Duy Cong Tran

Follow-up on Programmed Cell Death 1 Inhibitor for Cutaneous Squamous Cell Carcinoma

Author Contributions: Dr Guy and Ms Berkowitz had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Guy, Watson. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Guy, Berkowitz. Administrative, technical, or material support: Guy, Watson.

A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology.

Background Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. Methods A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. Results A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. Conclusions Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on—and in some cases improving—the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use by patients, referring physicians, and consulting dermatologists. Teledermatology has also been used as an educational tool for patients. A significant number of studies detailed strategies to improve the current state of teledermatology, either by implementing new programs or improving technologies. Telemedicine use is widespread among plastic surgeons and is enabling the spread of expertise beyond major medical centers. Further research is needed to conclusively demonstrate benefit in routine clinical care.

Levocarnitine for vismodegib‐associated muscle spasms: a pilot randomized, double‐blind, placebo‐controlled, investigator‐initiated trial

Smoothened inhibitors (SIs) are a new, targeted therapy for the treatment of advanced basal cell carcinoma (BCC), but their usage is significantly limited by the most common side effect, muscle spasms. Muscle spasms affect up to 80% of users, and are the most common reason for drug discontinuation despite tumor response. Currently, no placebo-controlled trials exist to guide the management of vismodegib-related muscle spasms. The medical literature suggests that the naturally occurring substance, levocarnitine (LC), can improve contractile function of muscle and reduce markers of exercise-induced stress. Hence, we explored the effect of oral LC on vismodegib-related muscle spasms via a double-blind, randomized, placebo-controlled, two-period crossover design. This article is protected by copyright. All rights reserved.

Pembrolizumab for advanced basal cell carcinoma: an investigator-initiated, proof-of-concept study

Anne Lynn S. Chang, MDa, Duy C. Tran, BSa, John G. D. Cannon, BSa, Shufeng Li, MSa, Mark Jeng, PhDa, Roma Patel, PA-Cb, Lindsay Van der Bokke, RNb, Alana Pague, BSb, Richard Brotherton, RNb, Kerri E. Rieger, MD PhDc, Ansuman T. Satpathy, MD, PhDd, Kathryn E. Yost, BSd, Sunil Reddy, MDe, Kavita Sarin, MD, PhDa, A. Dimitrios Colevas, MDe aDepartment of Dermatology, Stanford University School of Medicine, Stanford. bStanford Cancer Institute, Cancer Clinical Trials Office, Stanford. cStanford Dermatopathology Service, Department of Pathology, Stanford University School of Medicine and Stanford Cancer Institute, Stanford.

Cell-Based Therapies in Vascularized Composite Allotransplantation

Background Dendritic cells (DCs) are bone marrow‐derived, professional antigen‐presenting cells with tolerogenic function. The ability of DCs to regulate alloantigen‐specific T cell responses and to promote tolerance has aligned them ideally for a role in vascularized composite allotransplantation (VCA). In this study, we summarize the current evidence for DC therapies for tolerance induction to alleviate the requirement for chronic immunosuppression. Method A comprehensive and structured review of manuscripts published on VCA was performed using the MEDLINE and PubMed databases. All eligible studies published from the year 2000 to 2017 were included in the final results. Result Nineteen original preclinical and clinical studies that employed cell therapy for VCA were included in this review. In vivo DC therapy was found to direct the alloimmune response toward either transplant rejection or tolerance in VCA models. While injection of mature DCs rapidly increases T‐cell activity in humans and promotes transplant rejection, the injection of immature DCs acts as an immunosuppressant and inhibits T‐cell activity. In addition to immature DCs, mesenchymal stem cells were also found to have a positive effect on allotransplantation of solid organs and bone marrow via cytokine expression which decreases the alloreactive effector lymphocytes and increases CD4+/CD25+/FoxP3 Tregs. Despite the promising findings, the efficacy of cell‐based therapies varies greatly across studies, partly due to different methods of cell isolation and purification techniques, source, route and timing of administration, and combination immunosuppressive therapy. Conclusion Additional research is needed to evaluate the efficacy and safety of DC and other cell‐based therapeutic measures in human allotransplant recipients. Future direction will focus on the development of novel methods to reduce immunosuppression and develop more individualized management, as well as the clinical application of basic research in the mechanisms of immunologic tolerance.

An exploratory open-label, investigator-initiated study to evaluate the efficacy and safety of combination sonidegib and buparlisib for advanced basal cell carcinomas

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Initial in vitro functional characterization of serum exosomal microRNAs from patients with metastatic basal cell carcinoma

Basal cell carcinoma (BCC) is the most common of human malignancies, but the mechanism by which metastasis occurs is poorly understood1. Serum exosomes, 30-100 nanometer membrane-bound vesicles containing regulatory microRNAs (miRs), are emerging as a mechanism for cancer metastasis in melanoma2, breast3, prostate4, and lung cancers5, but the role of exosomes in BCC metastasis is not known. In this pilot study, we assessed for differences in exosomal composition in BCC patients with and without metastasis, and whether these differences confer functional changes in vitro. This article is protected by copyright. All rights reserved.

An 18-year retrospective study on the outcomes of keratoacanthomas with different treatment modalities at a single academic center.

DEAR EDITORS, The clinical course for keratoacanthomas (KAs) varies from self-resolving to invasive cancers. KA is often treated with surgical intervention, but other treatments such as electrodessication and curettage, cryotherapy, topical medications, intralesional chemotherapy, acitretin and active surveillance have been employed. Randomized controlled studies of different treatment modalities are lacking. The largest systematic review consisted of 113 case reports and case series (445 patients included) and reported 18 recurrent or persistent KA cases (4%), but this data is prone to publication bias, as unusual cases are more likely to be reported and treatment outcomes could not be directly compared. Our study examines KA recurrence and persistence rates of different treatment approaches at a single institution. After Institutional Review Board approval, we searched the Stanford Cancer Institute Research Database from January 1998 to February 2016 using the keywords ‘keratoacanthoma’, ‘crateriform’ or ‘cup-shaped’ and applied the following two inclusion criteria: (i) at least one KA-positive biopsy read by a Stanford dermatopathologist and (ii) at least one dermatology visit documenting treatment of KAs. After manual chart review, 261 patients (with 363 KAs) met these criteria (Fig. 1). ‘Recurrence’ was defined as regrowth of treated lesions documented as no clinically visible lesion after first treatment approach (FTA). ‘Persistence’ was defined as lesions clinically visible at the same anatomic location after FTA.