St. Joseph's Hospital and Medical Center

About: St. Joseph's Hospital and Medical Center is a healthcare organization based out in Phoenix, Arizona, United States. It is known for research contribution in the topics: Aneurysm & Population. The organization has 2785 authors who have published 4630 publications receiving 168355 citations.

A Randomized Trial of Bevacizumab for Newly Diagnosed Glioblastoma

Abstract: Background Concurrent treatment with temozolomide and radiotherapy followed by maintenance temozolomide is the standard of care for patients with newly diagnosed glioblastoma. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor A, is currently approved for recurrent glioblastoma. Whether the addition of bevacizumab would improve survival among patients with newly diagnosed glioblastoma is not known. Methods In this randomized, double-blind, placebo-controlled trial, we treated adults who had centrally confirmed glioblastoma with radiotherapy (60 Gy) and daily temozolomide. Treatment with bevacizumab or placebo began during week 4 of radiotherapy and was continued for up to 12 cycles of maintenance chemotherapy. At disease progression, the assigned treatment was revealed, and bevacizumab therapy could be initiated or continued. The trial was designed to detect a 25% reduction in the risk of death and a 30% reduction in the risk of progression or death, the two coprimary ...

Molecular classification of cutaneous malignant melanoma by gene expression profiling

Abstract: The most common human cancers are malignant neoplasms of the skin. Incidence of cutaneous melanoma is rising especially steeply, with minimal progress in non-surgical treatment of advanced disease. Despite significant effort to identify independent predictors of melanoma outcome, no accepted histopathological, molecular or immunohistochemical marker defines subsets of this neoplasm. Accordingly, though melanoma is thought to present with different 'taxonomic' forms, these are considered part of a continuous spectrum rather than discrete entities. Here we report the discovery of a subset of melanomas identified by mathematical analysis of gene expression in a series of samples. Remarkably, many genes underlying the classification of this subset are differentially regulated in invasive melanomas that form primitive tubular networks in vitro, a feature of some highly aggressive metastatic melanomas. Global transcript analysis can identify unrecognized subtypes of cutaneous melanoma and predict experimentally verifiable phenotypic characteristics that may be of importance to disease progression.

Incorporation of Bevacizumab in the Primary Treatment of Ovarian Cancer

Abstract: METHODS In our double-blind, placebo-controlled, phase 3 trial, we randomly assigned eligible patients with newly diagnosed stage III (incompletely resectable) or stage IV epithelial ovarian cancer who had undergone debulking surgery to receive one of three treatments All three included chemotherapy consisting of intravenous paclitaxel at a dose of 175 mg per square meter of body-surface area, plus carboplatin at an area under the curve of 6, for cycles 1 through 6, plus a study treatment for cycles 2 through 22, each cycle of 3 weeks’ duration The control treatment was chemotherapy with placebo added in cycles 2 through 22; bevacizumab-initiation treatment was che motherapy with bevacizumab (15 mg per kilogram of body weight) added in cycles 2 through 6 and placebo added in cycles 7 through 22 Bevacizumab-throughout treatment was chemotherapy with bevacizumab added in cycles 2 through 22 The primary end point was progression-free survival RESULTS Overall, 1873 women were enrolled The median progression-free survival was 103 months in the control group, 112 in the bevacizumab-initiation group, and 141 in the bevacizumab-throughout group Relative to control treatment, the hazard ratio for progression or death was 0908 (95% confidence interval [CI], 0795 to 1040; P = 016) with bevacizumab initiation and 0717 (95% CI, 0625 to 0824; P<0001) with bevacizumab throughout At the time of analysis, 763% of patients were alive, with no significant differences in overall survival among the three groups The rate of hypertension requiring medical therapy was higher in the bevacizumab-initiation group (165%) and the bevacizumab-throughout group (229%) than in the control group (72%) Gastrointestinal-wall disruption requiring medical intervention occurred in 12%, 28%, and 26% of patients in the control group, the bevacizumab-initiation group, and the bevacizumab-throughout group, respectively CONCLUSIONS The use of bevacizumab during and up to 10 months after carboplatin and pacli taxel chemotherapy prolongs the median progression-free survival by about 4 months in patients with advanced epithelial ovarian cancer (Funded by the National Cancer Institute and Genentech; ClinicalTrialsgov number, NCT00262847)

Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy

Abstract: Summary Purpose: We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy Methods: Participants were adults with medically refractory partial seizures, including secondarily generalized seizures Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation Results: One hundred ten participants were randomized Baseline monthly median seizure frequency was 195 In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0002) Unadjusted median declines at the end of the blinded phase were 145% in the control group and 404% in the stimulated group Complex partial and “most severe” seizures were significantly reduced by stimulation By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure-free for at least 6 months Five deaths occurred and none were from implantation or stimulation No participant had symptomatic hemorrhage or brain infection Two participants had acute, transient stimulation-associated seizures Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events Discussion: Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures Benefit persisted for 2 years of study Complication rates were modest Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures