Alejandro Recio Boiles

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• Recio-boiles, A., Tsoris, A., Babiker, H. M., Recio Boiles, A., & Kashyap, S. (2019). Cancer, Rectal (Rectum). In StatPearls. StatPearls Publishing, Treasure Island (FL).
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  Colon and rectal cancer (CRC) combined is the third most commonly diagnosed cancer and the second deadliest in the United States. Rectal cancer has distinct environmental associations and genetic risk factors different from colon cancer. The incidence of new cases and mortality of rectal cancer has been steadily declining for the past years, although noticed to rise in recent years on younger adults (less than 50 years). The transformation of the normal rectal epithelium to a dysplastic lesion and eventually an invasive carcinoma requires an accumulation of genetic mutations either somatic (acquired) and/or germline (inherited) in approximately 10 to 15 years period. Tumor regression grade after pre-operative therapy and pathological staging are the most important prognostic indicators of rectal cancer. All newly diagnosed patients with rectal cancer should be universally screened for DNA mismatch repair/microsatellite status that is present in up to 13% of all sporadic rectal cancer cases. A careful history and physical examination, including a digital rectal exam, are paramount on clinical suspicion. An endoscopy examination with rigid sigmoidoscopy is required to measure the distance from the lesion to the anal verge (less than 15 cm) and for tissue biopsy for pathological confirmation of rectal cancer. Baseline computed tomography of the chest, abdomen, and pelvis may initially grossly rule out metastatic stage. Nevertheless, a combined approach by magnetic resonance imaging or transrectal ultrasound will accurately determine tumor extension and node status of the local rectal disease at diagnosis. An interprofessional evaluation by medical oncology, radiation oncology, and surgical oncology should discuss the best peri-operative chemo-radiotherapy route that could augment the chance of cure on high-risk patients. Oligo-metastatic, liver and lung, and local-recurrence patients with rectal cancer are potentially curable with multimodality therapies. Palliative systemic therapy is reserved for non-surgical candidates to ameliorate symptoms, improve quality of life and prolong life expectancy. [1][2][3][4]
• Babiker, H. M., Recio-boiles, A., & Recio Boiles, A. (2017). Cancer, Pancreas, Mucinous Cystic. In StatPearls. StatPearls Publishing, Treasure Island (FL).

Journals/Publications

• Estrada-Mendizabal, R. J., Dhaliwal, A. S., Bertolo, A. J., Batai, K., Heimark, R., Recio-Boiles, A., & Chipollini, J. (2023). Prostate Cancer Disparities in Metastatic and Treatment Status for Hispanic Americans Based on Country of Origin Compared to Non-Hispanic Whites Using the National Cancer Database. Clinical genitourinary cancer.
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  Among Hispanic-American (HA) men, prostatic cancer (PCa) accounts for nearly one-quarter of the total cancer burden. We sought to identify differences in PCa presentation and treatment status for HA subgroups based on country/region of origin.
• Halder, R., Veeravelli, S., Cheng, C., Estrada-Mendizabal, R. J., & Recio-Boiles, A. (2023). Health Disparities in Presentation, Treatment, Genomic Testing, and Outcomes of Pancreatic Cancer in Hispanic and Non-Hispanic Patients. Journal of racial and ethnic health disparities, 10(6), 3131-3139.
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  There are few conflicting results regarding the treatment and outcomes of Hispanic patients with pancreatic cancer. This study comprehensively evaluated the differences in baseline characteristics, treatments, genomic testing, and outcomes among Hispanic (H) and Non-Hispanic (NH) patients with early-stage (ES) and late-stage (LS) pancreatic cancer (PC).
• Paster, I. C., Zeng, J., Recio-Boiles, A., & Chipollini, J. (2023). Gender, Racial and Ethnic Differences in Pathologic Response Following Neoadjuvant Chemotherapy for Bladder Cancer Patients. Urology, 178, 105-113.
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  To evaluate trends and racial variations of pathologic complete response (CR) in patients with muscle-invasive bladder cancer undergoing cystectomy.
• Recio Boiles, A. (2023).

  Impact of Aspirin Use on Outcomes in Patients With Hepatocellular Cancer: A Nationwide Analysis. 

  . World J Oncol., 14(3):195-204.. doi:10.14740/wjon1601.
• Recio-boiles, A., Heimark, R., Chipollini, J., Cheng, C., & Batai, K. (2022). Disparities in prostate cancer: An ethnicity comparative focus among Hispanic Americans versus non-Hispanic whites.. Journal of Clinical Oncology, 40(6_suppl), 23-23. doi:10.1200/jco.2022.40.6_suppl.023
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  23 Background: Prostate cancer (PCa) is a clinically heterogeneous disease and the incidence and mortality risk varies widely among racial/ethnic groups. Among Hispanic American (HA) men, PCa accounts for nearly one-quarter of the total cancer burden; in addition, advanced stage and mortality rates are significantly higher in HA compared to Non-Hispanic White (NHW) men. Despite a decade of declining overall incidence rates, incidence rates of advanced PCa appear to be increasing over time among HA men, a similar pattern seen among Non-Hispanic Blacks (NHB). Methods: Using the National Cancer Database, we identified patients with histologically confirmed prostate adenocarcinoma with reported race/ethnicity, clinical staging, Gleason score ≥ 6, and PSA at diagnosis between 2010 and 2016. HAs were divided into four major subgroups: Mexican/Chicano, Puerto Ricans, Cubans, and Central/South Americans. NHB, Asian, and other racial groups were excluded. Statistical analysis was derived from the Kruskal-Wallis test for continuous variables and χ2 test for categorical variables. Univariable and multivariable logistic regression models were used to evaluate the association of HA ethnic subgroups with metastatic presentation and primary treatment. Results: A total of 428,829 patients were included with 5,625 (1.3%) being HA. Mexican comprised 51.2% of HAs and presented with higher PSA and Gleason score at diagnosis and more advanced cT, N1 and M1 stage when compared to NHW men and other HA subgroups (all, p < 0.001) (Table). After adjusting for age, PSA, year of diagnosis, cT, N, insurance, income, education, and performance score, Mexican had 1.32 (95%CI: 1.07-1.63, p = 0.01) higher odds of initial metastatic presentation and 0.68 (95%CI: 0.55-0.85, p < 0.001) lower odds of receiving treatment compared to NHW men while no statistically significant difference was seen for the other HA subgroups. Conclusions: Even after accounting for socioeconomic disparities, Mexican men present with a more aggressive disease when compared to NHW and other HA subgroups. Our results warrant further investigations into potential biological factors affecting HA PCa as well as identifications of potential barriers to treatment for vulnerable populations.[Table: see text]
• Recio-boiles, A., Obeng-kusi, M., Choi, B., & Abraham, I. (2022). Network meta-analysis (NMA) of second-line (2L) treatment options in metastatic renal cell carcinoma.. Journal of Clinical Oncology, 40(6_suppl), 337-337. doi:10.1200/jco.2022.40.6_suppl.337
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  337 Background: Immune checkpoint inhibitors, in combination either with a cytotoxic T-lymphocyte-associated protein 4 or tyrosine kinase inhibitor are approved for first-line (1L) therapy of metastatic renal cell carcinoma (mRCC). Of those, several have been shown to improve median progression-free survival (mPFS) in the 2L. A recent NMA by Irbaz et al. (PMID 33824031) identified the most effective 1L treatments for mRCC. In the absence of head-to-head randomized clinical trials (RCT), we performed an indirect comparison of 2L treatments for mRCC. Methods: We conducted literature searches in Medline, Embase, Cochrane Library, and Google Scholar to identify RCTs evaluating 2L treatments in mRCC. We extracted the mPFS hazard ratios (HR) and 95% confidence intervals (CI). We used a normal likelihood model that incorporates log HRs of the treatment differences for conducting the NMA. P-scores, measuring the certainty that one treatment is better than another averaged over all competing treatments, were used to rank treatments. Higher p scores indicate better outcomes. Data were analyzed with R netmeta package v.1.5-0. Results: All 8 therapies included in this analysis showed benefits in mPFS over placebo (Table). The combination of lenvatinib+everolimus had the lowest hazard of disease progression or death and pazopanib was the highest compared to placebo. Lenvatinib+everolimus ranked highest with a p-score of 0.96 followed by cabozantinib (0.88), and lenvatinib (0.79); with others having p-scores of 0.60 or less (placebo p-score 0.00). Conclusions: This NMA revealed that lenvatinib+everolimus and cabozantinib are most likely to produce the highest PFS benefit in 2L in mRCC. Future studies are needed to evaluate 1L and 2L sequencing options to further inform clinical practice. [Table: see text]
• Sardar, M., Recio-Boiles, A., Mody, K., Karime, C., Chandana, S. R., Mahadevan, D., Starr, J., Jones, J., Borad, M., & Babiker, H. (2022). Pharmacotherapeutic options for pancreatic ductal adenocarcinoma. Expert opinion on pharmacotherapy, 23(18), 2079-2089.
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  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.
• Tagawa, S. T., Sternberg, C. N., Recio-boiles, A., Ramamurthy, C., Pouessel, D., Pichardo, C., Petrylak, D. P., Park, C. H., Loriot, Y., Grivas, P., Goswami, T., Flechon, A., Davis, N. B., Bupathi, M., Bhatia, A., Barthelemy, P., & Agarwal, N. (2022). TROPHY-U-01 Cohort 3: Sacituzumab govitecan (SG) in combination with pembrolizumab (Pembro) in patients (pts) with metastatic urothelial cancer (mUC) who progressed after platinum (PLT)-based regimens.. Journal of Clinical Oncology, 40(6_suppl), 434-434. doi:10.1200/jco.2022.40.6_suppl.434
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  434 Background: Checkpoint inhibitors (CPIs) are standard therapy for pts with mUC after PLT-based regimens, with limited long-term disease control. SG is an antibody-drug conjugate composed of an anti-trophoblast cell-surface antigen 2 (Trop-2) antibody coupled to SN-38 (a topoisomerase-I inhibitor) via a proprietary hydrolyzable linker. In the TROPHY-U-01 registrational phase 2 trial, SG monotherapy demonstrated significant activity and manageable safety in pts with mUC who progressed after prior PLT-based chemotherapy and CPI, with 27% objective response rate (ORR) and median overall survival of 11 months (Tagawa, et al. J Clin Oncol. 2021). Here, we present interim efficacy and safety results of combining SG with Pembro as 2nd-line therapy in CPI-naive pts with mUC who progressed after PLT-based chemotherapy (cohort 3). Methods: TROPHY-U-01 is a multicohort, open-label, global phase 2 trial. Eligible pts had measurable disease, Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1, and creatinine clearance ≥30 mL/min. The recommended phase 2 dose (RP2D) was determined during a 10-pt safety lead-in, and additional pts were enrolled at the RP2D in a Simon 2-stage design. Primary endpoint: ORR by blinded independent central review per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). Key secondary endpoints: investigator-assessed ORR, clinical benefit rate [CBR; complete response (CR) + partial response (PR) + stable disease], progression-free survival (PFS), and safety. Results: At the time of data cutoff, 41 pts received at least a dose of SG at the RP2D (10 mg/kg). Of these 41 pts, median (range) age was 67y (46–86), 83% men, 61% ECOG PS 1, 76% had ≥1 Bellmunt risk factor, and median (range) number of prior anticancer regimens was 1 (1–3). At a median follow-up of 5.8 mo, the investigator-assessed ORR was 34% (95% CI, 20.1–50.6; 1 CR; 13 PR); CBR was 44% (95% CI, 28.5–60.3); 6-mo PFS rate was 47%. Median time to response was 2.0 mo (95% CI, 1.3–2.8). Most common treatment-emergent adverse events (TEAEs) were diarrhea (76%), nausea (59%), anemia (56%), neutropenia (44%), and asthenia (41%). Treatment-related grade ≥3 AEs occurred in 59% of pts. Key grade ≥3 TEAEs of any cause included diarrhea (24%), anemia (20%), febrile neutropenia (10%), fatigue (7%), and asthenia (5%). Two pts discontinued treatment due to treatment-related AEs. No treatment-related death occurred. Conclusions: SG in combination with Pembro demonstrated encouraging ORR and CBR, with an overall manageable safety profile with no new safety signal in CPI-naive pts who progressed after prior PLT-based chemotherapy. The data support further evaluation of SG plus CPI in mUC. Limitations: small sample size, short follow-up, and lack of randomization. Biomarker evaluation is ongoing. Clinical trial information: NCT03547973.
• Chipollini, J., Pollock, G., Hsu, C. H., Batai, K., Recio-Boiles, A., & Lee, B. R. (2021). National trends and survival outcomes of penile squamous cell carcinoma based on human papillomavirus status. Cancer medicine, 10(21), 7466-7474.
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  There are no series evaluating penile squamous cell carcinoma (pSCC) based on human papillomavirus (HPV) infection. Herein, we present national registry data on clinical and survival outcomes for pSCC based on HPV status.
• Gelmann, E. P., Recio-boiles, A., Mcbride, A., Chipollini, J., Chineke, I. G., & Cheng, C. (2021). Is first-line immune checkpoint inhibitors (ICI) beneficial to platinum-eligible patients (pts) with advanced urothelial carcinoma (aUC)? a meta-analysis.. Journal of Clinical Oncology, 39(15_suppl), e16506-e16506. doi:10.1200/jco.2021.39.15_suppl.e16506
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  e16506 Background: ICI have proven to benefit patients diagnosed with aUC who are platinum-ineligible. The role of platinum-eligible patients, in the first-line setting is being further elucidated after single positive randomized clinical trial (RCT) with ICI. Hence, we performed a meta-analysis to interpret the association of Overall Survival (OS) and PD-1 or PD-L1 inhibitors as first-line therapies in platinum-eligible patients with aUC. Methods: Randomized controlled trials were retrieved from PubMed, Web of Science, and Cochrane Library according to established inclusion criteria. Each article was assessed by the Newcastle-Ottawa Scale. The Hazard Risk (HR) and 95% confidence intervals (CI) were calculated. Random effect or fixed-effect model was used to calculate the pooled HR, based on heterogeneity significance. Sensitivity analysis and publication bias detection were performed. All statistical analysis were performed using RevMan software (v5.4; Cochrane library) and R Core Team (2016, Vienna, Austria), and all p-values were two-tailed, and the significance level was 0.05. Results: Sixty-seven articles were obtained from the database search, and based on inclusion/exclusion criteria, five RCTs were selected involving 4063 patients. All studies were considered moderate to high quality. A statistically significant association was found between initiation of immunotherapy as first-line treatment to platinum-eligible patients and increased OS (HR 0.87; 95% CI: 0.81,0.94, p = 0.004, I2= 38%). The subgroup analysis included positive PD1 (HR 0.81; 95% CI: 0.70,0.94, p = 0.004, I2= 34%) vs. negative expression (HR 0.96; 95% CI: 0.83,1.11, p = 0.58, I2= 0%); cisplatin (HR 0.81; 95% CI: 0.69,0.96, p = 0.02, I2= 47%) vs. carboplatin administration (HR 0.87; 95% CI: 0.76,1.01, p = 0.06, I2= 21%); male (HR 0.87; 95% CI: 0.77,0.97, p = 0.01, I2= 44%) vs. female (HR 0.85; 95% CI: 0.70,1.04, p = 0.11, I2= 0%); ECOG score 0 (HR 0.77; 95% CI: 0.67,0.89, p = 0.0005, I2= 0%) vs. ≥ 1 (HR 0.90; 95% CI: 0.78,1.02, p = 0.11, I2= 6%); Caucasian (HR 0.81; 95% CI: 0.73, 0.91, p = 0.0003, I2= 39%) vs. other race (HR 0.92; 95% CI: 0.75, 1.13, p = 0.44, I2= 0%). Similar association regardless of visceral lesion or age. Funnel plot, Egger's test (p = 0.6944), and Begg's test (0.7726) found no publication bias of analysis. Conclusions: This meta-analysis showed improved OS in platinum-eligible patients receiving first-line ICI in aUC. Furthermore, a subgroup analysis yielded an increased OS and cisplatin, positive PD1 status, ECOG 0, male gender, and Caucasian race. In this rapidly evolving clinical practice changes, our meta-analysis provides support to currently recommended avelumab maintenance after platinum induction therapy in the first-line setting and further provide guidance on patient selection for aUC.
• Martinez, F., Brucks, E., Otsuji, J., Mehnoor, H., Arif-Tiwari, H., Babiker, H. M., & Recio-Boiles, A. (2021). Using Advanced Molecular Profiling to Identify the Origin of and Tailor Treatment for an Intracranial Mass of Unknown Primary. JCO precision oncology, 5, 981-987.
• Zhou, H., Sun, C., Recio-boiles, A., Mcbride, A., Chineke, I., & Cheng, C. (2021). Birth Rates After Radioactive Iodine Treatment for Well Differentiated Cancer in Female Patients With Reproductive Potentials: A Meta- Analysis. Journal of the Endocrine Society, 5(Supplement_1), A857-A858. doi:10.1210/jendso/bvab048.1750
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  Abstract The association between radioactive iodine (RAI) therapy and reduced fertility has remained controversial, in part because no large-scale randomized clinical trials or prospective studies have been done in this regard. Hence, we performed this meta-analysis to investigate the association between radioactive iodine therapy and birth rates in female patients in their reproductive years diagnosed with well- differentiated thyroid cancer. Relevant articles were retrieved from PubMed Central and PubMed according to the established inclusion criteria, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Each article was assessed by the Newcastle-Ottawa Scale (NOS). The overall relative risk (RR) and 95% confidence intervals (CI) were calculated to estimate the association between radioactive iodine (RAI) therapy and birth rates. Random effect or fixed-effect model was used to calculate the pooled OR, based on heterogeneity significance. Subgroup analysis was conducted based on different age groups (35 years old). Sensitivity analysis and publication bias detection were also performed. All statistical analyses were performed using RevMan software (version 5.3; Cochrane library) and STATA 12.0 software (Stata Corp., College Station, TX), and all P values were two-tailed, the test level was 0.05. 105 articles were obtained from the database search, and 6 articles were obtained from other sources. Three articles involving 32237 participants were included. All studies were considered moderate to high quality. Overall, no statistically significant association was observed (RR 1.02; 95% CI: 0.71,1.48, p=0.91, I2=96%). In subgroup analysis, groups with age 35 y/o (RR 0.71; 95%CI: 0.59, 0.85, p=0.0002, I2=0%), there was an associated reduction in birth rates in patients who received radioactive iodine treatment. In contrast, in the group between 25 and 34 years of age, no statistically significant observation was made (RR 0.99; 95% CI:0.79,1.22, p= 0.89, I2=82%). Sensitivity analysis confirmed the stability of the result. Egger’s test, and Begg’s test found no publication bias of analysis (p= 0.824; p=0.602). This meta-analysis demonstrated that overall, no statistically significant association between RAI treatment and birth rates in female patients within their reproductive ages diagnosed with well- differentiated thyroid cancer. However, in the subgroup analysis, an association was found between RAI treatment and reduced birth rates in females 35 years old. In contrast, no association of RAI treatment with birth rates in females 25-34 years old was found. More highly powered prospective studies of this topic are needed in the future to further elucidate the impact of RAI treatment on birth rates and fertility.
• Brucks, E. B., Veeravelli, S., Saboda, K., Roe, D. J., Recio-boiles, A., Mcbride, A., Martinez, F. J., Leiva, J. A., Halder, R., & Babiker, H. M. (2020). Retrospective Real-World Analysis of the Primary Safety Outcomes in Venous Thromboembolism of High-Risk Major Bleeding Cancer Patients Receiving Therapeutic Anticoagulation. Blood, 136(Supplement 1), 15-16. doi:10.1182/blood-2020-139641
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  Introduction The therapeutic anticoagulation of cancer-associated venous thromboembolism (VTE) is challenging because of the increased risk for thromboembolic recurrence and major bleeds (MB). Direct oral anticoagulants (DOACs) have emerged over Low Molecular Weight Heparin (LMWH) as a preferred treatment option by improving efficacy without compromising safety. Despite these advantages, major bleeding was noted to be a safety concern in recent randomized clinical trials, mainly for gastrointestinal (GI) and genitourinary (GU) high-risk cancer patients. We evaluated our cancer center's institutional experience to determine the safety signals among VTE treatments and clinical risk factors which can predict an adverse outcome to further develop our clinical practice decisions in oncology patients. Methods This is a retrospective chart review of patients receiving DOACs and LMWH with histologically proven GI or GU malignancy and symptomatic or incidental VTE treated at The University of Arizona Cancer Center from November 2013 to February 2020. Patients were excluded if DOACs were prescribed for any other reason not related to VTE, or the thrombotic event was determined to be unrelated to active malignancy. The primary safety outcome was defined as documented major bleeding by hemoglobin reduction of ≥2 g/dL, transfusion of ≥2 units of Packed Red Blood Cells, bleeding in a critical site, or bleeding contributing to death. The secondary efficacy outcome was defined as documented recurrent deep vein thrombosis (DVT), nonfatal pulmonary embolism (PE), or fatal PE. Data was collected as individually and composite outcome (MB+rVTE) before six months. Continuous non-normally distributed data are compared using the non-parametric Kruskal-Wallis Rank Sum. Categorical data are compared using χ2 or Fisher's exact test. Logistic regression was used to assess the relationship between anticoagulant therapy and the 3 outcome measurements. The relationship between therapies was adjusted for clinical risk factors using logistic regression. Statistical analyses were performed using Stata16. Results Our review included 160 patients with similar baseline characteristics who were prescribed enoxaparin (n=53), apixaban (n=55), and rivaroxaban (n=52) except for white race and active smokers [Table 1]. Primary MB outcome events at six months were 7.5%, 10.9%, and 17.3% for enoxaparin, apixaban, and rivaroxaban, with no statistical difference among therapies or cancer type [p>0.05]. Secondary rVTE outcome events at six months were 7.5%, 3.6%, and 5.7% for enoxaparin, apixaban, and rivaroxaban, respectively, with no significant difference among therapies or cancer type [p>0.05]. There were no differences in individual or composite outcomes of LMWH, apixaban, rivaroxaban, or DOAC by GI or GU cancer type. There are no statistically significant clinical associations between anticoagulation therapy by the three outcome measurements in either GI or GU cancer. Beyond six months on enoxaparin, apixaban, and rivaroxaban, there were 5.6%, 3.6%, and 5.7% added events to MB, and 3.7%, 1.8%, and 0% to rVTE, respectively. Conclusions Our retrospective review has shown similar efficacy in preventing recurrent VTE among anticoagulants and indirectly equivalent to those published by the randomized clinical trials. Notably, the rate of MB for our real-world high-risk GI/GU cancer was 2.8 times higher in patients receiving DOACs compared to those on clinical trial [MB 6% SELECT-D Young et al. 2018 and MB 3.8% Caravaggio Agnelli et al. 2020] and in agreement with a recent meta-analysis [relative risk GI 1.9 and GU 4.9, Giustozzi et al. 2020]. We recognized there are inherited selection bias in both clinical trials and retrospective studies, although baseline characteristics are similar. Future clinical trial designs should consider including real-world high-risk patients according to associated clinical risk factors to aid in the appropriate choice of therapeutic anticoagulation. Disclosures No relevant conflicts of interest to declare.
• Recio-Boiles, A., Hammad, H., Howell, K., Kalb, B. T., Nfonsam, V. N., Scott, A. J., Babiker, H. M., & Elquza, E. (2020). Locally Advanced Rectal Cancer Evaluation by Magnetic Resonance Imaging after Neoadjuvant Therapy on Decision Making: Cancer Center Experience and Literature Review. Journal of gastrointestinal cancer, 51(1), 254-259.
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  An accurate clinical and radiological staging is the pyramid of treatment decisions in locally advanced rectal cancer (LARC). Guidelines recommended neoadjuvant chemoradiation therapy (CRT) followed by surgical resection for fit patients with LARC. Determining the aggressiveness of intervention while avoiding needless morbidity according to patient risk remains an unmet pre-operative decision-making need. With newer magnetic resonance imaging (MRI) techniques and image acquisition available at our Cancer Center, we seek to retrospectively review the correlation between pre- and post-CRT MRI response to the surgical pathological stage in order to aide multidisciplinary team decision making.
• Recio-Boiles, A., Karass, M., Galeas, J. N., Sukrithan, V., Gutwein, A. H., & Babiker, H. M. (2020). Implementation of a Low-Cost Quality Improvement Intervention Increases Adherence to Cancer Screening Guidelines and Reduces Healthcare Costs at a University Medical Center. Journal of cancer education : the official journal of the American Association for Cancer Education, 35(5), 930-936.
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  Adherence to US Preventative Services Task Force (USPSTF) cancer screening guidelines remains considerably lower than the recommendation of the Healthy People 2020 initiative. Patient populations recommended for screening are not screened at an appropriate rate, and populations not recommended for screening are inappropriately screened. Closer adherence to guidelines should improve outcomes and reduce costs, estimated to reach $158 billion/year by 2020. We evaluated whether a use of low-cost educational health maintenance (HM) card by medical residents at a university hospital could impact education and adherence to updated cancer screening guidelines. We also analyzed savings to the healthcare system. Adherence to cervical, breast, and colorectal cancer screening guidelines, defined as percentage that was screened (or not screened) in accordance with the USPSTF guidelines, in clinic visits from December 2012 (n = 336) was compared to those from December 2013 (n = 306) after a quality improvement intervention. Post-intervention, adherence to screening guidelines increased by 40.8% (p 
• Recio-Boiles, A., Vondrak, J., Veeravelli, S., Mancuso, J. J., Saboda, K., Roe, D. J., Riaz, I. B., Scott, A. J., Elquza, E., McBride, A., & Babiker, H. M. (2020). Analyzing outcomes of neoadjuvant and adjuvant treatment for borderline-resectable pancreatic adenocarcinoma in the perioperative period at an academic institution. Annals of pancreatic cancer, 3.
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  Only 15-20% of pancreatic ductal adenocarcinoma (PDAC) patients are upfront surgical candidates at presentation, and for this cohort of patients, the 5-year survival is a mere 20% despite adjuvant therapy. Previous data indicate that in clinical practice most of these cases are "borderline-resectable," and there is currently no mature data on perioperative treatment.
• Babiker, H. M., Davis, L., Larson, K., Placencia, C., Swensen, C., Tenneti, P., Lim, M., Cañamar, R., Curtis, J., Castillo, E., Mancuso, J., Rensvold, D., Martinez, S., Macias, L., Recio-Boiles, A., Chandana, S. R., & Mahadevan, D. (2019). A Multidisciplinary Evaluation of Barriers to Enrolling Cancer Patients into Early Phase Clinical Trials: Challenges and Patient-centric Recommendations. Expert opinion on investigational drugs, 28(8), 675-686.
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  : Early phase clinical trials are the first clinical research step to bringing new cancer therapeutics to patients. At this stage, a new drug's safety, dosing, and scheduling profiles are established as the main endpoints. However, excellent responses due to biomarker-guided and immune checkpoint trials in early phase have resulted in direct approvals of new anti-cancer drugs. Despite doubling of the success rate of new drug approvals, many barriers exist to expeditiously bring active new drugs to the clinic. : This review covers roles of members of the early phase program and the challenges they face in enrolling advanced cancer patients to trials. Practical solutions are provided from the perspective of the investigators, regulatory, investigational pharmacy, research nurses, clinical research coordinators, budgets, contracts, and data management. : We are witnessing a burgeoning era in drug development with rapid approval of efficacious drugs. This is achieved by a strong collaboration between investigators, academic institutions, pharmaceutical sponsors, scientists, Food and Drug Administration (FDA), and community practices. Herein, we discuss some of the challenges faced by early phase clinical trials programs and discuss methods of improvement.
• Babiker, H. M., Karass, M., Recio-Boiles, A., Chandana, S. R., McBride, A., & Mahadevan, D. (2019). Everolimus for the treatment of advanced pancreatic ductal adenocarcinoma (PDAC). Expert opinion on investigational drugs, 28(7), 583-592.
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  : PDAC is a lethal malignancy with a clear unmet need; almost all patients fail 1, 2, and 3 line multi-agent cytotoxic chemotherapy. The mammalian target of rapamycin (mTOR) has been identified as a key signaling node enhancing tumor survival and drug resistance in PDAC; hence, it is considered a promising therapeutic target. : We comprehensively reviewed the evidence from preclinical and phase I and II clinical trials, based on the authors'clinical experience and a PubMed, Cochrane library, Embase, and Google Scholar search everolimus + pancreatic cancer. : Everolimus has not demonstrated efficacy in PDAC; however, an mTOR inhibitor in combination with stroma-targeted therapies may be a promising area to explore in clinical trials.
• Recio-Boiles, A., Nallagangula, A., Veeravelli, S., Vondrak, J., Saboda, K., Roe, D., Elquza, E., McBride, A., & Babiker, H. M. (2019). Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios inversely correlate to clinical and pathologic stage in patients with resectable pancreatic ductal adenocarcinoma. Annals of pancreatic cancer, 2.
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  Post-surgical pathology (SP) staging correlates with long-term survival. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to predict prognosis and extent of tumor in patients with metastatic pancreatic ductal adenocarcinoma (PDAC). This study aimed to correlate NLR and PLR to radiological clinical staging (CS), carbohydrate antigen (CA) 19-9 tumor marker and SP staging in patients with resectable-PDAC (R-PDAC); and to investigate NLR and PLR as potential markers to guide neoadjuvant therapy.
• Recio-Boiles, A., Veeravelli, S., Vondrak, J., Babiker, H. M., Scott, A. J., Shroff, R. T., Patel, H., Elquza, E., & McBride, A. (2019). Evaluation of the safety and effectiveness of direct oral anticoagulants and low molecular weight heparin in gastrointestinal cancer-associated venous thromboembolism. World journal of gastrointestinal oncology, 11(10), 866-876.
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  Gastrointestinal cancer (GICA) is associated with a higher incidence of venous thromboembolism (VTE) compared to other solid tumors, moreover, recurrent VTE and major bleeding (MB) complications during anticoagulation treatment have an associated increase rate. GICA-VTE remains a challenging clinical scenario with MB concerns for utilization of direct oral anticoagulants (DOAC), especially with active cancer therapies.
• Recio-Boiles, A., Galeas, J. N., Goldwasser, B., Sanchez, K., Man, L. M., Gentzler, R. D., Gildersleeve, J., Hollen, P. J., & Gralla, R. J. (2018). Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT). Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26(7), 2353-2359.
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  Ongoing cancer cachexia trials evaluate sarcopenia by skeletal muscle index (SMI) at the L3 vertebrae level, commonly used as a standard. Routine chest CT institutional protocols widely differ in including L3. We investigated whether SMI at L1 assessment, rather than L3, would be reliable and more practicable for non-small cell lung cancer (NSCLC).
• Recio-Boiles, A., Ilmer, M., Rhea, P. R., Kettlun, C., Heinemann, M. L., Ruetering, J., Vykoukal, J., & Alt, E. (2016). JNK pathway inhibition selectively primes pancreatic cancer stem cells to TRAIL-induced apoptosis without affecting the physiology of normal tissue resident stem cells. Oncotarget, 7(9), 9890-906.
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  Successful treatment of solid cancers mandates targeting cancer stem cells (CSC) without impact on the physiology of normal tissue resident stem cells. C-Jun N-terminal kinase (JNK) signaling has been shown to be of importance in cancer. We test whether JNK inhibition would sensitize pancreatic CSCs to induction of apoptosis via low-dose TNFα-related apoptosis-inducing ligand (TRAIL).
• Ilmer, M., Vykoukal, J., Recio Boiles, A., Coleman, M., & Alt, E. (2014). Two sides of the same coin: stem cells in cancer and regenerative medicine. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 28(7), 2748-61.
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  Multipotent stromal cells (MSCs) derived from bone marrow, adipose tissue, cord blood, and other origins have recently received much attention as potential therapeutic agents with beneficial immunomodulatory and regenerative properties. In their native tissue environment, however, such cells also appear to have essential functions in building and supporting tumor microenvironments, providing metastatic niches, and maintaining cancer hallmarks. Here, we consider the varied roles of these tissue-resident stroma-associated cells, synthesize recent and emerging discoveries, and discuss the role, potential, and clinical applications of MSCs in cancer and regenerative medicine.-Ilmer, M., Vykoukal, J., Recio Boiles, A., Coleman, M., Alt, E. Two sides of the same coin: stem cells in cancer and regenerative medicine.
• Zhao, J., Vykoukal, J., Abdelsalam, M., Recio-Boiles, A., Huang, Q., Qiao, Y., Singhana, B., Wallace, M., Avritscher, R., & Melancon, M. P. (2014). Stem cell-mediated delivery of SPIO-loaded gold nanoparticles for the theranosis of liver injury and hepatocellular carcinoma. Nanotechnology, 25(40), 405101.
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  The treatment of liver injuries or hepatocellular carcinoma (HCC) has been hindered by the lack of efficient drug delivery. Even with the help of nanoparticles or other synthetic delivering agents, a large portion of the dose is still sequestered in the reticuloendothelial system. As an alternative, adipose-derived mesenchymal cells (AD-MSCs), which have the capability of homing to the injured liver, can be used as a unique carrier for theranostic agents. Theranostic agents must have the capacity for being non-toxic to host cells during transportation, and for timely activation once they arrive at the injury sites. In this study, we loaded AD-MSCs with superparamagnetic iron oxide-coated gold nanoparticles (SPIO@AuNPs) and tested their effects against liver injury and HCC in cells and in mice. SPIO@AuNP is a non-toxic magnetic resonance (MR)-active contrast agent that can generate heat when irradiated with near-infrared laser. Our results showed that SPIO@AuNPs were successfully transfected into AD-MSCs without compromising either cell viability (P > 0.05) or cell differentiability. In vivo MR imaging and histologic analysis confirmed the active homing of AD-MSCs. Upon laser irradiation, the SPIO@AuNP-loaded AD-MSCs could thermally ablate surrounding HCC tumor cells. SPIO@AuNP-loaded AD-MSCs proved a promising theranostic approach for injured liver and HCC.

Poster Presentations

• Chipollini, J., Heimark, R. L., Recio Boiles, A., Zeng, J., & Garcia, K. (2022, Fall). Prostate cancer presentation in Hispanic Americans: a nationwide comparative analysis of Hispanic Americans versus non-Hispanic whites. Western Section American Urological Association.
• Chipollini, J., Recio Boiles, A., Paster, I. C., & Zeng, J. (2022, Fall). Gender, racial and ethnic differences in pathologic response following neoadjuvant chemotherapy for baldder cancer patients.. Western Section American Urological Association.