Afreen Shariff

Overview:

Afreen Shariff, MD is an endocrinologist with expertise in endocrine disease in cancer patients. She is the Director of the Duke Endo-Oncology Program and an Associate Director for the Cancer Therapy Toxicity Program at the Duke Center for Cancer Immunotherapy. She holds a faculty appointment as an Assistant Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Duke University School of Medicine.

Dr. Shariff completed her medical school in India from Deccan College of Medical Sciences, Internal Medicine training from East Carolina University’s Brody School of Medicine and fellowship in Endocrinology from Duke University School of Medicine. Her clinical work and research is focused on high value care for endocrine disease in cancer patients.

She also chairs the Oncoendocrinology Special Interest Group (SIG) with the Endocrine Society and influences global networking, clinical practice and education in the field of Oncoendocrinology. At Duke, Dr. Shariff's work includes developing interdisciplinary partnerships, creating the clinical infrastructure and framework needed for AI assisted clinical decision making to improve access and coordinated care for patients with cancer therapy related toxicities. She also hosts and produces the podcast series Checkpoint NOW that emphasizes shared decision making between oncologists and subspecialists

Positions:

Assistant Professor of Medicine

Medicine, Endocrinology, Metabolism, and Nutrition
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 2008

University of Hyderabad (India)

Internal Medicine Residency

East Carolina University, Brody School of Medicine

Fellowship in Endocrinology, Metabolism and Nutrition, Medicine

Duke University School of Medicine

Publications:

Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in South Asians: a Unique Population with a Growing Challenge.

PURPOSE OF REVIEW: The purpose of this review is to summarize our current knowledge of factors that influence clinical decision making and management of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) among South Asians (SA). RECENT FINDINGS: ASCVD and T2DM in SAs have been examined in recent times. Pathophysiologic and genetic factors including the role of adiponectin, visceral adiposity, lower beta cell function, and psycho-social factors like sedentary lifestyle, poor adherence to medications, and carbohydrate dense meals play a role in early development and the high-risk presentation of both ASCVD and T2DM in SA. Recently, large population-based cohort studies have attempted to compare outcomes and interventions that can be translated to timely detection and targeted interventions in this high-risk group. SAs in the USA are more likely to be diagnosed with T2DM and ASCVD when compared to non-Hispanic whites, non-Hispanic Blacks, and Hispanic populations. The development of personalized ethnic risk assessment tools and better representation of SAs in prospective studies are essential to increasing our understanding and management of cardio-metabolic disease in SA living in the USA.
Authors
Shariff, AI; Kumar, N; Yancy, WS; Corsino, L
MLA Citation
Shariff, Afreen I., et al. “Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in South Asians: a Unique Population with a Growing Challenge.Curr Diab Rep, vol. 20, no. 1, Jan. 2020, p. 4. Pubmed, doi:10.1007/s11892-020-1291-6.
URI
https://scholars.duke.edu/individual/pub1431458
PMID
32002674
Source
pubmed
Published In
Curr Diab Rep
Volume
20
Published Date
Start Page
4
DOI
10.1007/s11892-020-1291-6

Top Ten Tips Palliative Care Clinicians Should Know About Managing Immune-Mediated Endocrine Toxicities in Cancer.

Immune checkpoint inhibitors (ICI), such as PD-1/PDL-1 and CTLA-4, have become widely used in the treatment of solid and hematological malignancies; their use and side effects are increasingly seen in the palliative care (PC) population. These drugs can result in immune-mediated endocrinopathies; the thyroid is the most common endocrine gland affected, but the pituitary, adrenals, and pancreas may be affected as well. Symptoms may be insidious and nonspecific. A high index of suspicion and routine laboratory monitoring allows for prompt diagnosis and treatment, which can significantly improve symptoms and increase quality of life. In this study, we present an approach to monitoring and initial management of ICI-induced endocrinopathies in the PC patient population.
Authors
Ferreira, MN; Rao, M; Kamal, AH; Shariff, A
MLA Citation
Ferreira, Michelle N., et al. “Top Ten Tips Palliative Care Clinicians Should Know About Managing Immune-Mediated Endocrine Toxicities in Cancer.J Palliat Med, vol. 25, no. 11, Nov. 2022, pp. 1715–20. Pubmed, doi:10.1089/jpm.2022.0204.
URI
https://scholars.duke.edu/individual/pub1524041
PMID
35696238
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
25
Published Date
Start Page
1715
End Page
1720
DOI
10.1089/jpm.2022.0204

A Phase 2 Clinical Trial of Combination Nivolumab, Ipilimumab, and Paclitaxel in Patients With Untreated Metastatic NSCLC: The OPTIMAL Trial.

INTRODUCTION: Most patients with advanced NSCLC will experience disease progression and death within 2 years. Novel approaches are needed to improve outcomes. METHODS: We conducted an open-label, nonrandomized, phase 2 trial in patients with treatment-naive, advanced NSCLC to assess the safety and efficacy of nivolumab 360 mg every 3 weeks, ipilimumab 1 mg/kg every 6 weeks, and four to six cycles of paclitaxel 80 mg/m2 on days 1 and 8 of every 21-day treatment. The primary end point of the study was median progression-free survival (PFS), with secondary end points of safety, objective response rate, and median overall survival (OS). RESULTS: A total of 46 patients underwent consent and received treatment. The median age was 66 (range: 48-82) years, most had adenocarcinoma (63%), and 50% (23) had programmed death-ligand 1 greater than or equal to 1%. The median follow-up on the study as of October 2021 was 19 months. The primary end point of median PFS was 9.4 months (95% confidence interval [CI]: 5.9-16.6) in all patients regardless of programmed death-ligand 1 expression. The objective response rate for patients in the study was 47.8% (95% CI: 33.4-62.3). The 12-month OS rate was 69.5% (95% CI: 53%-81%), and median OS was not yet reached. Treatment-related grade greater than or equal to 3 adverse events was found in 54.3% of the patients. CONCLUSIONS: The toxicity observed was consistent with other reported chemo-immunotherapeutic combinations and was manageable. The primary end point of exceeding median PFS of 9 months was achieved with nivolumab, ipilimumab, and weekly paclitaxel and should be evaluated further in a randomized trial.
MLA Citation
Clarke, Jeffrey M., et al. “A Phase 2 Clinical Trial of Combination Nivolumab, Ipilimumab, and Paclitaxel in Patients With Untreated Metastatic NSCLC: The OPTIMAL Trial.Jto Clin Res Rep, vol. 3, no. 6, June 2022, p. 100337. Pubmed, doi:10.1016/j.jtocrr.2022.100337.
URI
https://scholars.duke.edu/individual/pub1524906
PMID
35719867
Source
pubmed
Published In
Jto Clinical and Research Reports
Volume
3
Published Date
Start Page
100337
DOI
10.1016/j.jtocrr.2022.100337

The management of toxicities from immune, targeted and ADCs treatments in patients with urothelial cancer.

Newly approved systemic treatment options for metastatic urothelial cancer (mUC) have diversified treatments and improved responses and survival for chemotherapy refractory disease. These systemic treatments have associated toxicities which need appropriate management for patients to stay on treatment and potentially have longer benefit from treatment. We review the expected toxicities of immune checkpoint inhibitors, FGFR inhibitors such as erdafitinib, and antibody drug conjugates such as enfortumab vedotin and sacituzumab govitecan.
Authors
Atiq, S; Hirshman, N; Shariff, A; Zhang, T
MLA Citation
Atiq, Saad, et al. “The management of toxicities from immune, targeted and ADCs treatments in patients with urothelial cancer.Urol Oncol, Dec. 2021. Pubmed, doi:10.1016/j.urolonc.2021.10.002.
URI
https://scholars.duke.edu/individual/pub1505293
PMID
34973855
Source
pubmed
Published In
Urol Oncol
Published Date
DOI
10.1016/j.urolonc.2021.10.002

A RARE CASE OF PRIMARY HYPERPARATHYROIDISM, HYPEREMESIS GRAVIDARUM, AND WERNICKE ENCEPHALOPATHY.

OBJECTIVE: To describe a rare case of Wernicke encephalopathy (WE) as a result of hyperemesis gravidarum due to primary hyperparathyroidism (PHPT) in pregnancy. METHODS: We present the clinical presentation, supportive laboratory values, diagnostic dilemmas, treatment, clinical outcome, and supportive literature review of a patient with WE as a result of hyperemesis gravidarum due to PHPT in pregnancy. RESULTS: A 27-year-old previously healthy G1P0 female presented with initial symptoms of right upper-quadrant pain, nausea, vomiting, and paresthesias at 17.3 weeks of gestation. The patient later developed neurologic symptoms including acute encephalopathy, ataxia, and intranuclear ophthalmoplegia. The suspicion for WE was confirmed with characteristic findings on brain magnetic resonance imaging. WE was attributed to severe malnutrition from hyperemesis gravidarum and poor prenatal care. Hypercalcemia with an elevated parathyroid hormone level was identified following an unfortunate intrauterine fetal demise, raising suspicion for PHPT. PHPT was confirmed, and after undergoing successful parathyroidectomy, the patient regained normal neurologic function, with the exception of mild lower-extremity paresthesias. CONCLUSION: This case is an example where early recognition and treatment of hyperparathyroidism can be masked by severe malnutrition and present in an unusual way with neurologic symptoms of WE. Early recognition and suspicion are critical in preventing poor fetal outcomes and long-term consequences.
Authors
Stahl, J; Winters, N; Shariff, A
MLA Citation
Stahl, Jennifer, et al. “A RARE CASE OF PRIMARY HYPERPARATHYROIDISM, HYPEREMESIS GRAVIDARUM, AND WERNICKE ENCEPHALOPATHY.Aace Clin Case Rep, vol. 5, no. 2, 2019, pp. e108–11. Pubmed, doi:10.4158/ACCR-2018-0286.
URI
https://scholars.duke.edu/individual/pub1428727
PMID
31967013
Source
pubmed
Published In
Aace Clin Case Rep
Volume
5
Published Date
Start Page
e108
End Page
e111
DOI
10.4158/ACCR-2018-0286

Research Areas:

Immune Checkpoint Inhibitors
Immune-related Adverse Events
Immunotherapy
Immunotherapy--Complications