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하혜림,방주희,남아롱,박지은,Mei Hua Jin,방영주,오도연 대한암학회 2019 Cancer Research and Treatment Vol.51 No.2
Purpose The soluble programmed death-ligand 1 (sPDL1) has immunosuppressive activity and is a candidate biomarker for immuno-oncology drug development. In this study, we measured sPDL1 at pre- and post-chemotherapy and at disease progression to uncover the dynamics of sPDL1 during treatment in biliary tract cancer (BTC) patients. Materials and Methods From 90 BTC patients (training cohort, 53; validation cohort, 37) who were candidates for palliative first-line chemotherapy, blood was collected at pre- and post-chemotherapy (at the time of best response) and at disease progression. The sPDL1 levels were measured using an enzyme-linked immunosorbent assay. Responses to chemotherapy, overall survival (OS), and other prognostic factors including the neutrophil-lymphocyte ratio (NLR) were analyzed. Results The OS of all patients was 11.5 months (confidence interval [CI], 9.7 to 16.2). The best response was complete response in seven (7.8%), partial response in 20 (22.2%), stable disease in 52 (57.8%), and disease progression (PD) in 11 patients (12.2%). Patients with high pre-chemotherapy sPDL1 ( 1.30 ng/mL) showed worse OS than patients with low prechemotherapy sPDL1 (9.1 months vs. 12.5 months, p=0.003). In multivariate analyses, high pre-chemotherapy sPDL1 (hazard ratio [HR], 1.96; 95% CI, 1.2 to 3.9; p=0.011) and high pre-chemotherapy NLR (HR, 1.82; 95% CI, 1.1 to 3.0; p=0.020) were independent poor prognostic factors for OS. At the time of PD, sPDL1 was increased significantly compared with pre-chemotherapy sPDL1 (1.59 ng/mL vs. 0.72 ng/mL, p=0.003). Conclusion The sPDL1 at pre-chemotherapy confers the prognostic value for OS in BTC patients under palliative chemotherapy. The dynamics of sPDL1 during chemotherapy correlate with disease burden and have prognostic value.
The Future of Adjuvant Therapy in Renal Cell Carcinoma: Recent Insights and Prospects
하혜림,임주한 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.3
Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.
Reduced Dose Intensities of Doxorubicin in Elderly Patients with DLBCL in Rituximab Era
하혜림,김범석,김태민,전윤경,이세훈,김동완,김철우,허대석 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1
Purpose The dose intensity of doxorubicin (DID) is important to the survival of diffuse large B cell lymphoma (DLBCL) patients. However, due to expected toxicities, most elderly patients can- not receive full doses of anthracyclines. The purpose of this study was to evaluate the effect of DID on the survival of elderly DLBCL patients (age ! 70 years) in the rituximab era. Materials and Methods We analyzed 433 DLBCL patients who were treated with R-CHOP between December 2003 and October 2011 at the Seoul National University Hospital. Of these patients, 19.2% were aged ! 70 years. We analyzed the survival outcomes according to DID. Results Significantly poorer overall survival (OS) was observed for patients aged ! 70 years (2-year OS rate: 59.9% vs. 84.2%; p < 0.001). DID " 10 mg/m2/wk had a significant effect on the OS and progression-free survival (PFS) in elderly patients (2-year OS rate: 40.0% in DID " 10 mg/m2/wk vs. 62.6% in DID > 10 mg/m2/wk; p=0.031; 2-year PFS: 35.0% vs. 65.7%; p=0.036). The OS on each 1.7 mg/m2/wk doxorubicin increment above 10 mg/m2/wk in elderly patients was not significant among the groups (2-year OS rate: 75.0% in DID 10.0- 11.7 mg/m2/wk vs. 66.7% in DID 15.0-16.7 mg/m2/wk; p=0.859). Treatment related mor- tality was not related to DID. Conclusion DID can be reduced up to 10 mg/m2/wk in elderly DLBCL patients in the rituximab era. Maintenance of DID > 10 mg/m2/wk and judicious selection of elderly patients who are tolerant to DID is necessary.
Managing Side Effects of Cytotoxic Chemotherapy in Patients With High Grade Gliomas
하혜림,임주한 대한뇌종양학회 2022 Brain Tumor Research and Treatment Vol.10 No.3
Cytotoxic chemotherapy has been a mainstay of cancer treatment since the 1940s. In the recent era of emergent targeted therapies and immunotherapies, many cytotoxic chemotherapy agents including temozolomide are still one of main weapons for the treatment of high grade gliomas. However, cytotoxic chemotherapy often causes side effects. Proper management of chemotherapy-induced toxicity can have a significant impact on a patient’s quality of life and clinical outcomes. Many supportive care ad- vances have transformed our ability to give full doses of chemotherapy, which is important for achieving their full efficacy. Prevention and treatment strategies have been developed for many chemotherapy-re- lated toxicities. This review focused on managing gastrointestinal toxicity, chemotherapy-induced nau- sea and vomiting, and hematologic toxicities such as thrombocytopenia during cytotoxic chemothera- py treatment in high-grade brain tumors.
Thromboembolism in Mycobacterium tuberculosis Infection: Analysis and Literature Review
하혜림,김기환,박진현,이정규,허은영,김진수,김덕겸,최인실,정희순,임효정 대한감염학회 2019 Infection and Chemotherapy Vol.51 No.2
Background: Tuberculosis is associated with hypercoagulation; however, there are few reports of cases thromboembolism and tuberculosis at the same time in the real world. The purpose of this study was to report the incidence and clinical course of thromboembolism in patients diagnosed with tuberculosis. Materials and Methods: We retrospectively analyzed the data of patients who were diagnosed with both tuberculosis and thromboembolism including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) at Seoul National University Boramae Medical Center from January 2000 through March 2015. Results: Among the 7905 tuberculosis patients, 49 (0.6%) exhibited PTE, DVT, or both at or after the time of tuberculosis diagnosis. All patients treated for tuberculosis started with isoniazid, ethambutol, rifampicin, and pyrazinamide. Eight patients were switched to treatment with second-line medication because of resistance or adverse events. About half of the patients (n = 21, 44.7%) had thrombosis at the time of tuberculosis diagnosis. Of 48 patients treated for thromboembolism, 36 received warfarin. A total of 20 patients improved symptom caused by thrombosis, and 10 patients were confirmed cure by image study such as computed tomography or doppler ultrasonography. Eight patients who were treated with warfarin had persistent thrombosis. Five patients (10.2%) experienced major bleeding that required hospitalization. All of these bleeding events were associated with warfarin therapy. Conclusions: Careful attention to PTE/DVT is needed at the time of diagnosis of tuberculosis and during anti-tuberculosis therapy. Warfarin therapy administered with anti-tuberculosis medication requires frequent monitoring to prevent major bleeding.
박재훈,배혜림,하재경,이훈,서창석 한국엔터프라이즈아키텍처학회 2010 정보기술아키텍처연구 Vol.7 No.3
In general, business processes of the port logistics are defined differently among each country and not be standardized. As a result, it makes very difficult for the port management driver to achieve the information interchange and process standardization. Also, inefficient result can be leaded to the situation that data are not integrated in the perspective of the management of port, due to the individual operation of the port management drivers. These problems increase the requirement for the enterprise management by standardizing and automating the port process. BPM(Business Process Management) is widely adapted to visualize the business process, to control and execute the resource and system automatically related to business performance. In order to apply the BPM to port community system, integrated construct architecture and process redesign can be considered very important factors. 일반적으로 기업 내외의 업무 프로세스를 가시화하고, 업무의 수행과 관련된 자원 및 시스템을프로세스에 맞게 실행하고 통제하며, 전체 업무 프로세스를 효율적으로 관리하기 위한 목적으로BPM(Business Process Management) 기법이 널리 적용되고 있다. 항만물류 환경의 급격한 변화로인해 항만 물류와 관련된 비즈니스 프로세스는 각 국가의 항만 마다 조금씩 다르게 정의 되고 있어 프로세스 표준화가 이루어 지지 못하고 있는 실정이다. 이러한 점들은 항만 프로세스 표준화 및 자동화를 통한 전사적인 업무 관리에 대한 요구사항을 증가시킴과 동시에 항만 주체들 간의 유기적인 정보통합과 체계적인 관리를 위한 항만 커뮤니티 시스템(PCS: Port Community System) 개발에 대한필요성을 증대시키고 있다. 이러한 PCS에 BPM기법을 적용하므로 프로세스 자동화 및 표준화가 가능하게 되고 항만 관리의 효율성을 극대화 시킬 수 있다. 하지만 BPM기법을 기존의 PCS에 접목시키기 위해서는 항만 프로세스에 대한 정확한 이해를 바탕으로 한 프로세스 재설계와 시스템간의 원활한 연동을 위한 통합 아키텍쳐(architecture) 구성이 중요한 요구 사항으로 작용한다. 본 연구에서는BPM기반의 PCS 구축을 위해 T업체의 선박 관리 시스템을 대상으로 개발 사례를 대상으로 통합 아키텍처 구성과 프로세스 재설계 관점에 초점을 맞추어 소개하고자 한다.