D Raghavan

Carolinas HealthCare System, Charlotte, North Carolina, United States

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Publications (250)1686.41 Total impact

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    ABSTRACT: To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC).
    Journal of Clinical Oncology 09/2014; 32(30). DOI:10.1200/JCO.2013.54.8404 · 17.88 Impact Factor
  • Journal of Clinical Oncology 07/2014; DOI:10.1200/JCO.2014.55.2349 · 17.88 Impact Factor
  • Derek Raghavan
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    ABSTRACT: In germ cell cancers, the unique reversibility of malignancy and the balance between somatic differentiation and de-differentiation may be critical to late relapse that is dominated by non-germ cell elements. Targeting regulators of differentiation may provide a solution, which may be elucidated via serial liquid biopsies (assessing circulating tumor cells).
    Clinical Cancer Research 05/2014; 20(14). DOI:10.1158/1078-0432.CCR-14-0691 · 8.19 Impact Factor
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    ABSTRACT: Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.
    The Oncologist 04/2014; 19(5). DOI:10.1634/theoncologist.2013-0379 · 4.54 Impact Factor
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    ABSTRACT: Neoadjuvant cisplatin-based combination chemotherapy provides a 5% increase in cure rate, an increase in median survival of about 3 years, and statistically significant and clinically relevant increments in overall survival for patients with invasive bladder cancer. Despite compelling level 1 data, it has become quite clear that facts that are similar to those that changed the paradigm of treatment of breast cancer in the 1970s have not had a similar influence on patterns of practice in bladder cancer care. Instead of using this proven approach, cystectomy alone or surgery followed by adjuvant chemotherapy is often used as a functional alternative for patients with deeply invasive and/or node-metastatic disease discovered at radical cystectomy. However, there is no well-powered level 1 evidence to support routine adjuvant chemotherapy for invasive bladder cancer, and some randomized trials have shown inferior outcomes. There is a clear need for a well designed, randomized trial that tests the utility of adjuvant chemotherapy for invasive bladder cancer, but until that has been completed, neoadjuvant chemotherapy followed by definitive local treatment should be the standard of care for invasive bladder cancer.
    Annals of Oncology 02/2014; 25(10). DOI:10.1093/annonc/mdu092 · 6.58 Impact Factor
  • Derek Raghavan
    Seminars in Oncology 12/2013; 40(6):659-661. DOI:10.1053/j.seminoncol.2013.10.001 · 3.94 Impact Factor
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    ABSTRACT: To analyze the association between cancer incidence and oral diabetes therapy (biguanide, sulfonylurea, thiazolidinedione, meglitinide) in men and women with type 2 diabetes mellitus. A retrospective analysis of the electronic health record-based Cleveland Clinic Diabetes Registry (25,613 patients) was cross-indexed with the histology-based Tumor Registry (48,051 cancer occurrences) over an 8-year period (1998-2006). Multiple imputations were used to account for missing data. Cox regression with propensity scores was used to model time to development of incident cancer in each of the imputed datasets and the results were pooled. During 51,994 person follow-up years, 892 incident cancer cases were identified; prostate (14.5%) and breast (11.7%) malignancies were most frequent. In women, thiazolidinedione use was associated with a 32% decreased cancer risk compared to sulfonylurea use (HR 0.68 [95% CI 0.48-0.97] in the adjusted analysis). Comparison of insulin secretagogues (sulfonylurea, meglitinide) versus insulin sensitizers (biguanide, thiazolidinedione) demonstrated a 21% decreased cancer risk in insulin sensitizers (HR 0.79 [95% CI 0.64-0.98] in the adjusted analysis). Oral diabetes therapy showed no significant difference in men. Adjustments were made for age, BMI, LDL, HDL, triglycerides, CHD, diabetes oral monotherapy, race, gender, hemoglobin A1c, statin use, income, insulin use, GFR, new diabetes status, prior cancer, prior cerebrovascular accident (stroke or transient ischemic event), systolic/diastolic blood pressure, tobacco use (ever/never), and the propensity score for receiving a biguanide. Oral insulin sensitizers, particularly thiazolidinedione, are associated with decreased malignancy risk in women with type 2 diabetes mellitus.
    Diabetes Obesity and Metabolism 11/2013; 16(3). DOI:10.1111/dom.12231 · 5.46 Impact Factor
  • Journal of Clinical Oncology 10/2013; 31(34). DOI:10.1200/JCO.2013.53.3943 · 17.88 Impact Factor
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    ABSTRACT: Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. The National Cancer Institute (NCI) and the ASCO (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided.
    Journal of Oncology Practice 10/2013; DOI:10.1200/JOP.2013.001119
  • Derek Raghavan
    The Oncologist 08/2013; 18(8):895-6. DOI:10.1634/theoncologist.2013-0281 · 4.54 Impact Factor
  • Derek Raghavan
    European journal of cancer (Oxford, England: 1990) 07/2013; 49(15). DOI:10.1016/j.ejca.2013.06.007 · 4.82 Impact Factor
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    ABSTRACT: Castration resistance occurs in most patients with metastatic hormone-sensitive prostate cancer who are receiving androgen-deprivation therapy. Replacing androgens before progression of the disease is hypothesized to prolong androgen dependence. Men with newly diagnosed, metastatic, hormone-sensitive prostate cancer, a performance status of 0 to 2, and a prostate-specific antigen (PSA) level of 5 ng per milliliter or higher received a luteinizing hormone-releasing hormone analogue and an antiandrogen agent for 7 months. We then randomly assigned patients in whom the PSA level fell to 4 ng per milliliter or lower to continuous or intermittent androgen deprivation, with patients stratified according to prior or no prior hormonal therapy, performance status, and extent of disease (minimal or extensive). The coprimary objectives were to assess whether intermittent therapy was noninferior to continuous therapy with respect to survival, with a one-sided test with an upper boundary of the hazard ratio of 1.20, and whether quality of life differed between the groups 3 months after randomization. A total of 3040 patients were enrolled, of whom 1535 were included in the analysis: 765 randomly assigned to continuous androgen deprivation and 770 assigned to intermittent androgen deprivation. The median follow-up period was 9.8 years. Median survival was 5.8 years in the continuous-therapy groufp and 5.1 years in the intermittent-therapy group (hazard ratio for death with intermittent therapy, 1.10; 90% confidence interval, 0.99 to 1.23). Intermittent therapy was associated with better erectile function and mental health (P<0.001 and P=0.003, respectively) at month 3 but not thereafter. There were no significant differences between the groups in the number of treatment-related high-grade adverse events. Our findings were statistically inconclusive. In patients with metastatic hormone-sensitive prostate cancer, the confidence interval for survival exceeded the upper boundary for noninferiority, suggesting that we cannot rule out a 20% greater risk of death with intermittent therapy than with continuous therapy, but too few events occurred to rule out significant inferiority of intermittent therapy. Intermittent therapy resulted in small improvements in quality of life. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00002651.).
    New England Journal of Medicine 04/2013; 368(14):1314-25. DOI:10.1056/NEJMoa1212299 · 54.42 Impact Factor
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    ABSTRACT: Purpose Enzastaurin is an oral serine/threonine kinase inhibitor that inhibits the beta isoform of protein kinase C and which may have therapeutic activity in prostate cancer. We explored the efficacy of docetaxel/prednisone with or without enzastaurin in patients with castration-resistant metastatic prostate cancer. Methods A nonrandomized safety cohort consisting of 14 patients was followed by a double-blind randomized Phase II trial. Patients received standard doses of docetaxel (75 mg/m(2)) with prednisone 10 mg daily with or without 500 mg/day of enzastaurin. Results There was no difference in the objective response rate between the enzastaurin and placebo arms (placebo: 7 [15.2 %]; enzastaurin: 6 [15.0 %]; P = 1.00). The median PFS was 229 days for patients in the enzastaurin arm versus 213 days for the placebo arm (P = 0.524). The 1-year overall survival rates were almost identical, with 76.7 % and 75.1 % in the enzastaurin and placebo arms, respectively. Therapy was well tolerated although the combination of enzastaurin and docetaxel was more myelosuppressive than with docetaxel alone. Conclusions The clinical activity of docetaxel/prednisone plus enzastaurin cannot be distinguished from docetaxel/prednisone alone, given the limitations of a randomized Phase II design. Although the toxicity profile was favorable for the enzastaurin-containing regimen, there is no compelling rationale to move this combination forward for the treatment of castration-resistant metastatic prostate cancer.
    Investigational New Drugs 02/2013; DOI:10.1007/s10637-013-9940-0 · 2.93 Impact Factor
  • Derek Raghavan
    Mayo Clinic Proceedings 01/2013; 88(1):1-3. DOI:10.1016/j.mayocp.2012.11.004 · 5.81 Impact Factor
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    ABSTRACT: Deeply invasive bladder cancer, representing approximately 20% of incident cases, is cured by radical cystectomy or radiotherapy in less than 50% of cases. In an effort to improve cure rates, based on objective response rates in metastatic disease of 40%-70% from combination chemotherapy regimens, systemic chemotherapy has been incorporated into programs of definitive treatment for this disease. Several randomized trials and a meta-analysis have confirmed a survival benefit from neoadjuvant chemotherapy followed by definitive local treatment, reflecting both median survival figures and cure rates. Despite several promising phase II trials, no randomized trial of classical adjuvant chemotherapy for bladder cancer has demonstrated an overall survival benefit, despite increments in disease-free survival. Molecular prognostication has been studied in an effort to improve the utility of systemic therapy for invasive non-metastatic bladder cancer, but randomized trials have not shown associated survival benefit. Despite level 1 evidence of a survival benefit from neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin [Adriamycin], cisplatin) or cisplatin, methotrexate, and vinblastine (CMV) chemotherapy, more than 50% of incident cases do not receive such treatment.
    Seminars in Oncology 10/2012; 39(5):588-97. DOI:10.1053/j.seminoncol.2012.08.003 · 3.94 Impact Factor
  • Derek Raghavan
    Seminars in Oncology 10/2012; 39(5):523. DOI:10.1053/j.seminoncol.2012.08.002 · 3.94 Impact Factor
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    ABSTRACT: Small cell bladder cancer (SCBC) is a rare and aggressive form of bladder cancer. It exhibits similar biological behavior to small cell lung carcinoma. Untreated, it is associated with a very poor prognosis. Appropriate oncologic surgery remains the mainstay of treatment of this disease but is not curative alone in the majority of the cases. Adding systemic therapy to the treatment regimen has been shown to improve survival. The most common chemotherapy regimens used in published series include a platinum complex plus etoposide, although doxorubicin-based regimens and standard urothelial cancer regimens also have been associated with response. Despite robust chemotherapy responses, metastatic disease is associated with relapse and a median overall survival of 18 months or less. Better understanding of the molecular alterations driving SCBC may facilitate the development of new therapeutic strategies and improved outcomes.
    Seminars in Oncology 10/2012; 39(5):615-8. DOI:10.1053/j.seminoncol.2012.08.009 · 3.94 Impact Factor
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    ABSTRACT: Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership.
    British Journal of Cancer 09/2012; 107(7):1017-21. DOI:10.1038/bjc.2012.240 · 4.82 Impact Factor
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    Siran M Koroukian, Paul M Bakaki, Derek Raghavan
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    ABSTRACT: A study was undertaken to compare survival and 5-year mortality by Medicaid status in adults diagnosed with 8 select cancers. Linking records from the Ohio Cancer Incidence Surveillance System (OCISS) with Ohio Medicaid enrollment data, the authors identified Medicaid and non-Medicaid patients aged 15 to 54 years and diagnosed with the following incident cancers in the years 1996-2002: cancer of the testis; Hodgkin and non-Hodgkin lymphoma; early stage melanoma, colon, lung, and bladder cancer; and pediatric malignancies (n = 12,703). Medicaid beneficiaries were placed in the pre-diagnosis group if they were enrolled in Medicaid at least 3 months before cancer diagnosis, and in the peri/post-diagnosis group if they enrolled in Medicaid upon or after being diagnosed with cancer. The authors also linked the OCISS with death certificates and data from the US Census. By using Cox and logistic regression analysis, they examined the association between Medicaid status and survival and 5-year mortality, respectively, after adjusting for patient covariates. Nearly 11% of the study population were Medicaid beneficiaries. Of those, 45% were classified in the peri/post-diagnosis group. Consistent with higher mortality, findings from the Cox regression model indicated that compared with non-Medicaid, patients in the Medicaid pre-diagnosis and peri/post-diagnosis groups experienced unfavorable survival outcomes (adjusted hazard ratio [AHR], 1.52; 95% confidence interval [CI], 1.27-1.82 and AHR, 2.01; 95% CI, 1.70-2.38, respectively). Medicaid status was associated with unfavorable survival, even after adjusting for confounders. The findings reflect the vulnerability of Medicaid beneficiaries and possible inadequacies in the process of care.
    Cancer 09/2012; 118(17):4271-9. DOI:10.1002/cncr.27380 · 4.90 Impact Factor
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    ABSTRACT: This correspondence is in response to the article: Abratt RP. The fast neutron therapy programme for patients in South Africa should come to an end. S Afr Med J 2012;102(2):58. Other correspondence in this series: Neutron radiotherapy: a different perspective. S Afr Med J 2012;102(5):269; Neutron radiotherapy should continue. S Afr Med J 2012;102(5):269-270; Neutron radiotherapy, Abratt reply. S Afr Med J 2012;102(5):270-217; Neutron radiotherapy: Society comments. S Afr Med J 2012;102(5):271.
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 05/2012; 102(5):271. · 1.71 Impact Factor

Publication Stats

10k Citations
1,686.41 Total Impact Points

Institutions

  • 2011–2014
    • Carolinas HealthCare System
      Charlotte, North Carolina, United States
  • 2012
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States
  • 2005–2012
    • Cleveland Clinic
      • Department of Anatomic Pathology
      Cleveland, Ohio, United States
  • 1997–2011
    • University of Chicago
      Chicago, Illinois, United States
    • University of Illinois at Chicago
      • Section of Hematology and Oncology
      Chicago, IL, United States
  • 2009
    • Memorial Sloan-Kettering Cancer Center
      New York, New York, United States
    • American Cancer Society
      Atlanta, Georgia, United States
  • 2008
    • Dana-Farber Cancer Institute
      • Lank Center for Genitourinary Oncology
      Boston, MA, United States
  • 1983–2008
    • Royal Prince Alfred Hospital
      • • Department of Medical Oncology
      • • Department of Radiation Oncology
      Camperdown, New South Wales, Australia
  • 2006
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2004–2006
    • Columbia University
      • Herbert Irving Comprehensive Cancer Center
      New York City, New York, United States
    • Cancer Research UK
      Londinium, England, United Kingdom
  • 2000–2005
    • University of Southern California
      • Norris Comprehensive Cancer Center
      Los Angeles, California, United States
    • University of California, Los Angeles
      Los Ángeles, California, United States
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, IN, United States
  • 2003
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 1991–1998
    • Roswell Park Cancer Institute
      • Department of Medicine
      Buffalo, NY, United States
    • Peter MacCallum Cancer Centre
      Melbourne, Victoria, Australia
  • 1992
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 1980–1990
    • University of Sydney
      Sydney, New South Wales, Australia
  • 1987
    • Concord Hospital
      Concord, New Hampshire, United States
  • 1981–1987
    • Ludwig Institute for Cancer Research Australia
      Melbourne, Victoria, Australia
  • 1982
    • Ludwig Institute for Cancer Research
      La Jolla, California, United States