median time to event, 1.5 months; range 1.0–24.8 months). Three radiographic patterns of tumoral cavitation were noted: (1) development of cavity within the dominant lung tumor (n = 8); (2) development of non-dominant cavitary nodules (n = 3); and (3) development of non-dominant cavitary nodules with adjacent interstitial abnormalities (n = 3). Eleven patients (79%) demonstrated subsequent filling in of cavitation (the time from the cavity formation to filling in; median 3.7 months; range 1.9–22.7 months). No significant difference was observed in the clinical characteristics, including smoking history, or in the survival between patients who developed cavitation and those who did not. Smoking history demonstrated a significant difference across 3 radiographic cavitation patterns (P = 0.006). Hemoptysis was noted in 1 patient with cavity formation and 4 patients without, with no significant difference between the 2 groups. Conclusion: Tumoral cavitation occurred in 19% in patients with NSCLC treated with bevacizumab and demonstrated 3 radiographic patterns. Subsequent filling in of cavitation was noted in the majority of cases.
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    A Phase I trial of high dose gefitinib for patients with leptomeningeal metastases from non-small cell lung cancer
    (Impact Journals LLC, 2015) Jackman, David M.; Cioffredi, Leigh A.; Jacobs, Lorraine; Sharmeen, Farhana; Morse, Linda K.; Lucca, Joan; Plotkin, Scott; Marcoux, Paul J.; Rabin, Michael; Lynch, Thomas J.; Johnson, Bruce; Kesari, Santosh
    Introduction: There are few effective treatment options for leptomeningeal metastasis (LM) in non-small-cell lung cancer (NSCLC). This study assessed the feasibility of high-dose gefitinib in patients with LM from NSCLC harboring EGFR mutations or prior systemic response to EGFR-TKI. Methods: This phase I open-label trial of a novel gefitinib dosing schedule employed a 3+3 design. Eligible NSCLC patients with LM had known EGFR mutations and/or prior response to EGFR-TKI. Patients alternated 2 weeks of high-dose daily gefitinib (dose levels: 750 mg, 1000 mg, 1250 mg) with 2 weeks of maintenance therapy (500 mg daily). Primary endpoints were safety and toxicity. Secondary endpoints included overall survival (OS), neurological progression-free survival, radiological response, and cytological response in cerebrospinal fluid (CSF). Results: Seven patients were treated: 3 at 750 mg dose level, 4 at 1000 mg dose level. There were no DLTs at the 750 mg dose level, and one DLT (toxic epidermal necrolysis) at the 1000 mg dose level. The study was closed due to slow accrual. Median neurological PFS was 2.3months (range 1.6–4.0 months); median OS was 3.5months (range 1.6–5.1months). Though there were no radiologically documented remissions of LM disease, four patients had improvement in neurological symptoms. One patient cleared their CSF of NSCLC cells, while 2 others had decrease in malignant cells in CSF. Conclusion: Although the MTD was not defined due to slow accrual, this study provides important information about the tolerability and CSF penetration of high-dose gefitinib as a therapeutic option for modest palliation for NSCLC patients with LM and a known EGFR mutation.
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    Case report of tracheobronchial squamous cell carcinoma treated with radiation therapy and concurrent chemotherapy
    (Elsevier BV, 2016) Agrawal, Vishesh; Marcoux, J.; Rabin, Michael; Vernovsky, Inna; Wee, Jon; Mak, Raymond
    Tracheobronchial tumors include primary malignant tumors, secondary malignant tumors, and benign tumors. Primary malignant tumors of the trachea are rare, representing only 0.1% to 0.4% of all malignant disease. Squamous cell carcinoma (SCC) and adenoid cystic carcinoma are the most common histological subtypes, making up approximately two-thirds of primary tracheal neoplasms.1 Such tumors have typically been treated with surgical resection and adjuvant radiation therapy (RT; Table 1). Medically inoperable tumors are usually treated with definitive RT, but because of the rarity of these tumors, there are no randomized trials to determine the optimal treatment regimen. A radiation dose of ∼60 Gy has been most commonly reported for external beam RT, with higher doses having significant toxicity of the tracheal and esophageal tissue using historical techniques. In contrast to definitive RT, the use of definitive RT with concurrent chemotherapy for tracheal SCC has been sparingly described in the literature. In this report, we describe our experience with 2 patients at our institution who received definitive RT using modern techniques with concurrent chemotherapy for tracheobronchial SCC.