Jennifer Garst

Overview:

1. Non-small cell and small cell lung cancer - intervention, epidemiology and treatment.
2. Clinical trials of combined modality therapy, cancer drug development, and new treatment approaches and supportive care for lung cancer.
3. Lung cancer as a women's health issue.
4. Supportive care for lung cancer patients including management of taste alteration, weight loss and declining performance status.
5. Clinical research in the Duke Oncology Outreach (DOORS) & DOC affiliate setting.
6. Standardization of management for common oncologic problems.

Clinical Research:

1. Principal Investigator:
TOP 96-02, "A Phase I/II Dose Escalation Study of Concurrent Navelbine and Radiation Inoperable Stage III"
TOP 96-03, "A Phase I/II Study of Weekly Docetaxel and Vinorelbine in Advanced and Relapsed Non-Small Cell Lung Carcinoma"
TOP 97-01, "A Phase I/II Study: Sequential Topotecan and Carboplatin/VP-16 for the Treatment of Small Cell Lung Cancer"
TOP 98-01, "A Phase I/II Study: Weekly CPT-11 with Vinorelbine in Advanced Non-Small Cell Lung Carcinoma"
TOP 98-02, "A Phase I/II Trial of Concurrent Carboplatin and Vinorelbine Chemotherapy with Radiation Followed by Surgery in Patients with Non-Small Cell Lung Carcinoma"
TOP 99-01, "A Feasibility Trial of Filgrastim-SD/01 to Support Carboplatin/ Navelbine (SD/01-CaN) Chemotherapy for the Treatment of Thoracic Malignancies"
TOP 00-03, "Phase II Trial of Gemcitabine and Oxaliplatin in the Treatment of Non-Small Cell Lung Cancer (NSCLC)"
TOP 00-01, "A Pilot Study of the Relative Velocity of Serum Tumor Marker CYFRA 21-1 as an Indicator of Early Chemotherapeutic Response in Advanced Non-Small Cell Lung Cancer"
"Evaluation of Oral Antiemetic Regimens for Moderately-High to Highly Emetogenic Chemotherapy: Pilot Study of Oral Ondansetron in Acute Chemotherapy Inducted Emesis (CIE) and a Randomized Double Blind Comparison of Ondansetron versus Dexamethasone versus Procholorperazine in Delayed CIE"
2. Co-Principal Investigator:
"A Phase I/II Study of Active Immunotherapy with Dexosomes Loaded with
Mage3.A2 and Mage4.A2 Peptides in HLA A2+ Patients with Metastatic
Non-Small Cell Lung Cancer Expressing Mage3 or Mage4 (AP Cells,
Inc.)"
3D 97-01, "A Phase I Dose Escalation Research Study of Radiotherapy Using Three-Dimensional Treatment Planning Following Neoadjuvant Chemotherapy for Stage IIB/III Non-Small Cell Lung Cancer"
"Phase IV Pharmacokinetic Study in Chemonaive Patients with Stage IIIB or IV
Non-Small Cell Lung Cancer (NSCLC) Receiving Gemcitabine and
Cisplatin (Eli Lilly B9E-MC-JHQK)"
3. Initiation, organization and development of the Multidisciplinary Thoracic Oncology clinic
with clinical research at DVAMC, 1996
4. Development of four oncology clinical pathways at Duke University Medical Center, 1997
5. Implementation of 3 clinical research trials at DOORS Asheboro site, Randolph Hospital,
1997

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

Medical College of Georgia School of Medicine

Intern, Medicine

University of Texas Southwestern Medical Center, Medical School

Resident, Medicine

University of Texas Southwestern Medical Center, Medical School

Fellow, Hematology, Oncology

Duke University School of Medicine

Grants:

Publications:

Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients.

BACKGROUND: Abnormalities in taste and smell functioning occur with elevated frequency in both older adults and patients with cancer. With the predicted increase in both of these populations in the coming decades, it is imperative to evaluate potential interventions that are designed to help older cancer patients compensate for the additive burden of this disease and its treatment on age-related taste and smell losses. OBJECTIVE: The purpose of the current study was to determine if providing instruction and products for flavor enhancement of foods to elderly cancer patients in addition to nutritional information would improve their nutritional status, and, by extension, functional and immune status as well as quality of life. DESIGN: One hundred and seven subjects enrolled in the study. Fifty-four subjects were in the experimental group that received flavor enhancement plus nutritional information; fifty-three control subjects received only nutritional information. Subjects were evaluated 1 month, 3 months, and 8 months after beginning chemotherapy. At every session, subjects completed taste and smell assessments as well as questionnaires related to nutritional status, activities of daily living, and quality of life. Blood samples were also obtained to determine immune parameters. RESULTS: At the eight-month time point, experimental subjects had better scores on the mini nutritional assessment (MNA) and the physical function assessment of the quality of life questionnaire. Also at eight months, self-reported taste and smell perception for experimental subjects was better than that of controls as well as better than at earlier time points. Tests that assessed quantity and quality of food intake, as well as a number of immune parameters declined over time and did not differ significantly between groups. CONCLUSION: The combination of flavor enhancement, chemosensory education, and nutritional information for elderly cancer patients improved their nutritional assessment on the MNA and physical function over time. On the whole, experimental subjects perceived themselves to be better functioning at eight months than did their control counterparts.
Authors
Schiffman, SS; Sattely-Miller, EA; Taylor, EL; Graham, BG; Landerman, LR; Zervakis, J; Campagna, LK; Cohen, HJ; Blackwell, S; Garst, JL
MLA Citation
Schiffman, S. S., et al. “Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients.J Nutr Health Aging, vol. 11, no. 5, Sept. 2007, pp. 439–54.
URI
https://scholars.duke.edu/individual/pub697442
PMID
17657366
Source
pubmed
Published In
The Journal of Nutrition, Health & Aging
Volume
11
Published Date
Start Page
439
End Page
454

Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?

PURPOSE: To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). METHODS AND MATERIALS: The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. RESULTS: Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7% and 38%, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4% and 25% at a dose of approximately 74 Gy and 86 Gy, respectively. CONCLUSION: Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.
Authors
Miller, KL; Shafman, TD; Anscher, MS; Zhou, S-M; Clough, RW; Garst, JL; Crawford, J; Rosenman, J; Socinski, MA; Blackstock, W; Sibley, GS; Marks, LB
MLA Citation
Miller, Keith L., et al. “Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?Int J Radiat Oncol Biol Phys, vol. 61, no. 1, Jan. 2005, pp. 64–69. Pubmed, doi:10.1016/j.ijrobp.2004.02.066.
URI
https://scholars.duke.edu/individual/pub766857
PMID
15629595
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
61
Published Date
Start Page
64
End Page
69
DOI
10.1016/j.ijrobp.2004.02.066

Tuberculous osteomyelitis complicating a vertebral fracture

Authors
Raj, G; Smith, J; Garst, J; Hollenberg, HG
MLA Citation
Raj, G., et al. “Tuberculous osteomyelitis complicating a vertebral fracture.” Infectious Diseases in Clinical Practice, vol. 3, no. 3, Jan. 1994, pp. 201–03. Scopus, doi:10.1097/00019048-199405000-00014.
URI
https://scholars.duke.edu/individual/pub1102682
Source
scopus
Published In
Infectious Diseases in Clinical Practice
Volume
3
Published Date
Start Page
201
End Page
203
DOI
10.1097/00019048-199405000-00014

Vaccine therapy in non-small-cell lung cancer.

Lung cancer is the leading cause of death from cancer worldwide. First-line therapy is based on stage at diagnosis and can include chemotherapy, radiation, and surgery. Despite advances, the prognosis for advanced-stage lung cancer is very poor. Vaccines with the capability to activate the host immune system may have a role in second-line therapy. Advances in the understanding of cellular and molecular immunology are forming the basis for improving vaccine therapy. Most trials to date have demonstrated safety but inconsistent efficacy. Further research is needed to enhance this potential.
Authors
Albright, C; Garst, J
MLA Citation
Albright, Carol, and Jennifer Garst. “Vaccine therapy in non-small-cell lung cancer.Curr Oncol Rep, vol. 9, no. 4, July 2007, pp. 241–46. Pubmed, doi:10.1007/s11912-007-0029-9.
URI
https://scholars.duke.edu/individual/pub963900
PMID
17588347
Source
pubmed
Published In
Current Oncology Reports
Volume
9
Published Date
Start Page
241
End Page
246
DOI
10.1007/s11912-007-0029-9

Carboplatin/paclitaxel or carboplatin/vinorelbine followed by accelerated hyperfractionated conformal radiation therapy: report of a prospective phase I dose escalation trial from the Carolina Conformal Therapy Consortium.

PURPOSE: To prospectively determine the maximum-tolerated dose of accelerated hyperfractionated conformal radiotherapy (RT; 1.6 Gy bid) for unresectable locally advanced lung cancer (IIB to IIIA/B) following induction carboplatin/paclitaxel (C/T) or carboplatin/vinorelbine (C/N). METHODS: Induction chemotherapy, C/T or C/N, was followed by escalating doses of conformally-planned RT (73.6 to 86.4 Gy in 6.4-Gy increments). Concurrent boost methods delivered 1.6 and 1.25 Gy bid to the gross and clinical target volumes, respectively. RESULTS: Between November 1997 and February 2002, 44 patients were enrolled (median age, 59 years; 59% male; stage III, 98%; median tumor size, 4 cm). Thirty-nine patients completed induction chemotherapy: 19 had a partial response, seven progressed, 15 had no response, and three were not assessable. Chemotherapy-associated toxicities were similar in the two chemotherapy groups. The incidence of grade > or = 3 RT-induced toxicity was 1/13, 2/14, and 4/12 at 73.6, 80, and 86.4 Gy, respectively, thus defining the maximum tolerated dose at approximately 80 Gy. Toxicities were in both lung and esophagus and were similar in the two chemotherapy arms. With a median followup of 34 months in the survivors, the actuarial 2-year survival was 47%, the median survival was 18 months. Fifteen patients had tumor relapse: 5 local failures in the high-dose volume, 2 regional failures outside of the high-dose volume, and 8 distant metastases. CONCLUSION: High-dose conformal twice-daily radiation therapy to approximately 80 Gy appears tolerable in well-selected patients with unresectable lung cancer following either C/T or C/N. Dose-limiting toxicities are mainly pulmonary and esophageal.
Authors
Marks, LB; Garst, J; Socinski, MA; Sibley, G; Blackstock, AW; Herndon, JE; Zhou, S; Shafman, T; Tisch, A; Clough, R; Yu, X; Turrisi, A; Anscher, M; Crawford, J; Rosenman, J; Carolina Conformal Therapy Consortium,
URI
https://scholars.duke.edu/individual/pub709842
PMID
15514374
Source
pubmed
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
22
Published Date
Start Page
4329
End Page
4340
DOI
10.1200/JCO.2004.02.165