Peter Fecci

Overview:

As the Director of both the Brain Tumor Immunotherapy Program and the Center for Brain and Spine Metastasis at Duke University, I focus our programmatic interests on the design, optimization, and monitoring of immune-based treatment platforms for patients with intracranial tumors, whether primary or metastatic. Within this broad scope, however, my own group looks more specifically at limitations to immunotherapeutic success, with a particular focus on understanding and reversing T cell dysfunction in patients with glioblastoma (GBM) and brain metastases. We employ a systematic approach to categorizing T cell dysfunction (Woroniecka et al, Clin Cancer Res 2018 Aug 15;24(16):3792-3802), and whereas our earlier work addressed concerns for regulatory T cell-induced tolerance, we now heavily study T cell ignorance and exhaustion, as well. Regarding the former, we recently published the novel phenomenon of S1P1-mediated bone marrow T cell sequestration in patients with intracranial tumors (Chongsathidkiet et al, Nat Medicine 2018 Sep;24(9):1459-1468). Regarding the latter, we have likewise recently identified and characterized exhaustion as a significant limitation to T-cell function within GBM (Woroniecka et al, Clin Cancer Res 2018 Sep 1;24(17):4175-4186). I very much look to collaboratively integrate our approaches with others investigating innovative treatment options. I continue my focus on combining strategies for reversing T cell deficits with current and novel immune-based platforms as a means of deriving and improving rational and precise anti-tumor therapies. It is my sincerest desire to forge a career focused on co-operative, multi-disciplinary, organized brain tumor therapy. Ultimately, my goal is to help coordinate the efforts of a streamlined and effective center for brain tumor research and clinical care. I hope to play some role in ushering in a period where the science and treatment arms of brain tumor therapy suffer no disjoint, but instead represent the convergent efforts of researchers, neuro-oncologists, medical oncologists, radiation oncologists, biomedical engineers, and neurosurgeons alike. I hope to see such synergy become standard of care.

Positions:

Associate Professor of Neurosurgery

Neurosurgery
School of Medicine

Associate Professor in Immunology

Immunology
School of Medicine

Associate Professor in Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2007

Duke University School of Medicine

Ph.D. 2007

Duke University

Internship, General Surgery

Massachusetts General Hospital

Residency, Neurosurgery

Massachusetts General Hospital

Postdoctoral Fellow

Dana-Farber Cancer Institute

Instructor, Neurosurgery

Massachusetts General Hospital

Grants:

Laser Ablation of Abnormal Neurolgoical Tissue using Robotic Neuroblate System (LAANTERN) Prospective Registry

Administered By
Neurosurgery
Awarded By
Monteris Medical, Inc.
Role
Principal Investigator
Start Date
End Date

NINDS Research Education Programs for Residents and Fellows in Neurosurgery

Administered By
Neurosurgery
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

LITT and Short Course Radiation for Patients with GBM Requiring Standard Treatment Alternatives (LASR)

Administered By
Duke Cancer Institute
Awarded By
Monteris Medical, Inc.
Role
Principal Investigator
Start Date
End Date

Directed Chemotherapy Delivery for Leptomeningeal Metastases

Administered By
Neurosurgery
Awarded By
Minnetronix, Inc
Role
Co Investigator
Start Date
End Date

Validation of Novel Therapeutic Approach for Leptomeningeal Metastases

Administered By
Neurosurgery
Awarded By
Minnetronix, Inc
Role
Co Investigator
Start Date
End Date

Publications:

Cold-inducible RNA-binding protein (CIRBP) as a biomarker to predict recurrence of brain metastases.

Authors
Chongsathidkiet, P; Fecci, PE
MLA Citation
Chongsathidkiet, Pakawat, and Peter E. Fecci. “Cold-inducible RNA-binding protein (CIRBP) as a biomarker to predict recurrence of brain metastases.Neuro Oncol, vol. 23, no. 9, Sept. 2021, pp. 1419–20. Pubmed, doi:10.1093/neuonc/noab122.
URI
https://scholars.duke.edu/individual/pub1482815
PMID
34036364
Source
pubmed
Published In
Neuro Oncol
Volume
23
Published Date
Start Page
1419
End Page
1420
DOI
10.1093/neuonc/noab122

Inpatient palliative care utilization for patients with brain metastases.

Introduction: Given the high symptom burden and complex clinical decision making associated with a diagnosis of brain metastases (BM), specialty palliative care (PC) can meaningfully improve patient quality of life. However, no prior study has formally evaluated patient-specific factors associated with PC consultation among BM patients. Methods: We examined the rates of PC consults in a cohort of 1303 patients with BM admitted to three tertiary medical centers from October 2015 to December 2018. Patient demographics, surgical status, 30-day readmission, and death data were collected via retrospective chart review. PC utilization was assessed by identifying encounters for which an inpatient consult to PC was placed. Statistical analyses were performed to compare characteristics and outcomes between patients who did and did not receive PC consults. Results: We analyzed 1303 patients admitted to the hospital with BM. The average overall rate of inpatient PC consultation was 19.6%. Rates of PC utilization differed significantly by patient race (17.5% in White/Caucasian vs 26.0% in Black/African American patients, P = .0014). Patients who received surgery during their admission had significantly lower rates of PC consultation (3.9% vs 22.4%, P < .0001). Patients who either died during their admission or were discharged to hospice had significantly higher rates of PC than those who were discharged home or to rehabilitation (P < .0001). Conclusions: In our dataset, PC consultation rates varied by patient demographic, surgical status, discharging service, and practice setting. Further work is needed to identify the specific barriers to optimally utilizing specialty PC in this population.
Authors
Price, M; Howell, EP; Dalton, T; Ramirez, L; Howell, C; Williamson, T; Fecci, PE; Anders, CK; Check, DK; Kamal, AH; Goodwin, CR
MLA Citation
Price, Meghan, et al. “Inpatient palliative care utilization for patients with brain metastases.Neurooncol Pract, vol. 8, no. 4, Aug. 2021, pp. 441–50. Pubmed, doi:10.1093/nop/npab016.
URI
https://scholars.duke.edu/individual/pub1488917
PMID
34277022
Source
pubmed
Published In
Neuro Oncology Practice
Volume
8
Published Date
Start Page
441
End Page
450
DOI
10.1093/nop/npab016

Re-evaluating Biopsy for Recurrent Glioblastoma: A Position Statement by the Christopher Davidson Forum Investigators.

Patients with glioblastoma (GBM) need bold new approaches to their treatment, yet progress has been hindered by a relative inability to dynamically track treatment response, mechanisms of resistance, evolution of targetable mutations, and changes in mutational burden. We are writing on behalf of a multidisciplinary group of academic neuro-oncology professionals who met at the collaborative Christopher Davidson Forum at Washington University in St Louis in the fall of 2019. We propose a dramatic but necessary change to the routine management of patients with GBM to advance the field: to routinely biopsy recurrent GBM at the time of presumed recurrence. Data derived from these samples will identify true recurrence vs treatment effect, avoid treatments with little chance of success, enable clinical trial access, and aid in the scientific advancement of our understanding of GBM.
Authors
Nduom, EK; Gephart, MH; Chheda, MG; Suva, ML; Amankulor, N; Battiste, JD; Campian, JL; Dacey, RG; Das, S; Fecci, PE; Hadjipanayis, CG; Hoang, KB; Jalali, A; Orringer, D; Patel, AJ; Placantonakis, D; Rodriguez, A; Yang, I; Yu, JS; Zipfel, GJ; Dunn, GP; Leuthardt, EC; Kim, AH
MLA Citation
Nduom, Edjah K., et al. “Re-evaluating Biopsy for Recurrent Glioblastoma: A Position Statement by the Christopher Davidson Forum Investigators.Neurosurgery, vol. 89, no. 1, June 2021, pp. 129–32. Pubmed, doi:10.1093/neuros/nyab063.
URI
https://scholars.duke.edu/individual/pub1480838
PMID
33862619
Source
pubmed
Published In
Neurosurgery
Volume
89
Published Date
Start Page
129
End Page
132
DOI
10.1093/neuros/nyab063

Commentary: A Neurosurgeon's Guide to Cognitive Dysfunction in Adult Glioma.

Authors
Srinivasan, ES; Tsvankin, V; Fecci, PE
MLA Citation
Srinivasan, Ethan S., et al. “Commentary: A Neurosurgeon's Guide to Cognitive Dysfunction in Adult Glioma.Neurosurgery, vol. 89, no. 1, June 2021, pp. E1–2. Pubmed, doi:10.1093/neuros/nyaa408.
URI
https://scholars.duke.edu/individual/pub1485644
PMID
33289515
Source
pubmed
Published In
Neurosurgery
Volume
89
Published Date
Start Page
E1
End Page
E2
DOI
10.1093/neuros/nyaa408

CD4 T-Cell Exhaustion: Does It Exist and What Are Its Roles in Cancer?

In chronic infections and in cancer, persistent antigen stimulation under suboptimal conditions can lead to the induction of T-cell exhaustion. Exhausted T cells are characterized by an increased expression of inhibitory markers and a progressive and hierarchical loss of function. Although cancer-induced exhaustion in CD8 T cells has been well-characterized and identified as a therapeutic target (i.e., via checkpoint inhibition), in-depth analyses of exhaustion in other immune cell types, including CD4 T cells, is wanting. While perhaps attributable to the contextual discovery of exhaustion amidst chronic viral infection, the lack of thorough inquiry into CD4 T-cell exhaustion is particularly surprising given their important role in orchestrating immune responses through T-helper and direct cytotoxic functions. Current work suggests that CD4 T-cell exhaustion may indeed be prevalent, and as CD4 T cells have been implicated in various disease pathologies, such exhaustion is likely to be clinically relevant. Defining phenotypic exhaustion in the various CD4 T-cell subsets and how it influences immune responses and disease severity will be crucial to understanding collective immune dysfunction in a variety of pathologies. In this review, we will discuss mechanistic and clinical evidence for CD4 T-cell exhaustion in cancer. Further insight into the derivation and manifestation of exhaustive processes in CD4 T cells could reveal novel therapeutic targets to abrogate CD4 T-cell exhaustion in cancer and induce a robust antitumor immune response.
Authors
Miggelbrink, AM; Jackson, JD; Lorrey, SJ; Srinivasan, ES; Waibl-Polania, J; Wilkinson, DS; Fecci, PE
MLA Citation
Miggelbrink, Alexandra M., et al. “CD4 T-Cell Exhaustion: Does It Exist and What Are Its Roles in Cancer?Clin Cancer Res, vol. 27, no. 21, Nov. 2021, pp. 5742–52. Pubmed, doi:10.1158/1078-0432.CCR-21-0206.
URI
https://scholars.duke.edu/individual/pub1485795
PMID
34127507
Source
pubmed
Published In
Clinical Cancer Research
Volume
27
Published Date
Start Page
5742
End Page
5752
DOI
10.1158/1078-0432.CCR-21-0206

Research Areas:

Blood-Brain Barrier
Brain metastasis
Cancer
Glioma
Glioma, Subependymal
Immunotherapy
Immunotherapy, Active
T cells
T cells--Effect of drugs on
T cells--Receptors
Translational Medical Research