Nova Xu

All Publications

• Durable responses to trastuzumab deruxtecan in patients with leptomeningeal metastases from breast cancer with variable HER2 expression. Journal of neuro-oncology Rogawski, D., Cao, T., Ma, Q., Roy-O'Reilly, M., Yao, L., Xu, N., Nagpal, S. 2024

  Abstract

  PURPOSE: Emerging data suggest that trastuzumab deruxtecan (T-DXd) is an active treatment for brain metastases from HER2+breast cancer. We aimed to characterize the activity of T-DXd in the treatment of leptomeningeal metastases (LM) from a range of HER2-altered cancers.METHODS: We reviewed neuro-oncology clinic records between July 2020 and December 2023 to identify patients who received T-DXd to treat LM.RESULTS: Of 18 patients identified, 6 had HER2+breast cancer, 8 had HER2-low/negative breast cancer, 2 had HER2+gastroesophageal cancer, and 2 had HER2-mutant non-small cell lung cancer (NSCLC). 10/18 (56%) patients had cytologically confirmed LM by CSF cytology or circulating tumor cell (CTC) capture. A partial response (PR) on MRI using the EORTC/RANO-LM Revised-Scorecard occurred in 4/6 (67%) patients with HER2+breast LM, 2/8 (25%) patients with HER2-low/negative breast cancer, and 0/4 (0%) patients with HER2+gastroesophageal cancer or HER2-mutant NSCLC. Median overall survival after initiating T-DXd was 5.8 months. Survival after initiating T-DXd was numerically longer for HER2+breast cancer patients compared with HER2-low/negative breast and HER2-altered non-breast cancer patients (13.9 months vs. 5.2 months and 4.6 months, respectively). Landmark analysis showed that patients with radiologic LM response to T-DXd by 2.5 months had longer survival than non-responders (14.2 months vs. 2.6 months, HR 0.18, 95% CI 0.05-0.63, p<0.05), and landmark analyses at 3.5 and 4.5 months after starting T-DXd showed a similar but nonsignificant trend.CONCLUSION: T-DXd induces LM responses in a subset of patients, and such responses may be associated with prolongation of survival. Prospective trials are needed to clarify the role of T-DXd in treating LM and which patients are most likely to benefit.

  View details for DOI 10.1007/s11060-024-04788-y

  View details for PubMedID 39073687

• Factors Predicting Readmission and Mortality in Patients Admitted for Malignant Bowel Obstruction. The American surgeon Xu, N., Sun, B. J., Yue, T. M., Lee, B. 2024: 31348241250045

  Abstract

  Malignant bowel obstruction (MBO) is a common complication of patients with advanced malignancies and has poor prognosis. Currently, there are limited guidelines for MBO management or predicting outcomes for these patients.To identify patient factors associated with readmission and mortality after hospital admission for MBO.A 5-year retrospective review was performed from 2017 to 2022 at a single tertiary institution to evaluate patients admitted for MBO. All patients had advanced cancer of gastrointestinal or gynecologic primary. Patient demographics, socioeconomic factors, tumor characteristics, and inpatient outcomes were collected. Multivariable analyses were performed to determine variables predicting hospital readmission for recurrent MBO and 90-day mortality.210 patients were included. Mean age was 61 years, 28% were male, and 19% did not primarily speak English. 35% of patients lived over 50 miles from the hospital. On multivariable analysis, non-English speaking patients exhibited increased risk of readmission for MBO (OR = 2.82, P = .039). Older age was associated with decreased risk for MBO readmission (OR = .96, P = .007). Ascites was associated with increased mortality (OR = 2.17, P = .043). Earlier palliative care (PC) consultation predicted decreased readmission (OR = .24, P < .001) yet increased mortality at 90 days (OR = 3.20, P = .003).Patient age, primary language, and PC consult were predictors for MBO readmission, which may impact 90-day mortality. Given the palliative nature of MBO, modifiable factors such as PC consultation and multidisciplinary goals of care discussions should be prioritized in order to reduce readmissions and focus on quality of life (QOL) for this patient population.

  View details for DOI 10.1177/00031348241250045

  View details for PubMedID 38676624

• Surgical Palliation for Malignant Bowel Obstruction in Preventing Hospital Readmission: Experience of a Tertiary Care Center. Annals of surgical oncology Sun, B. J., Yue, T. M., Xu, N., Ayala, C. I., Lee, B. 2024

  View details for DOI 10.1245/s10434-024-15318-5

  View details for PubMedID 38668918

• ASO Visual Abstract: Improved Postoperative Pain Management Outcomes After Implementation of Enhanced Recovery After Surgery (ERAS) Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). Annals of surgical oncology Yue, T. M., Sun, B. J., Xu, N., Ohkuma, R., Fowler, C., Lee, B. 2024

  View details for DOI 10.1245/s10434-024-15208-w

  View details for PubMedID 38553655

• Improved Postoperative Pain Management Outcomes After Implementation of Enhanced Recovery After Surgery (ERAS) Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). Annals of surgical oncology Yue, T. M., Sun, B. J., Xu, N., Ohkuma, R., Fowler, C., Lee, B. 2024

  Abstract

  Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for patients with peritoneal carcinomatosis is promising but has potential for significant morbidity and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a standardized protocol designed to optimize perioperative care. This study describes trends in epidural and opioid use after implementing ERAS for CRS-HIPEC at a tertiary academic center.A retrospective analysis of patients undergoing CRS-HIPEC from January 2020 to September 2023 was conducted. ERAS was implemented in February 2022. Medication and outcomes data were compared before and after ERAS initiation. All opioids were converted to morphine milligram equivalents (MMEs).A total of 136 patients underwent CRS-HIPEC: 73 (54%) pre- and 63 (46%) post-ERAS. Epidural usage increased from 63% pre-ERAS to 87% post-ERAS (p = 0.001). Compared with those without epidurals, patients with epidurals had decreased total 7-day oral and intravenous (IV) opioid requirements (45 MME vs. 316 MME; p < 0.001). There was no difference in 7-day opioid totals between pre- and post-ERAS groups. After ERAS, more patients achieved early ambulation (83% vs. 53%; p < 0.001), early diet initiation (81% vs. 25%; p < 0.001), and early return of bowel function (86% vs. 67%; p = 0.012).ERAS implementation for CRS-HIPEC was associated with increased epidural use, decreased oral and IV opioid use, and earlier bowel function return. Our study demonstrates that epidural analgesia provides adequate pain control while significantly decreasing oral and IV opioid use, which may promote gastrointestinal recovery postoperatively. These findings support the implementation of an ERAS protocol for effective pain management in patients undergoing CRS-HIPEC.

  View details for DOI 10.1245/s10434-024-15120-3

  View details for PubMedID 38466484

  View details for PubMedCentralID 3087875

• Timing of Palliative Care Consultation in Malignant Bowel Obstruction Management Decreases Hospital Readmission Sun, B., Yue, T., Xu, N., Einkauf, K. B., Lee, B. LIPPINCOTT WILLIAMS & WILKINS. 2023: S213-S214

  View details for Web of Science ID 001094086300454

• Timing of Palliative Care Consultation in Malignant Bowel Obstruction Management Decreases Hospital Readmission Sun, B., Yue, T., Xu, N., Einkauf, K. B., Lee, B. LIPPINCOTT WILLIAMS & WILKINS. 2023: S213-S214

  View details for Web of Science ID 001100379000026

• ASO Visual Abstract: Impact of Successful Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). Annals of surgical oncology Sun, B. J., Yue, T. M., Xu, N., Fowler, C., Lee, B. 2023

  View details for DOI 10.1245/s10434-023-14334-1

  View details for PubMedID 37741926

• Impact of Successful Implementation of an Enhanced Recovery After Surgery Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Annals of surgical oncology Sun, B. J., Yue, T. M., Xu, N., Fowler, C., Lee, B. 2023

  Abstract

  Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex operations for the treatment of peritoneal metastases. Enhanced recovery after surgery (ERAS) protocols are intended to standardize preoperative, intraoperative, and postoperative pathways, with the goal of improving patient care. This study describes feasibility and outcomes after implementing an ERAS protocol for CRS/HIPEC at a tertiary academic center.A single-institution experience of CRS/HIPEC was reviewed from January 2020 to March 2023. Patients were categorized according to whether they underwent CRS/HIPEC before or after ERAS initiation. Outcomes and protocol adherence were evaluated.A total of 115 CRS/HIPEC operations were included-74 before and 41 after ERAS implementation. Median age was younger in the post-ERAS group, whereas sex, comorbidities, peritoneal carcinomatosis index, operation performed, and operative time were similar between groups. The most common primary cancer sites were gynecologic (40%), appendiceal (24%), and colorectal (22%). Adherence to all postoperative ERAS components was 76%. More post-ERAS patients ambulated by postoperative day (POD) 1 (90% vs. 54%; p < 0.001), tolerated liquid diet by POD 2 (88% vs. 32%; p < 0.001), and had foley removed by POD 3 (86% vs. 43%; p < 0.001). There was a trend toward decreased length of stay in the post-ERAS cohort (7 vs. 8 days; p = 0.092), with no difference in major complications, intensive care unit admission, or 30-day readmission.Despite the heterogeneity of CRS/HIPEC operations, implementing an ERAS protocol for our patients was feasible and resulted in postoperative outcomes and adherence comparable with that of other major abdominal surgeries. This supports the potential for success in ERAS programs for CRS/HIPEC patients.

  View details for DOI 10.1245/s10434-023-14222-8

  View details for PubMedID 37684372

  View details for PubMedCentralID 10088912

• Efficacy of Surgical Management of Malignant Bowel Obstruction on Preventing Hospital Readmission - Experience of a Tertiary Care Center Sun, B. J., Ayala, C. I., Einkauf, K. B., Xu, N., Yue, T. M., Lee, B. SPRINGER. 2023: S110

  View details for Web of Science ID 001046841200228

• Outcomes of Procedural-Based Palliation for Malignant Bowel Obstruction Sun, B. J., Xu, N., Yue, T. M., Einkauf, K. B., Lee, B. SPRINGER. 2023: S103

  View details for Web of Science ID 001046841200213