Shethal Bearelly

Interests

Research

Function outcomes and quality of life after head and neck cancer treatment

Teaching

Head and Neck CancerThyroid and Parathyroid surgeryRobotic SurgeryMicrovascular Reconstructive Surgery

Courses

Scholarly Contributions

Chapters

• Schoem, S. R., Rosbe, K., & Bearelly, S. (2014). Aerodigestive foreign bodies and caustic ingestions.. In Cummings Otolaryngology: Head and Neck Surgery(pp Edition 6, Chapter 207).

Journals/Publications

• Bauman, J. E., Saba, N. F., Roe, D., Bauman, J. R., Kaczmar, J., Bhatia, A., Muzaffar, J., Julian, R., Wang, S., Bearelly, S., Baker, A., Steuer, C., Giri, A., Burtness, B., Centuori, S., Caulin, C., Klein, R., Saboda, K., Obara, S., & Chung, C. H. (2023). Randomized Phase II Trial of Ficlatuzumab with or without Cetuximab in pan-refractory, recurrent/metastatic head and neck cancer.. J Clin Oncol, 41(22), 3851-3862. doi:10.1200/JCO.22.01994
• Groysman, M., Gleadhill, C., Baker, A., Wang, S. J., & Bearelly, S. (2023). Comparison of margins and survival between transoral robotic surgery (TORS) and non-robotic endoscopic surgery for oropharyngeal cancer.. Am J Otolaryngol, 44(6). doi:10.1016/j.amjoto.2023
• Groysman, M., Bearelly, S., Baker, A., Wang, S. J., & Symms, J. (2022). Association of Perioperative Complications with Vitamin D Levels in Major Head and Neck Surgery. J Laryngoscope, 132(3), 578-583.
• Groysman, M., Yi, S. K., Robbins, J. R., Hsu, C. C., Julian, R., Bauman, J. E., Baker, A., Wang, S. J., & Bearelly, S. (2022). The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early age oropharyngeal malignancy. Am J Otolaryngology, 43(1), 103243.
• Yi, S. K., Wang, S. J., Robbins, J. R., Julian, R., Hsu, C. C., Groysman, M., Bearelly, S., Bauman, J. E., & Baker, A. (2022). The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy.. American journal of otolaryngology, 43(1), 103243. doi:10.1016/j.amjoto.2021.103243
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  To evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC)..The National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 M0 OPSCC (AJCC v.7) who underwent treatment from 2010 to 2016. Demographics, tumor characteristics, treatment type, social, and geographic factors were all collected. Univariate analysis and multivariate logistic regression were then performed..Among 9267 identified patients, 1774 (19.1%) received transoral robotic surgery (TORS), 1191 (12.9%) received transoral endoscopic surgery, and 6302 (68%) received radiation therapy. We found that lower cancer stage, lower comorbidity burden and HPV- positive status predicted a statistically significant increased likelihood of receiving surgery. Patients who reside in suburban or small urban areas (>1 million population), were low-to- middle income, or rely on Medicaid were less likely to receive surgery. Patients that reside in Medicaid-expansion states were more likely to receive TORS (p > .0001). Patients that reside in states that expanded Medicaid January 2014 and after were more likely to receive non-robotic transoral endoscopic surgery (p > .0001)..Poorer baseline health, lower socioeconomic status and residence in small urban areas may act as barriers to accessing minimally invasive transoral surgery while residence in a Medicaid-expansion state may improve access. Barriers to accessing robotic surgery may be greater than accessing non-robotic surgery.
• Bearelly, S., & Morris-Wiseman, L. F. (2021). Interprting microscopic positive margins in differentiated thyroid cancer.. Clinical Thyroidology, 33(4), 184-186.
• Chung, C. H., Caulin, C., Centuori, S., Baker, A., Bearelly, S., Bauman, J. E., Saba, N. F., Roe, D., Bauman, J. R., Kaczmar, J. M., Bhatia, A. K., Muzaffar, J., Julian, R. A., Wang, S., Steuer, C. E., Giri, A., Burtness, B., Saboda, K., & Obara, S. (2021). Randomized phase II trial of ficlatuzumab with or without cetuximab in pan-refractory, advanced head and neck squamous cell carcinoma (HNSCC).. Journal of Clinical Oncology, 39(15_suppl), 6015-6015. doi:10.1200/jco.2021.39.15_suppl.6015
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  6015 Background: Cetuximab (C), an anti-EGFR monoclonal antibody (mAb), is approved for advanced HNSCC but benefits a minority. Crosstalk between the EGFR and hepatocyte growth factor (HGF)/cMet pathways is a known resistance mechanism. HGF is also immunosuppressive within the tumor microenvironment. A Phase I study confirmed the safety of C and ficlatuzumab (F), an IgG1 anti-HGF mAb, with preliminary efficacy and biomarker data suggesting that dual pathway inhibition may overcome tumor-intrinsic or immune cetuximab resistance. Methods: The primary objective of this phase II randomized, non-comparative trial was to evaluate the efficacy of F (20 mg/kg every 2 wks), with or without C (500 mg/m 2 every 2 wks), in pan-refractory, advanced HNSCC. Eligibility criteria included recurrent/metastatic HNSCC, performance status (PS) 0-1, C resistance (defined as progression on or within 6 months of exposure), and resistance to or ineligibility for platinum and anti-PD1 mAb. Randomization was stratified by HPV status and center. The primary endpoint was median progression-free survival (mPFS). An arm was deemed worthy of further study if the lower bound of the 90% 1-sided confidence interval (CI) excluded the historical control of 2 months. Secondary objectives included overall response rate (ORR) in the overall and HPV-stratified populations. A Bayesian continuous monitoring rule for futility was applied. Results: 60 patients were randomized and 58 treated between Jan 2018 and Dec 2020 (27 to F; 33 to FC). Baseline characteristics were balanced across major prognostic variables including age, PS, HPV status, platinum resistance, and PD1 mAb exposure. Median time since prior cetuximab was 3.5 months (range 0-48 months). Grade ≥3 adverse events attributed to F included: pneumonitis (2); edema (3); diarrhea (1); LFT elevation (1); rash (2); electrolyte abnormality (2). The Table presents efficacy data. The F arm stopped for futility after 26 evaluable subjects accrued. The FC arm completed accrual and met the primary endpoint; 32 evaluable subjects had mPFS of 3.6 months (lower bound 90% 1-sided CI: 2.3 months) and ORR of 19% (6/32). All responses were in HPV- subjects, including 2 complete (CR) and 4 partial responses (PR) to the FC combination and 1 PR to F monotherapy. The mPFS and ORR for the HPV- population (n = 16) on FC were 3.8 months and 38% (6/16). Mechanistic signaling and immune biomarkers are under analysis. Conclusions: The well-tolerated FC combination met the primary PFS endpoint in pan-refractory, advanced HNSCC with notable activity in HPV- HNSCC, warranting phase III investigation. Clinical trial information: NCT03422536. [Table: see text]
• Elwell, Z., Bearelly, S., Aboul-Nar, K., & Lara, J. (2021). Unilateral Cysticercosis of the Parotid Gland: Case report, diagnosis and clinical management. Case Reports in Otolaryngology.
• Hamman, J., Howe, C. L., Borgstrom, M., Baker, A., Wang, S. J., & Bearelly, S. (2021). Impact of Close Margins in Head and Neck Mucosal Squamous Cell Carcinoma: A Systematic Review. Laryngoscope.
• Rizvi, O., Nielsen, T., & Bearelly, S. (2020). Mucosa-associated lymphoid tissue lymphoma of the larynx. Case Reports in Otolaryngology.
• Roe, D. J., Saba, N. F., Bearelly, S., Baker, A., Caulin, C., Chung, C. H., Centuori, S. M., Stabile, L. P., Giri, A., Bhatia, A. K., Steuer, C. E., Wang, S. J., Julian, R., Muzaffar, J., Burtness, B., Kaczmar, J. M., Bauman, J., & Bauman, J. E. (2020). Randomized, phase II study of ficlatuzumab with or without cetuximab in patients with pan-refractory, recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).. Journal of Clinical Oncology, 38(15_suppl), TPS6594-TPS6594. doi:10.1200/jco.2020.38.15_suppl.tps6594
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  TPS6594 Background: Patients with pan-refractory R/M HNSCC, with clinical resistance to cytotoxic therapy, anti-EGFR molecular targeting, and immunotherapy, have poor survival. An established tumor-intrinsic resistance mechanism to cetuximab, an anti-EGFR IgG1 monoclonal antibody (mAb), is activation of the hepatocyte growth factor (HGF)/cMet pathway, which converges with the EGFR network at both the PI3K/Akt and MAPK nodes allowing for reciprocal compensation. Moreover, over-expression of HGF in the tumor microenvironment is immunosuppressive. Convergent data suggest that HGF/cMet pathway inhibition concurrent with EGFR blockade may overcome cetuximab resistance. We previously reported a Phase I study of ficlatuzumab, a humanized anti-HGF IgG1 mAb, with cetuximab in cetuximab-resistant R/M HNSCC. The combination showed promising safety, overall response rate (ORR) and progression-free survival (PFS). Preliminary biomarker analyses showed that high circulating cMet was associated with poor PFS whereas serum Veristrat, a proteomic classifier associated with worse prognosis in the setting of anti-EGFR monotherapy, was not. An increase in total peripheral T cells, particularly the CD8 + subset, was associated with treatment response while progression was associated with expansion of a unique myeloid population. We designed a follow-on randomized phase II trial evaluating ficlatuzumab with or without cetuximab in pan-refractory, R/M HNSCC with signaling and immune correlatives. Methods: This is a multicenter phase II trial with a randomized, non-comparative, two-arm design (ficlatuzumab 20 mg/kg with or without cetuximab 500 mg/m 2 every 2 weeks) in patients with pan-refractory R/M HNSCC. Key eligibility criteria include: R/M HNSCC; cetuximab resistance (progression during or within 6 months of cetuximab-radiation or palliative cetuximab); platinum resistance; prior exposure to anti-PD1 mAb; ECOG 0-1; consent to baseline research biopsy. The primary objective is to evaluate the efficacy of each arm as measured by PFS. To test the hypothesis that either regimen improves historical PFS from 2 to 3.33 months requires 66 eligible patients. Key secondary endpoints are ORR and survival. Mechanistic biomarkers include tumor HGF/cMet pathway activation, tumor and peripheral immune profiles, soluble cMet, and serum Veristrat. Thirty-five of 66 subjects have enrolled at 6 centers. A Bayesian continuous monitoring rule for futility has not been triggered for either arm. Clinical trial information: NCT03422536 .
• Han, J., Yi, S. K., Bearelly, S., Erman, A., Sindhu, S., Wang, S. J., Baumann, J. E., & Hsu, C. C. (2019). Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease.. Head and Neck, 41(12), 4076-4087.
• Rizvi, O., Nielsen, T., & Bearelly, S. (2018). Mucosa-associated lymphoid tissue lymphoma of the larynx.. Case Reports in Otolaryngology.
• Bearelly, S., & Cheung, S. W. (2017). Topography of oral structures.. JAMA Otolaryngology-Head and Neck, 143(1), 73-80.
• Bearelly, S., Wang, S. J., & Cheung, S. W. (2017). Oral sensory dysfunction following radiotherapy. Laryngoscope, 127(10), 2282-2286.
• Tang, A. L., Bearelly, S., & Mannion, K. (2017). The expanding role of scapular free-flaps. Current Opinion in Otolaryngology Head and Neck Surgery, 25(5), 411-415.
• Bearelly, S., Heaton, C. M., Seth, R., & Knott, P. D. (2016). Laryngopharyngeal repair in salvage laryngectomy.. Current Otorhinolaryngology Report. doi:10.1007/s40136-016-0125-1
• Bearelly, S., Prendes, B. L., Wang, S. J., Glastonbury, C., & Orloff, L. A. (2015). Transoral robotic assisted surgical excision of a retropharyngeal parathyroid adenoma: A case report.. Head and Neck, 37(11), E150-152.
• Bearelly, S., & Wang, S. J. (2014). Predictors of salivary fistulas in patients undergoing salvage total laryngectomy.. International Scholarly Research Notices.
• Jalisi, S., Bearelly, S., Abdillahi, A., & Truong, M. T. (2013). Outcomes in head and neck oncologic surgery at academic medical centers in the United States. Laryngoscope, 123(3), 689-98.

Presentations

• Morrell, W. G., Rhode, S. L., Mannion, K., Sinard, R. J., Langerman, A., Bearelly, S., Arambula, A., & Netterville, J. L. (2018, October). 30 Year Single Institution Experience with Carotid Body Tumors. American Academy of Otolaryngology-Head and Neck Foundation Annual Meeting. Atlanta, GA.
• Bearelly, S., & Cheung, S. W. (2017, January). Oral Sensory Dysfunction Following Radiotherapy. Triological Society Combined Sections Meeting. New Orleans, LA: TRIO Society.
• Bearelly, S., & Cheung, S. W. (2016, June). Oral Sensory Dysfunction Following Radiotherapy. UCSF Resident Research Symposium. UCSF: University of California.
• Bearelly, S., Netterville, J., & Naslund, T. (2016, Fall). Skull Base Resection to Expose the Petrous Carotid. American College of Surgeons, Clinical Conference. Washington DC: American College of Surgeons.
• Bearelly, S., & Cheung, S. W. (2015, June). Sensory Topography of the Oral Cavity. UCSF Resident Research Symposium. UCSF: University of California.
• Bearelly, S., Pletcher, S. D., Durr, M. L., Goldberg, A. N., & Murr, A. H. (2014, January). Do Endoscopic Findings Predict Symptoms of Sinusitis: The DIP core and Sinonasal Symptoms. Triological Society Combined Sections Meeting. Miami Beach, FL: TRIO Society.

Poster Presentations

• Bauman, J. E., Saba, N., Roe, D., Bauman, J., Kaczmar, J., Bhatia, A., Muzaffar, J., Julian, R., Wang, S. J., Bearelly, S., Baker, A., Steuer, C., Giri, A., Burtness, B., Centuori, S., Caulin, C., Saboda, K., Obara, S., & Chung, C. (2021, July). Randomized Phae II Trial of Fixlatuzumab with or without Cetuximab in Pan-Refractory, Advanced Head and Neck Squamous Cell Carcinoma. ASCO Annual Meeting. Virtual: ASCO.
• Vance, C., Groysman, M., Baker, A., Wang, S. J., & Bearelly, S. (2021, July). Comparison of Margins and Survival between Transoral Robotic Surgery (TORS) and Non-Robotic Endoscope Surgery for Oropharymgeal Cancer. AHNS 10th International Conference on Head and Neck Cancer. Virtual: AHNS (American Head and Neck Society).
• Bearelly, S. (2018, June). Randomized, Phase II Study of Ficlatuzumab with or without Cetuximab in patients (pts) with Cetuximab-resistant, recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). Annual Meeting of the American Society of Clinical Oncology. Chicago, IL: American Society of Clinical Oncology.
• Bearelly, S., Markey, J. M., Faden, D. L., & Russell, M. S. (2016, June). Improving Patient Education for Tracheostomies. UCSF Incentive Program Sympoium. San Francisco, CA: UCSF.
• Bearelly, S., Nolan, A. L., & Yung, K. C. (2015, January). Primary Subglottic Neuroendocrine Carcinoma: A Case Report and Literature Review. Triological Society Combined Sections Meeting. Coronado Island, CA: TRIO Society.
• Bearelly, S., Aliphas, A., Berman, J., & Grillone, G. (2011, January). Oropharyngeal Stenosis in a Patient with Sarcoidosis: A Case Report. Triological Society Combined Sections Meeting. Scottsdale, AZ: TRIO Society.
• Bearelly, S. (2009, February). microRNA Expression Profiling of Thyroid Cancer: Role of miR222 in Papillary Thyroid Cancer. Boston University Medical Student Summer Research Symposium. Boston, MA: Boston University.