Sima Ehsani Chimeh

Interests

Teaching

Interested to continue teaching medical students, residents and fellows in the hospital and outpatient clinic whenever possible.

Research

Research interest in the management of breast cancer, survivorship, and genetic risk assessment of cancer.

Courses

Scholarly Contributions

Journals/Publications

• Martinez, J. A., Taljanovic, M. S., Nuncio Zuniga, A. A., Wertheim, B. C., Roe, D., Ehsani Chimeh, S., Jiralerspong, S., Segar, J., & Chalasani, P. (2022). Feasibility Trial to Evaluate Tendon Stiffness Obtained from Shear Wave Elastography Imaging as a Biomarker of Aromatase Inhibitor-Induced Arthralgias. Journal of Clinical Medicine.
• Chimeh, S. E., Meybodi, H. R., Larijani, B., Tavangar, S. M., Ghavimehr, E., Naghavi, A., Sarhangi, N., & Hasanzad, M. (2021). Genomic medicine on the frontier of precision medicine. Journal of diabetes and metabolic disorders. doi:10.1007/s40200-021-00880-6
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  Genomic medicine has created a great deal of hope since the completion of the Human Genome Project (HGP). Genomic medicine promises disease prevention and early diagnosis in the context of precision medicine. Precision medicine as a scientific discipline has introduced as an evolution in medicine. The rapid growth of high-development technologies permits the assessment of biological systems. Study of the integrated profiles of omics, such as genome, transcriptome, proteome and other omics information lead to significant advances in personalized and precision medicine. In the context of precision medicine, pharmacogenomics can play an important role in order to discriminate responders and non-responders to medications and avoiding toxicity and achieving the optimum dose. So precision medicine in accordance with genomic medicine will transform medicine from conventional evidence-based medicine in the diagnosis and treatment towards precision based-medicine. In this review, we have summarized the related issues for genomic medicine and precision medicine.
• Chimeh, S. E., Meybodi, H. R., Nikfar, S., Tavangar, S. M., Afzali, M., Ayati, N., Sarhangi, N., & Hasanzad, M. (2021). Precision medicine journey through omics approach. Journal of diabetes and metabolic disorders. doi:10.1007/s40200-021-00913-0
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  It has been well established that understanding the underlying heterogeneity of numerous complex disease process needs new strategies that present in precision medicine for prediction, prevention and personalized treatment strategies. This approach must be tailored for each individual’s unique omics that lead to personalized management of disease. The correlation between different omics data should be considered in precision medicine approach. The interaction provides a hypothesis which is called domino effect in the present minireview. Here we review the various potentials of omics data including genomics, transcriptomics, proteomics, metabolomics, pharmacogenomics. We comprehensively summarize the impact of omics data and its major role in precision medicine and provide a description about the domino effect on the pathophysiology of diseases. Each constituent of the omics data typically provides different information in associated with disease. Current research, although inadequate, clearly indicate that the information of omics data can be applicable in the concept of precision medicine. Integration of different omics data type in domino effect hypothesis can explain the causative changes of disease as it is discussed in the system biology too. While most existing studies investigate the omics data separately, data integration is needed on the horizon of precision medicine by using machine learning.
• Ehsani Chimeh, S. (2020). Diffuse tensor imaging of lower extremities: a novel MR imaging technique for chemotherapy-induced peripheral neuropathy. Breast Cancer Res Treat. doi:DOI: 10.1007/s10549-020-05897-8
• Ehsani, S., Chalasani, P., Gimber, L. H., Win, H., Segar, J., Gimber, L. H., Ehsani, S., Chu, M., & Chalasani, P. (2020). Abstract P3-08-27: Imaging predictors for development of chemotherapy induced peripheral neuropathy. Cancer Research, 80. doi:10.1158/1538-7445.sabcs19-p3-08-27
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  Background: Chemotherapy induced peripheral neuropathy (CIPN) can affect up to a third of patients undergoing chemotherapy. CIPN is thought to be caused by drug induced damage to the peripheral motor or sensory nervous system. Symptoms range from tingling and numbness to balance issues and falls. Based on severity of symptoms, chemotherapy (CTX) is delayed, reduced, or discontinued which can adversely affect outcomes. Currently there are no predictive biomarkers to identify those at risk of developing CIPN. Diffuse tensor imaging (DTI), a subtype of diffusion-weighted imaging (DWI), measured by routine magnetic resonance imaging (MRI) is being increasingly evaluated to assess nerve fiber trajectory. DTI allows for quantitative measurements such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) which have shown some promising but mixed results in evaluating peripheral neuropathy and CIPN in some studies. We conducted a pilot study to evaluate if quantitative DTI measurements, FA and ADC, at mid-calf and ankle can evaluate CTX induced nerve damage and predict development of CIPN. Methods: We conducted a prospective study in patients with breast cancer who were treated with a taxane-based CTX regimen. Study was approved by our institutional review board and registered on clinicaltrials.gov (NCT03365895). Patients who were eligible to get CTX with a taxane based regimen (paclitaxel or docetaxel) were included. Patients with prior exposure to neurotoxic CTX, significant peripheral neuropathy at baseline, or history of diabetes were excluded. All patients completed pre and post CTX MRI of bilateral leg and ankles and a self-reported Functional Assessment of Cancer Therapy/Gynecological Oncology Group neurotoxic questionnaire (FACT-NTX). Patients were diagnosed with developing symptomatic neuropathy if the absolute increase in their FACT-NTX score was ≥3 at post treatment evaluation. Results: Twenty patients consented however 6 were ineligible. Fourteen patients completed all the study procedures. Median age of the evaluable patients was 53 years (33-72 years); 11/14 had paclitaxel CTX. For all patients, median baseline FACT-NTX score was significantly lower (2.5) than post treatment score (5.5) (p=0.009). Based on FACT-NTX score changes, 64% of patients developed symptomatic neuropathy. For all patients, the minimum FA values post-chemotherapy at mid-calf and ankle (0.42 and 0.41 respectively) are significantly lower than baseline (0.54 and 0.49 respectively, p= Conclusions: Our study highlights the use of measuring minimum FA value at the mid-calf and ankle to evaluate for CIPN. Our results indicate that minimum FA value decreased with CTX induced nerve damage and a lower baseline measurement is likely predictive of developing CIPN. This suggests that minimum FA value can be used as a non-invasive imaging biomarker to help predict those at risk for CIPN and potentially be used to implement prevention strategies. Additional clinical trials are warranted to further evaluate this promising predictive biomarker. Citation Format: Hninyee Win, Lana Gimber, Jennifer Segar, Michele Chu, Sima Ehsani, Pavani Chalasani. Imaging predictors for development of chemotherapy induced peripheral neuropathy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-27.
• Ehsani Chimeh, S., Laughlin, B., Chalasani, P., & Gonzalez, V. (2018). Oncologic Outcomes with Neoadjuvant chemotherapy and breast conservation for MRI Occult breast cancer. Archives of Breast Cancer 2018, 5, 138-143.
• Ehsani, S., & Wisinski, K. B. (2017). Genomic Testing in the Management of Early-Stage Breast Cancer. Journal of Clinical Outcomes Management. doi:(5):229-238
• Ehsani, S., & Wisinski, K. B. (2017). Genomic Testing in the Management of Early-Stage Breast Cancer. Journal of clinical outcomes management : JCOM, 24(5), 229-238.
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  To describe common genomic tests being used clinically to assess prognosis and guide adjuvant chemotherapy and endocrine therapy decisions for early-stage breast cancer.
• Rampurwala, M., Wisinski, K. B., Burkard, M. E., Ehsani, S., O'Regan, R. M., Carmichael, L., Kim, K., Kolesar, J., & Tevaarwerk, A. J. (2017). Phase 1b study of orteronel in postmenopausal women with hormone-receptor positive (HR+) metastatic breast cancer. Investigational new drugs, 35(1), 87-94.
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  Introduction Suppressing both androgens and estrogens may circumvent hormone receptor resistance in breast cancer by reducing androgen receptor stimulation. Selective inhibition of the 17, 20-lyase enzyme by orteronel leads to decreased androgen production in men and would be anticipated to reduce estrogen and androgen production in women. Thus, we conducted a phase 1b study of orteronel in postmenopausal women with hormone-receptor positive (HR+) metastatic breast cancer. Methods The primary objective was to identify the recommended phase 2 dose (R2PD) of orteronel in women; escalation was via standard 3 + 3 design. The initial dose was 300 mg BID and escalated to 400 mg BID. Cycle length was 28 days. Enrolled patients had HR+ metastatic breast cancer and were evaluated every 8 weeks for disease progression. Results Eight heavily pre-treated women enrolled [median age: 57 yo (range 47-73)]. Four received 300 mg BID at dose level 1; 4 received 400 mg BID at dose level 2. No dose limiting toxicities (DLTs) were observed. Adverse events (AE) at least possibly related to orteronel included grade 1-2 nausea (n = 4) and bone pain (n = 3), and grade 1 hypokalemia, hot flashes, myalgia and AST elevation (n = 2). The only grade 3 AE was hypertension (n = 2) with 8 patients receiving 34 cycles of treatment. No objective responses were seen; clinical benefit was seen in 2 patients with stable disease for more than 6 months. Serum estrogens and testosterone were suppressed from baseline on both doses of orteronel. Conclusions Orteronel 400 mg BID is well tolerated in postmenopausal women, and significantly suppresses serum estrogens and testosterone. Clinical benefit was seen among heavily pretreated postmenopausal women with HR+ metastatic breast cancer.
• Ehsani, S., Strigel, R. M., Pettke, E., Wilke, L., Tevaarwerk, A. J., DeMartini, W. B., & Wisinski, K. B. (2015). Screening magnetic resonance imaging recommendations and outcomes in patients at high risk for breast cancer. The breast journal, 21(3), 246-53.
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  The purpose of this study was to determine magnetic resonance imaging (MRI) screening recommendations and the subsequent outcomes in women with increased risk for breast cancer evaluated by oncology subspecialists at an academic center. Patients evaluated between 1/1/2007 and 3/1/2011 under diagnosis codes for family history of breast or ovarian cancer, genetic syndromes, lobular carcinoma in situ or atypical hyperplasia were included. Patients with a history of breast cancer were excluded. Retrospective review of prospectively acquired demographics, lifetime risk of breast cancer, and screening recommendations were obtained from the medical record. Retrospective review of the results of prospectively interpreted breast imaging examinations and image-guided biopsies were analyzed. 282 women were included. The majority of patients were premenopausal with a median age of 43. Most (69%) were referred due to a family history of breast or ovarian cancers. MRI was recommended for 84% of patients based on a documented lifetime risk >20%. Most women referred for MRI screening (88%) were compliant with this recommendation. A total of 299 breast MRI examinations were performed in 146 patients. Biopsy was performed for 32 (11%) exams and 10 cancers were detected for a positive predictive value (PPV) of 31% (based on biopsy performed) and an overall per exam cancer yield of 3.3%. Three cancers were detected in patients who did not undergo screening MRI. The 13 cancers were Stage 0-II; all patients were without evidence of disease with a median follow-up of 22 months. In a cohort of women seen by breast subspecialty providers, screening breast MRI was recommended according to guidelines, and used primarily in premenopausal women with a family history or genetic predisposition to breast cancer. Adherence to MRI screening recommendations was high and cancer yield from breast MRI was similar to that in clinical trials.
• Ehsani, S., Pettke, E., Szalkucki, L., Wisinski, K. B., Wilke, L. G., Tevaarwerk, A. J., & Strigel, R. M. (2012). Abstract P3-02-11: Screening Magnetic Resonance Imaging (MRI) of the breast in women at increased lifetime risk for breast cancer: A retrospective single institution study.. Cancer Research, 72. doi:10.1158/0008-5472.sabcs12-p3-02-11
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  Background: Multiple factors are associated with an increased lifetime risk of breast cancer, including inheritance of an abnormal BRCA 1/2 gene, history of lobular carcinoma in situ (LCIS) or atypical hyperplasia, family history of breast cancer or previous chest wall radiation. In 2007, the American Cancer Society released updated guidelines for breast cancer screening based on risk stratification. These guidelines added annual MRI screening to mammography for women with greater than or equal to a 20–25% lifetime risk. Breast MRI screening trials have consistently demonstrated a higher sensitivity of MRI for malignancy compared with mammography, with an additional cancer yield from MRI of approximately 3%. The purpose of this study was to evaluate MRI screening outcomes in women with an increased risk for breast cancer evaluated in an established breast subspecialty clinic within the University of Wisconsin (UW) Hospital and Clinics. Methods: Patients (Pts) were included if they were seen by a UW breast center nurse practitioner, medical or surgical oncologist between 1/1/2007–3/1/2011 with a diagnosis code of: family history of breast or ovarian cancer, genetic susceptibility to malignant neoplasm or genetic carrier, Hodgkin9s disease, LCIS, or atypical hyperplasia. Pts with a co-existing diagnosis of invasive breast cancer or ductal carcinoma in situ prior to initial encounter were excluded. Demographic information, breast cancer risk factors, estimated lifetime risk of breast cancer and screening recommendations were abstracted from the medical record. Results of subsequent breast imaging examinations (including breast MRI, diagnostic and screening mammography, and image-guided biopsies) were analyzed with the use of the mammography information system (PenRad™). Results: Of 276 women who met the inclusion criteria, 148 underwent at least 1 screening breast MRI. The majority of MRI screened pts were premenopausal (82%) and Caucasian (96.6%) with a mean age of 42.5 (range 20–68) at their initial encounter. Eighty five percent had a first degree relative with breast cancer and 72.3% of pts undergoing MRI screening had a documented lifetime risk of breast cancer of 20% or greater using a validated model. Within this MRI-screened cohort, 18.2% had a known genetic predisposition to breast cancer. Over the time assessed, 307 MRIs were performed in the 148 pts. Biopsy was recommended and performed based on the results of the MRI in 31 of 307 exams (10%). Ten cancers were detected for a positive predictive value based on biopsy performed of 32% and an overall cancer yield of 3.3% (10 of 307 MRI exams). All cancers were stage 0 - II. All pts are currently with no evidence of disease. Conclusion: Breast MRI has a high positive predictive value and cancer yield with an acceptable biopsy rate in a diverse group of high risk women undergoing breast MRI at an academic center outside of a clinical trial. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-11.
• Ehsani, S., Beckman, C., Stettner, A., Szalkucki, L., Wisinski, K. B., Wilke, L. G., Tevaarwerk, A. J., Strigel, R. M., Neuman, H. B., Burkard, M. E., & Becker, J. E. (2011). P4-11-21: A Retrospective Analysis of Women at Increased Lifetime Risk for Breast Cancer: Referral Patterns to Subspecialty Providers, Recommendations and Outcomes.. Cancer Research, 71. doi:10.1158/0008-5472.sabcs11-p4-11-21
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  Background: Inheritance of an abnormal BRCA 1/2 gene, a family history of breast cancer (BrCa), or a personal history of lobular carcinoma in situ (LCIS), atypical hyperplasia, or chest wall radiation can significantly increase an individual9s lifetime risk for developing BrCa. In 2007, the American Cancer Society (ACS) released updated guidelines for screening in women with a lifetime risk of BrCa ≥20-25%. These guidelines added MRI screening to annual mammography. The objective of our analysis is to characterize patients referred after the release of the 2007 ACS guidelines to subspecialty providers specifically for evaluation of BrCa risk and analyze subsequent screening and risk reduction recommendations in the cohort of patients (pts) with a predicted increased lifetime risk for BrCa. Methods: Pts seen at a single center (University of Wisconsin [UW]) between 1/2007-3/2011 by medical, surgical and/or gynecology-oncology for an increased lifetime risk of BrCa were identified by billing codes or evaluation in the UW Breast Cancer Prevention, Assessment and Tailored Health Screening (PATHS) Clinic. Pts with a personal history of BrCa prior to 1/2007 are excluded. Patients with a known genetic predisposition to BrCa, family history of breast cancer, or a personal history of LCIS, atypical hyperplasia or chest wall radiation are included in this analysis. All charts will be evaluated for documentation of the individual9s lifetime risk of BrCa and method used for risk-assessment, recommended and performed screening tests, concordance with ACS screening guidelines, patient adherence to initial and subsequent screening recommendations, and uptake of risk reduction strategies. Call-back rates for additional or follow-up imaging and/or biopsy following BrCa screening and characteristics of all new BrCa diagnoses will be collected. Results: 240 eligible pts were seen during the study period. 15% of pts referred had a known genetic predisposition to BrCa. Most pts (75%) were referred for a family history of BrCa. The majority of these pts had a predicted lifetime risk of BrCa in excess of 20%, with less than 10% of patients being referred having a lifetime risk Conclusion: Pts with a predicted increased lifetime risk for BrCa are often evaluated by oncology subspecialty providers. The primary factor related to referral is family history of BrCa. The majority of patients referred to a subspecialty provider have a calculated lifetime risk for BrCa in excess of 20%. This study evaluates provider assessment of BrCa risk and subsequent recommendations for screening and discussion of risk reduction strategies. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-21.
• Ehsani Chimeh, S., Ohadi, M., Shirazi, E., Tehranidoost, M., Moghimi, N., Keikhaee, M., & Aghajani, A. (2006). Attention-deficit/hyperactivity disorder (ADHD) association with the DAT1 core promoter -67 allele. Brain Res.

Presentations

• Ehsani Chimeh, S., Akbarian, M., Shahnia, S., Shahram, F., & Davatchi, F. (2001, July). Infection in Systemic lupus erythematosus (SLE), a 21 years study. Annual European Congress of Rheumatology.

Poster Presentations

• Cristofanilli, M., Chittoria, N., Ehsani Chimeh, S., Dolezal, M., Rui, H., Recknor, C., Kuo, D., Stork-Sloots, L., de Snoo, F., & Abramson, V. (2021, December). A Phase Ib/II Study of Leronlimab Combined with Carboplatin in Patients with CCR5+ Metastatic Triple-Negative Breast Cancer (mTNBC). San Antonio Breast Cancer Symposium. San Antonio, Texas.
• Oana, O., Chan, N., Wisinski, K., Millard, T., Kemmer, K., Phadke, S., Chen, Z., Fernandez, A. C., Clark, M., Conlin, A., Omene, C., Ehsani Chimeh, S., Dublis, S., & Gadi, V. K. (2023, December/Winter). A Phase II Study of Ribociclib and Endocrine Treatment of Physician’s Choice for Locoregional Recurrent, Resected Hormone Receptor Positive HER2 Negative Breast Cancer (RaPhLRR Study). . San Antonio Breast Cancer Symposium.
• Pusztai, L., Kalashnikova, E., Hobbs, E., Brown-Glaberman, U., Mita, M., Klein, P., Yan, F., Ehsani Chimeh, S., Razaq, W., Stopeck, A., Bhave, M., Loch, M., Sardesai, S., & Roussos, E. (2023, December/Winter). Circulating tumor DNA (ctDNA) monitoring of estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+/HER2-) high risk breast cancer during adjuvant endocrine therapy. . San Antonio Breast Cancer Symposium. San Antonio, Texas: SABCS.
• Whittaker, M., Farr, K., Potluri, P., Foster, N., Erdrich, J., Segar, J., Ehsani Chimeh, S., Jiralerspong, S., Roe, D., & Chalasani, P. (2022, December). Physician Practice Patterns of Breast Imaging After Treatment: Survey of Real-World Practice. San Antonio Breast Cancer Symposium. San Antonio Texas.
• Chalasani, P., Roe, D., Jiralerspong, S., Ehsani Chimeh, S., Segar, J., Erdrich, J., Foster, N., Potluri, P., Farr, K., & Whittaker, M. (2022, December). Physician Practice Patterns of Breast Imaging After Treatment: Survey of Real-World Practice. San Antonio Breast Cancer Symposium. San Antonio Texas.
• Ehsani, S. (2022, Dec/Winter). Evaluation of Dronabinol to Decrease Opioid Use for Cancer-Induced Bone Pain. San Antonio Breast Cancer Symposium.
• Ehsani, S. (2022, Dec/Winter). Physician Practice Patterns of Breast Imaging After Treatment: Survey of Real-World Practice . San Antonio Breast Cancer Symposium.
• Segar, J., Farr, K., Junak, M., Roe, D., Ehsani Chimeh, S., Jiralerspong, S., Ibrahim, M. M., & Vanderah, T. W. (2022, December). Evaluation of Dronabinol to Decrease Opioid Use for Cancer- Induced Bone Pain. San Antonio Breast Cancer Symposium. San Antonio Texas.
• Ehsani, S. (2021, Dec/winter). A Phase Ib/II Study of Leronlimab Combined with Carboplatin in Patients with CCR5+ Metastatic Triple-Negative Breast Cancer (mTNBC). . San Antonio Breast Cancer Symposium. San Antonio.
• Ehsani, S., Rampurwala, M., Burkard, M., Wisinski, K., Zeal, C., Koehn, T., Champeny, T., Rettig, J., Kim, K., Tevaarwerk, A., & Kolesar, J. (2014, June). Phase 1b study of orteronel in post-menopausal women woth hormone-receptor positive (HR+) metastatic breast cancer.. ASCO Annual Meeting.
• Ehsani, S., Strigel, R., Pettke, E., Wilke, L., Szalkucki, L., Tevaarwerk, A., & Wisinski, K. (2012, December). Screening Magnetic Resonance Imaging (MRI) of the Breast in Women at Increased Lifetime Risk for Breast Cancer: A Retrospective Single institution Study. San Antonio Breast Cancer Symposium.
• Ehsani, S., Pettke, E., Tevaarwerk, A., Wilke, L., Neuman, H., Beckman, C., Becker, J., Stettner, A., & Strigel, R. (2011, December). A retrospective analysis of women at increased lifetime risk for breast cancer: Referral patterns to subspecialty providers, recommendations and outcomes. San Antonio Breast Cancer Symposium.
• Ehsani, S., Roy, G., & Buller, G. (2009, Spring). Acute Renal Infarction and NSTEMI in a Young Woman Presenting With Right Lower Abdominal Pain. American College of Physicians.
• Ehsani, S., Roy, G., & Sam, A. (2009, Spring). Rash Decisions, Acute Febrile Neutrophilic Dermatosis. American College of Phycisians.
• Ehsani, S., & Alston, S. (2008, Spring). Posterior Reversible Encephalopathy Syndrome (PRES) and Late Postpartum Eclampsia. American College of Physicians.

Others

• Ehsani Chimeh, S. (2021, November). Breast Cancer; In Oncology Rapid Review Flash Cards. Wolter Kluwer.