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Reddington R, Galer M, Hagedorn A, Liu P, Barrack S, Husain E, Sharma R, Speirs V, Masannat Y. Incidence of male breast cancer in Scotland over a twenty-five-year period (1992-2017). Eur J Surg Oncol 2020; 46:1546-1550. [PMID: 31955992 DOI: 10.1016/j.ejso.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 01/14/2023] Open
Abstract
Male breast cancer (MBC) accounts for around 1% of all breast cancers diagnosed. There are inconsistent reports on the incidence of MBC which some propose may be rising. Here, for the first time, the incidence of MBC in Scotland over 25 years from 1992 to 2017 was examined through interrogating the Information Services Division Scotland database. Results showed MBC incidence rose with age, peaking in the 65-70 and 75-79 age groups. Both the total number and the age-adjusted incidence of MBC increased in Scotland since 1992. This rising trend was most clear in the North of Scotland. Interestingly a higher MBC incidence in some rural areas was also observed. Our findings emphasise the need for a better understanding of MBC risk factors so that improved prevention policies can be applied for patient benefit.
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Affiliation(s)
- Robyn Reddington
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Morgan Galer
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Amanda Hagedorn
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Peng Liu
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sophie Barrack
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Ehab Husain
- Department of Pathology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Ravi Sharma
- Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Valerie Speirs
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Yazan Masannat
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK; Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZD, UK.
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52
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Landgren O, Zeig-Owens R, Giricz O, Goldfarb D, Murata K, Thoren K, Ramanathan L, Hultcrantz M, Dogan A, Nwankwo G, Steidl U, Pradhan K, Hall CB, Cohen HW, Jaber N, Schwartz T, Crowley L, Crane M, Irby S, Webber MP, Verma A, Prezant DJ. Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster. JAMA Oncol 2019; 4:821-827. [PMID: 29710195 PMCID: PMC6145680 DOI: 10.1001/jamaoncol.2018.0509] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Question Are environmental exposures from the World Trade Center disaster site associated with multiple myeloma and its precursor disease, monoclonal gammopathy of undetermined significance (MGUS), in New York City firefighters? Findings In this case series, 16 participants were diagnosed with multiple myeloma after September 11, 2001, with a median age of disease onset of 57 years, and in subsets with relevant data, a high proportion of the cases had light-chain myeloma, and plasma cells were CD20 positive. In the screening study, World Trade Center exposure was found to be statistically significantly associated with light-chain MGUS and overall MGUS. Meaning World Trade Center disaster exposures are associated with myeloma precursor disease (MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age. Importance The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood. Objective To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS. Design, Setting, and Participants Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781). Exposures WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002. Main Outcomes and Measures Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS. Results Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93). Conclusions and Relevance Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Orsolya Giricz
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Kaznouri Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - George Nwankwo
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Ulrich Steidl
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Kith Pradhan
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Theresa Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | | | | | - Shani Irby
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mayris P Webber
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
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53
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Salto-Tellez M, Cree IA. Cancer taxonomy: pathology beyond pathology. Eur J Cancer 2019; 115:57-60. [PMID: 31108243 DOI: 10.1016/j.ejca.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 02/03/2023]
Abstract
The way we categorise and classify cancer types dictates not only the way we diagnose and treat patients but also many of our decisions on biomarker and drug development. In addition, cancer taxonomy proves the ground truth for future discoveries in the area of computational pathology and artificial intelligence. This editorial comment illustrates the relevance of cancer taxonomy in clinical and morphomolecular diagnosis, prognosis and therapeutic prediction; it shows its importance in identifying the epidemiology, aetiology and pathogenesis in oncology and explains its determinant role in computational tissue-based cancer diagnosis.
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Affiliation(s)
- Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.
| | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France.
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54
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Bell C, Kerr K, Moore K, McShane C, Anderson L, McKnight AJ, McAneney H. Communication strategies for rare cancers: a systematic review protocol. Syst Rev 2019; 8:102. [PMID: 31014400 PMCID: PMC6477728 DOI: 10.1186/s13643-019-1017-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/05/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Rare cancers comprise almost a quarter of all cancers in Europe, and patients generally have poorer outcomes than those suffering from more common cancers. This is attributed in part to a general lack of knowledge and awareness of rare cancers. This review aims to examine the communication strategies being used throughout the world to inform on rare cancers and to highlight any opportunities for improvement. METHODS A systematic review of literature published in English prior to November 2018 will be conducted, screening articles from the electronic databases MEDLINE, PubMed, EMBASE, Web of Science, PsycINFO, CINAHL Plus and the Cochrane Database of Systematic Reviews. Grey literature databases (GreyLit, OpenGrey) will also be searched in order to screen for any unpublished works. As well as primary literature, reference lists will be examined via forward and reverse citation screening. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Titles and abstracts will first be examined for eligibility, with remaining studies undergoing a full-text screening before being included in the final review. Individual studies will be screened for bias, and a meta-analysis performed provided there is enough data. If insufficient homogenous literature exists, a narrative summary of the literature will be produced. DISCUSSION Despite the broad topic and width of study type that will be considered, this review hopes to provide a reflective summary of the communication strategies available for people living with and working with rare cancer. It aims to reveal any gaps in the resources available, to contribute to the long-term improvement of diagnosis and management of rare cancers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099784.
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Affiliation(s)
- Catherine Bell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Katie Kerr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Kerry Moore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Charlene McShane
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Lesley Anderson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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55
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Demeure MJ. The Role of Precision Medicine in the Diagnosis and Treatment of Patients with Rare Cancers. Cancer Treat Res 2019; 178:81-108. [PMID: 31209842 DOI: 10.1007/978-3-030-16391-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Rare cancers pose unique challenges for patients and their physicians arising from a lack of information regarding the best therapeutic options. Very often, a lack of clinical trial data leads physicians to choose treatments based on small case series or case reports. Precision medicine based on genomic analysis of tumors may allow for selection of better treatments with greater efficacy and less toxicity. Physicians are increasingly using genetics to identify patients at high risk for certain cancers to allow for early detection or prophylactic interventions. Genomics can be used to inform prognosis and more accurately establish a diagnosis. Genomic analysis may also expose therapeutic targets for which drugs are currently available and approved for use in other cancers. Notable successes in the treatment of previously refractory cancers have resulted. New more advanced sequencing technologies, tools for interpretation, and an increasing array of targeted drugs offer additional hope, but challenges remain.
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Affiliation(s)
- Michael J Demeure
- Hoag Family Cancer Institute, Newport Beach, CA, USA.
- Translational Genomics Research Institute, Phoenix, AZ, USA.
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56
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Bacinschi XE, Ilie SM, Trifanescu OG, Serbanescu GL, Botnariuc I, Curea F, Orlov C, Anghel RM. Rare Pelvic Malignant Tumors in Adults: Treatment Features and Clinical Outcome in Nonmetastatic Disease (Single Institution Experience). Cancer Biother Radiopharm 2018; 34:56-66. [PMID: 30484700 DOI: 10.1089/cbr.2018.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nearly 200 cancers repertories are rare, and more than 20% are pelvic neoplasia. Diagnosis and treatment are challenging, even in reference centers, and survival is influenced by the aggressiveness of certain histologies and absence of a standard of care. PATIENTS AND METHODS The authors report the results of a retrospective analysis of patients that attended the Institute of Oncology, Bucharest, between 2004 and 2015, for nonmetastatic pelvic malignant tumor treatment and follow-up. The outcomes are compared between the rare and common histology groups. RESULTS Of the 60 cases analyzed, 17 patients (28.33%) bore a rare tumor, 33 (55%) were women, and the median age was 59 years. The majority was concerned by bladder (41.66%, 25 patients) and cervix (23.33%, 14 patients) neoplasms. For a median follow-up of 27.5 months, relapse was registered in 27 patients (45%), of whom 9 (33.33%) were from the rare group (53% of this subpopulation). The highest relapse rates were recorded in patients with rare bladder tumors (66.7%, 4 patients) compared with 42.1% (8 patients) in the common group (p = 0.294) and in prostate localization (66.7%, 2 patients) compared with 16.7% (1 patient) (p = 0.134). Estimated median relapse-free survival (RFS) was 60, 12 months in the rare group and 67 months for common tumors. CONCLUSIONS In nonmetastatic rare pelvic tumor patients, the outcome was found to be poorer than in those concerned by common histologies stratified by organ. A higher rate of relapse and the lowest median RFS were observed in bladder and prostatic cancers.
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Affiliation(s)
- Xenia E Bacinschi
- 1 Department of Oncology-Radiotherapy, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu," Bucharest, Romania
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Silvia M Ilie
- 1 Department of Oncology-Radiotherapy, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu," Bucharest, Romania
| | - Oana G Trifanescu
- 1 Department of Oncology-Radiotherapy, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu," Bucharest, Romania
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Georgia-Luiza Serbanescu
- 1 Department of Oncology-Radiotherapy, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu," Bucharest, Romania
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Inga Botnariuc
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Fabiana Curea
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Cristina Orlov
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Rodica M Anghel
- 1 Department of Oncology-Radiotherapy, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu," Bucharest, Romania
- 2 University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
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57
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Lopez-Beltran A, Canas-Marques R, Cheng L, Montironi R. Histopathologic challenges: The second OPINION issue. Eur J Surg Oncol 2018; 45:12-15. [PMID: 30360986 DOI: 10.1016/j.ejso.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/06/2018] [Indexed: 01/12/2023] Open
Abstract
Classification and definition criteria for rare cancer is still an open issue in clinical practice due to several factors, which include the limited available molecular data to better defining specific tumor groups or "families" of interest. An important issue related to the proper management of these entities is the correct diagnosis and subtyping of a given entity. The high complexity associated with the histopathologic diagnosis and eventual molecular analysis may suggest the use of a histopathologic second opinion from a specialized pathologist. Diagnostic inaccuracies and difference between primary diagnosis and second opinion are expected at the population level: however, the magnitude of this difference is remarkably high and calls for implementation of second opinion in routine practice outside reference centers.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Surgery and Pathology, University of Cordoba Medical School, Cordoba, Spain; Champalimaud Clinical Center, Lisbon, Portugal.
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Rodolfo Montironi
- Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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58
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Bergerot CD, Bergerot PG, Philip EJ, De Domenico EBL, Manhaes MFM, Pedras RN, Salgia MM, Dizman N, Ashing KT, Li M, Dale W, Pal SK. Assessment of distress and quality of life in rare cancers. Psychooncology 2018; 27:2740-2746. [DOI: 10.1002/pon.4873] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Cristiane Decat Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Paulo Gustavo Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Errol J. Philip
- The Notre Dame Laboratory for Psycho-Oncology Research; University of Notre Dame; Notre Dame IL USA
| | | | | | | | - Meghan M. Salgia
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Kimlin Tam Ashing
- Department of Population Sciences; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Min Li
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - William Dale
- Department of Supportive Care Medicine; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
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Groisberg R, Hong DS, Roszik J, Janku F, Tsimberidou AM, Javle M, Meric-Bernstam F, Subbiah V. Clinical Next-Generation Sequencing for Precision Oncology in Rare Cancers. Mol Cancer Ther 2018; 17:1595-1601. [PMID: 29654067 DOI: 10.1158/1535-7163.mct-17-1107] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/19/2018] [Accepted: 04/10/2018] [Indexed: 12/16/2022]
Abstract
The European Society for Medical Oncology defines rare cancers as 5 or fewer cases per 100,000 persons per year. For many rare cancers, no standard of care exists, and treatment is often extrapolated. Identifying potentially targetable genomic alterations in rare tumors is a rational approach to improving treatment options. We sought to catalog these mutations in rare tumors and to assess their clinical utility.For this retrospective analysis, we selected rare tumor patients from a dataset of patients who underwent clinical tumor genomic profiling. Sarcomas were excluded. To index potentially actionable alterations, patients' reports were reviewed for mutations in cancer-associated genes and pathways. Respective clinical records were abstracted to appraise the benefit of using a targeted therapy approach. Actionable alterations were defined as targeted by a drug available on-label, off-label, or in clinical trials.The 95 patients analyzed had 40 different tumor subtypes, most common being adenoid cystic (13%), cholangiocarcinoma (7%), and metaplastic breast (6%). At least one genomic alteration was identified in 87 patients (92%). The most common identifiable mutations were in TP53 (23%), KRAS (10%), PIK3CA (9%), CDKN2A/B (8%), BRAF (7%), MLL (7%), and ARID1A (6%). Thirty-six patients (38%) with 21 different tumors had at least one potentially actionable alteration. Thirteen patients received targeted therapy. Of these, 4 had a partial response, 6 had stable disease, and 3 had progressive disease as the best response.The addition of genomic profiling to management of rare cancers adds a potential line of therapy for cancers that have little or no standard of care. In our analysis, tumors with a BRAF alteration responded well to BRAF inhibitors. Mol Cancer Ther; 17(7); 1595-601. ©2018 AACR.
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Affiliation(s)
- Roman Groisberg
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Roszik
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, Texas.
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60
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Doytchinova IA, Flower DR. In silico prediction of cancer immunogens: current state of the art. BMC Immunol 2018; 19:11. [PMID: 29544447 PMCID: PMC5856276 DOI: 10.1186/s12865-018-0248-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/06/2018] [Indexed: 01/22/2023] Open
Abstract
Cancer kills 8 million annually worldwide. Although survival rates in prevalent cancers continue to increase, many cancers have no effective treatment, prompting the search for new and improved protocols. Immunotherapy is a new and exciting addition to the anti-cancer arsenal. The successful and accurate identification of aberrant host proteins acting as antigens for vaccination and immunotherapy is a key aspiration for both experimental and computational research. Here we describe key elements of in silico prediction, including databases of cancer antigens and bleeding-edge methodology for their prediction. We also highlight the role dendritic cell vaccines can play and how they can act as delivery mechanisms for epitope ensemble vaccines. Immunoinformatics can help streamline the discovery and utility of Cancer Immunogens.
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Affiliation(s)
- Irini A. Doytchinova
- Faculty of Pharmacy, Medical University of Sofia, 2 Dunav st, 1000 Sofia, Bulgaria
| | - Darren R. Flower
- School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET UK
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61
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Abstract
Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients' evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers.
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Affiliation(s)
- Raveendran K Pillai
- Division of Clinical Laboratory, Regional Cancer Centre, Thiruvananthapuram, India
| | - K Jayasree
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
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Yamane H, Kunisada T, Ozaki T, Ochi N, Honda Y, Nagasaki Y, Nakagawa N, Yamagishi T, Nakanishi H, Takigawa N. Patients with osteosarcoma and soft tissue sarcoma might become "cancer refugees" in some Japanese regional cities. Cancer Manag Res 2018; 10:353-359. [PMID: 29497333 PMCID: PMC5822855 DOI: 10.2147/cmar.s155282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose "Rare cancer" is defined as malignancy with a disease prevalence (age-adjusted incidence rate) of less than six per 100,000 population. Proper treatments which these patients need cannot always be performed unless they find dedicated facilities. Patients tend to be desperate, searching for advice and care. Thus, they are called "cancer refugees". Osteosarcoma and soft tissue sarcoma (OS/STS) are representative rare cancers in Japan. We conducted a retrospective analysis of patients with OS/STS to improve the current treatment modalities in a Japanese regional city. Patients and methods Twenty-one patients with OS/STS who were hospitalized to receive standard chemotherapy or palliative treatment were enrolled between October 2011 and January 2017. Patients with non-Hodgkin's lymphoma (NHL) and advanced cancer who were treated in the palliative care unit (PCU) of the Kawasaki Medical School General Medical Center were recruited as the control groups. We analyzed the difference in residential area between patients with OS/STS and the control groups. Results Approximately one-third of patients with OS/STS were referred from hospitals outside of Okayama prefecture. The ratio of patients with OS/STS referred from Okayama city and/or the same medical administration area of Okayama prefecture was lower than that of patients with NHL and advanced cancer who were treated in the PCU. Conclusion Because the medical environment of patients with OS/STS in Japanese local cities has not been consolidated, completing medical care within the patient's own medical administration area is difficult. Thus, some patients with OS/STS may become "cancer refugees" who are unable to receive standard therapy near their residence.
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Affiliation(s)
- Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Toshiyuki Kunisada
- Department of Orthopedics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopedics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Yoshihiro Honda
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Yasunari Nagasaki
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Nozomu Nakagawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Tomoko Yamagishi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Hidekazu Nakanishi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
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Solitary-fibrous tumor/hemangiopericytoma of the central nervous system: a population-based study. J Neurooncol 2018; 138:173-182. [DOI: 10.1007/s11060-018-2787-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
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Kato S, Kurasaki K, Ikeda S, Kurzrock R. Rare Tumor Clinic: The University of California San Diego Moores Cancer Center Experience with a Precision Therapy Approach. Oncologist 2018; 23:171-178. [PMID: 29038235 PMCID: PMC5813742 DOI: 10.1634/theoncologist.2017-0199] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patients with rare tumors may lack approved treatments and clinical trial access. Although each rare tumor is uncommon, cumulatively they account for approximately 25% of cancers. We recently initiated a Rare Tumor Clinic that emphasized a precision medicine strategy. MATERIALS AND METHODS We investigated the first 40 patients presenting at the Rare Tumor Clinic. Next-generation sequencing (NGS) of tissue and plasma-derived, circulating-tumor DNA (ctDNA), and protein markers were assessed. RESULTS Median age was 58 years (range, 31-78 years); 70% (28/40) were women; median number of previous systemic therapies was 2 (range 0-7). The most common diagnoses were sarcoma (n = 7) for solid tumors and Erdheim-Chester disease (n = 5) for hematologic malignancies. Twenty distinct diagnoses were seen. Examples of ultrarare tumors included ameloblastoma, yolk sac liver tumor, ampullary cancer, and Castleman's disease. Altogether, 32 of 33 patients (97%) with tissue NGS and 15 of 33 (45%) with ctDNA sequencing harbored ≥1 alteration. Overall, 92.5% of patients (37/40) had ≥1 actionable target based on either genomic (n = 32) or protein (n = 27) markers. In total, 52.5% (21/40) received matched therapy; 52.4% (11/21) achieved stable disease (SD) ≥6 months (n = 3), partial remission (PR; n = 6), or complete remission (CR; n = 2). Matched therapy resulted in significantly longer progression-free survival compared with last prior unmatched therapy (hazard ratio 0.26, 95% confidence interval 0.10-0.71, p = .008). CONCLUSION Identifying genomic and protein markers in patients with rare/ultrarare tumors was feasible. When therapies were matched, >50% of patients attained SD ≥6 months, PR, or CR. Further precision medicine clinical investigations focusing on rare and ultrarare tumors are urgently needed. IMPLICATIONS FOR PRACTICE Although rare tumors are infrequent by definition, when all subtypes of rare cancers are combined, they account for approximately 25% of adult malignancies. However, patients with rare tumors may lack approved treatments and clinical trial access. This paper describes an institutional a Rare Tumor Clinic focused on a precision medicine strategy. Performing genomics and protein analyses was feasible amongst patients with rare cancers. Over 50% of patients attained SD ≥6 months, PR, or CR when they received matched therapy (genomically targeted and/or immunotherapy). Further studies investigating the efficacy of the precision therapy approach among rare tumors are warranted.
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Affiliation(s)
- Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Kellie Kurasaki
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Sadakatsu Ikeda
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, San Diego, California, USA
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Lang JD, Hendricks WPD. Identification of Driver Mutations in Rare Cancers: The Role of SMARCA4 in Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT). Methods Mol Biol 2018; 1706:367-379. [PMID: 29423809 DOI: 10.1007/978-1-4939-7471-9_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cancer is a complex genetic disease that can arise through the stepwise accumulation of mutations in oncogenes and tumor suppressor genes in a variety of different tissues. While the varied landscapes of mutations driving common cancer types such as lung, breast, and colorectal cancer have been comprehensively charted, the genetic underpinnings of many rare cancers remain poorly defined. Study of rare cancers faces unique methodological challenges, but collaborative enterprises that incorporate next generation sequencing, reach across disciplines (i.e., pathology, genetic epidemiology, genomics, functional biology, and preclinical modeling), engage advocacy groups, tumor registries, and clinical specialists are adding increasing resolution to the genomic landscapes of rare cancers. Here we describe the approaches and methods used to identify SMARCA4 mutations, which drive development of the rare ovarian cancer, small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), and point to the broader relevance of this paradigm for future research in rare cancers.
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Affiliation(s)
- Jessica D Lang
- Translational Genomics Research Institute, 445 N Fifth Street, Phoenix, AZ, 85004, USA
| | - William P D Hendricks
- Translational Genomics Research Institute, 445 N Fifth Street, Phoenix, AZ, 85004, USA.
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Montes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica 2017; 41:e117. [PMID: 31384255 PMCID: PMC6645409 DOI: 10.26633/rpsp.2017.117] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/13/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To determine the global incidence of penile cancer. METHODS A systematic review and meta-analysis of observational studies was performed, with no limits on their language of publication. Analyses were performed using Stata 13 statistical software. A random-effects model was used, according to the heterogeneity found in the studies. The main outcome was expressed in terms of age-standardized incidence. RESULTS A total of 23 studies were eligible, with 71 156 penile cancer patients in 86 countries. According to the review conducted, the estimated age-standardized incidence of penile cancer worldwide is 0.84 cases per 100 000 person-years (95% confidence interval: 0.79-0.89). Romania reported the highest incidence, 7.26 per 100 000 person-years, between 1983 and 1987; however, some countries in Latin America and Africa reported an incidence of between 2.0 and 5.7 per 100 000. CONCLUSIONS Penile cancer is considered a rare malignancy due to its already-known, particularly low incidence rate. The estimated age-standardized incidence rate by the world standard population today is 0.84 cases per 100 000 person-years. There were no significant differences in the incidence rate of penile cancer with respect to the distribution by continent or the trend over time.
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Affiliation(s)
- Carlos Eduardo Montes Cardona
- Department of Urology, Universidad del ValleDepartment of Urology, Universidad del ValleSantiago de CaliColombiaDepartment of Urology, Universidad del Valle, Santiago de Cali, Colombia.
| | - Herney Andrés García-Perdomo
- Department of Urology, Universidad del ValleDepartment of Urology, Universidad del ValleSantiago de CaliColombiaDepartment of Urology, Universidad del Valle, Santiago de Cali, Colombia.
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Alvi MA, Wilson RH, Salto-Tellez M. Rare cancers: the greatest inequality in cancer research and oncology treatment. Br J Cancer 2017; 117:1255-1257. [PMID: 28934760 PMCID: PMC5672935 DOI: 10.1038/bjc.2017.321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Muhammad A Alvi
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Northern Ireland BT9 7AE, UK
| | - Richard H Wilson
- Colorectal Cancer Focus Group, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Northern Ireland BT9 7AE, UK
| | - Manuel Salto-Tellez
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Northern Ireland BT9 7AE, UK
- Tissue Pathology Department, Belfast Health and Social Care Trust, Northern Ireland BT12 6BA, UK
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Page DB, Wen H, Brogi E, Dure D, Ross D, Spinelli KJ, Patil S, Norton L, Hudis C, McArthur HL. Monosomy 17 in potentially curable HER2-amplified breast cancer: prognostic and predictive impact. Breast Cancer Res Treat 2017; 167:547-554. [PMID: 28986743 DOI: 10.1007/s10549-017-4520-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/21/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE HER2 copy number by fluorescence in situ hybridization (FISH) is typically reported relative to the centromere enumeration probe 17 (CEP17). HER2/CEP17 ratio could be impacted by alterations in the number of chromosome 17 copies. Monosomy of chromosome 17 (m17) is found in ~ 1900 cases of early-stage HER2-positive breast cancer annually in the United States; however, the efficacy of HER2-directed trastuzumab therapy in these patients is not well characterized. Here, we retrospectively identified HER2-amplified, stage I-III breast cancers with m17 and characterized the impact of trastuzumab treatment. METHODS From January 1, 2000 to June 1, 2011, we identified 99 women with HER2-amplified m17 breast cancers, as defined by a CEP17 signal of < 1.5 per nucleus and a HER2/CEP17 ratio of ≥ 2.0. RESULTS Most HER2-amplified m17 patients were treated with trastuzumab plus chemotherapy (51%, n = 50), whereas 31% (n = 31) received chemotherapy alone and 18% (n = 18) received no chemotherapy. The 4-year overall survival (OS) was superior with trastuzumab compared to chemotherapy alone or no chemotherapy (100 vs. 93 vs. 81%, respectively; p = 0.005). OS was not influenced by estrogen/progesterone-receptor (ER/PR) status, tumor stage, or degree of FISH positivity. A proportion of patients who would be considered HER2-negative by standard immunohistochemistry staging criteria (0-1+) were HER2 amplified by FISH. CONCLUSIONS In the largest series reported to date, patients with HER2-amplified m17 cancers treated with trastuzumab have outcomes comparable to patients from the large phase III adjuvant trastuzumab trials who were HER2-positive, supporting the critical role of HER2-directed therapy in this patient population.
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Affiliation(s)
- David B Page
- Providence Cancer Center, Earle A. Chiles Research Institute, 4805 NE Glisan St., Suite 6N40, Portland, OR, 97213, USA.
| | - Hannah Wen
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Edi Brogi
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Dana Dure
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Dara Ross
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Kateri J Spinelli
- Providence Cancer Center, Earle A. Chiles Research Institute, 4805 NE Glisan St., Suite 6N40, Portland, OR, 97213, USA
| | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Larry Norton
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Clifford Hudis
- Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Heather L McArthur
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, AC 1042B, Los Angeles, CA, 90048, USA.
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Sharifnia T, Hong AL, Painter CA, Boehm JS. Emerging Opportunities for Target Discovery in Rare Cancers. Cell Chem Biol 2017; 24:1075-1091. [PMID: 28938087 PMCID: PMC5857178 DOI: 10.1016/j.chembiol.2017.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022]
Abstract
Rare cancers pose unique challenges to research due to their low incidence. Barriers include a scarcity of tissue and experimental models to enable basic research and insufficient patient accrual for clinical studies. Consequently, an understanding of the genetic and cellular features of many rare cancer types and their associated vulnerabilities has been lacking. However, new opportunities are emerging to facilitate discovery of therapeutic targets in rare cancers. Online platforms are allowing patients with rare cancers to organize on an unprecedented scale, tumor genome sequencing is now routinely performed in research and clinical settings, and the efficiency of patient-derived model generation has improved. New CRISPR/Cas9 and small-molecule libraries permit cancer dependency discovery in a rapid and systematic fashion. In parallel, large-scale studies of common cancers now provide reference datasets to help interpret rare cancer profiling data. Together, these advances motivate consideration of new research frameworks to accelerate rare cancer target discovery.
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Affiliation(s)
- Tanaz Sharifnia
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Andrew L Hong
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Jesse S Boehm
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA.
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Abstract
There are limited published data on the burden of rare cancers in the United States. By using data from the North American Association of Central Cancer Registries and the Surveillance, Epidemiology, and End Results program, the authors provide information on incidence rates, stage at diagnosis, and survival for more than 100 rare cancers (defined as an incidence of fewer than 6 cases per 100,000 individuals per year) in the United States. Overall, approximately 20% of patients with cancer in the United States are diagnosed with a rare cancer. Rare cancers make up a larger proportion of cancers diagnosed in Hispanic (24%) and Asian/Pacific Islander (22%) patients compared with non-Hispanic blacks (20%) and non-Hispanic whites (19%). More than two-thirds (71%) of cancers occurring in children and adolescents are rare cancers compared with less than 20% of cancers diagnosed in patients aged 65 years and older. Among solid tumors, 59% of rare cancers are diagnosed at regional or distant stages compared with 45% of common cancers. In part because of this stage distribution, 5-year relative survival is poorer for patients with a rare cancer compared with those diagnosed with a common cancer among both males (55% vs 75%) and females (60% vs 74%). However, 5-year relative survival is substantially higher for children and adolescents diagnosed with a rare cancer (82%) than for adults (46% for ages 65-79 years). Continued efforts are needed to develop interventions for prevention, early detection, and treatment to reduce the burden of rare cancers. Such discoveries can often advance knowledge for all cancers. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:261-272. © 2017 American Cancer Society.
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Affiliation(s)
- Carol E DeSantis
- Director, Breast and Gynecological Cancer Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Joan L Kramer
- Assistant Professor of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Kato S, Krishnamurthy N, Banks KC, De P, Williams K, Williams C, Leyland-Jones B, Lippman SM, Lanman RB, Kurzrock R. Utility of Genomic Analysis In Circulating Tumor DNA from Patients with Carcinoma of Unknown Primary. Cancer Res 2017. [PMID: 28642281 DOI: 10.1158/0008-5472.can-17-0628] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Carcinoma of unknown primary (CUP) is a rare and difficult-to-treat malignancy, the management of which might be improved by the identification of actionable driver mutations. We interrogated 54 to 70 genes in 442 patients with CUP using targeted clinical-grade, next-generation sequencing of circulating tumor DNA (ctDNA). Overall, 80% of patients exhibited ctDNA alterations; 66% (290/442) ≥1 characterized alteration(s), excluding variants of unknown significance. TP53-associated genes were most commonly altered [37.8% (167/442)], followed by genes involved in the MAPK pathway [31.2% (138/442)], PI3K signaling [18.1% (80/442)], and the cell-cycle machinery [10.4% (46/442)]. Among 290 patients harboring characterized alterations, distinct genomic profiles were observed in 87.9% (255/290) of CUP cases, with 99.7% (289/290) exhibiting potentially targetable alterations. An illustrative patient with dynamic changes in ctDNA content during therapy and a responder given a checkpoint inhibitor-based regimen because of a mismatch repair gene anomaly are presented. Our results demonstrate that ctDNA evaluation is feasible in CUP and that most patients harbor a unique somatic profile with pharmacologically actionable alterations, justifying the inclusion of noninvasive liquid biopsies in next-generation clinical trials. Cancer Res; 77(16); 4238-46. ©2017 AACR.
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Affiliation(s)
- Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California.
| | - Nithya Krishnamurthy
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California
| | | | - Pradip De
- Avera Cancer Institute, Sioux Falls, South Dakota
| | | | | | | | - Scott M Lippman
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California
| | | | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California
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Leary AF, Quinn M, Fujiwara K, Coleman RL, Kohn E, Sugiyama T, Glasspool R, Ray-Coquard I, Colombo N, Bacon M, Zeimet A, Westermann A, Gomez-Garcia E, Provencher D, Welch S, Small W, Millan D, Okamoto A, Stuart G, Ochiai K. Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG): clinical trial design for rare ovarian tumours. Ann Oncol 2017; 28:718-726. [PMID: 27993794 PMCID: PMC6246130 DOI: 10.1093/annonc/mdw662] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This manuscript reports the consensus statements on designing clinical trials in rare ovarian tumours reached at the fifth Ovarian Cancer Consensus Conference (OCCC) held in Tokyo, November 2015. Three important questions were identified concerning rare ovarian tumours (rare epithelial ovarian cancers (eOC), sex-cord stromal tumours (SCST) and germ cell tumours (GCT)): (i) What are the research and trial issues that are unique to rare ovarian tumours? There is a lack of randomised phase III data defining standards of care which makes it difficult to define control arms, but identifies unmet needs that merit investigation. Internationally agreed upon diagnostic criteria, expert pathological review and translational research are crucial. (ii) What should be investigated in rare eOC, GCT and SCST? Trials dedicated to each rare ovarian tumour should be encouraged. Nonetheless, where the question is relevant, rare eOC can be included in eOC trials but with rigorous stratification. Although there is emerging evidence suggesting that rare eOC have different molecular profiles, trials are needed to define new type-specific standards for each rare eOC (clear cell, low grade serous and mucinous). For GCTs, a priority is reducing toxicities from treatment while maintaining cure rates. Both a robust prognostic scoring system and more effective treatments for de novo poor prognosis and relapsed GCTs are needed. For SCSTs, validated prognostic markers as well as alternatives to the current standard of bleomycin/etoposide/cisplatin (BEP) should be identified. (iii) Are randomised trials feasible? Randomised controlled trials (RCT) should be feasible in any of the rare tumours through international collaboration. Ongoing trials have already demonstrated the feasibility of RCT in rare eOC and SCST. Mucinous OC may be considered for inclusion, stratified, into RCTs of non-gynaecological mucinous tumours, while RCTs in high risk or relapsed GCT may be carried out as a subset of male and/or paediatric germ cell studies.
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Affiliation(s)
- A F Leary
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif, France
| | - M Quinn
- ANZGOG Coordinating Centre, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - E Kohn
- National Cancer Institute, Bethesda, MD, USA
| | | | | | - I Ray-Coquard
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif, France
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Shrivastava S. Cancer research: Challenges and promise for individualized treatment. JOURNAL OF RADIATION AND CANCER RESEARCH 2017. [DOI: 10.4103/jrcr.jrcr_26_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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James BC, Aschebrook-Kilfoy B, Cipriani N, Kaplan EL, Angelos P, Grogan RH. The Incidence and Survival of Rare Cancers of the Thyroid, Parathyroid, Adrenal, and Pancreas. Ann Surg Oncol 2016; 23:424-33. [PMID: 26467460 DOI: 10.1245/s10434-015-4901-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE With the exception of papillary and follicular thyroid cancer, malignant cancers of the thyroid, parathyroid, adrenal, and endocrine pancreas are uncommon. These rare malignancies present a challenge to both the clinician and patient, because few data exist on their incidence or survival. We analyzed the incidence and survival of these rare endocrine cancers (RECs), as well as the trends in incidence over time. METHODS We used the NCI's SEER 18 database (2000-2012) to investigate incidence and survival of rare cancers of the thyroid, parathyroid, adrenal, and endocrine pancreas. Cancers were categorized using the WHO classification systems. We collected data on incidence, gender, stage, size, and survival. Time trends were evaluated from 2000-2002 to 2010-2012. RESULTS We identified 36 types of rare cancers in the endocrine organs captured in the SEER database. RECs of the thyroid had the highest combined incidence rate (IR8.26), followed by pancreas (IR 3.24), adrenal (IR 2.71), and parathyroid (IR 0.41). The incidence rate for all rare endocrine organs combined increased 32.4 % during the study period. The majority of the increase was attributable to rare cancers of thyroid, which increased in not only microcarcinomas, but in all sizes. The mean 5-year survival for RECs is 59.56 % (range 2.49–100 %). CONCLUSIONS This study is a comprehensive analysis ofthe incidence and survival for rare malignant endocrine cancers. There has been an increase in incidence rate of almost all RECs and their survival is low. We hope that our data will serve as a source of information for clinicians as well as bring awareness regarding these uncommon cancers.
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Boyd N, Dancey JE, Gilks CB, Huntsman DG. Rare cancers: a sea of opportunity. Lancet Oncol 2016; 17:e52-e61. [PMID: 26868354 DOI: 10.1016/s1470-2045(15)00386-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 12/18/2022]
Abstract
Rare cancers, as a collective, account for around a quarter of all cancer diagnoses and deaths. Historically, they have been divided into two groups: cancers defined by their unusual histogenesis (cell of origin or differentiation state)--including chordomas or adult granulosa cell tumours--and histologically defined subtypes of common cancers. Most tumour types in the first group are still clinically and biologically relevant, and have been disproportionately important as sources of insight into cancer biology. By contrast, most of those in the second group have been shown to have neither defining molecular features nor clinical utility. Omics-based analyses have splintered common cancers into a myriad of molecularly, rather than histologically, defined subsets of common cancers, many of which have immediate clinical relevance. Now, almost all rare cancers are either histomolecular entities, which often have pathognomonic mutations, or molecularly defined subsets of more common cancers. The presence of specific genetic variants provides rationale for the testing of targeted drugs in rare cancers. However, in addition to molecular alterations, it is crucial to consider the contributions of both mutation and cell context in the development, biology, and behaviour of these cancers. Patients with rare cancers are disadvantaged because of the challenge of leading clinical trials in this setting due to poor accrual. However, the number of patients with rare cancers will only increase as more molecular subsets of common cancers are identified, necessitating a shift in the focus of clinical trials and research into these cancer types, which, by epidemiological definitions, will become rare tumours.
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Affiliation(s)
- Niki Boyd
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Janet E Dancey
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - David G Huntsman
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine and Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
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Adams LS, Miller JL, Grady PA. The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions. J Palliat Med 2016; 19:698-705. [PMID: 27249541 DOI: 10.1089/jpm.2015.0464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rare diseases are often life-limiting conditions, the majority of which require constant caregiving needs. The realization of a spectrum of palliative care throughout the trajectory of rare diseases could ensure individualized and caregiver-focused approaches to the care of patients and families. In June 2015, the National Institute of Nursing Research (NINR), the lead institute at the National Institutes of Health for end-of-life research, in conjunction with the National Center for Advancing Translational Sciences, Office of Rare Diseases Research (ORDR) held an interdisciplinary workshop on the unique challenges of caregiving and palliative care in adult and pediatric rare diseases. The panel identified gaps in current knowledge, and afforded suggestions for research opportunities in palliative care science to improve the care of individuals with serious, advanced, rare diseases and their caregivers. This meeting provided an in-depth opportunity to incorporate new concepts into palliative and end-of-life care for individuals with a range of rare diseases and their caregivers. This report presents a summary of the workshop.
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Affiliation(s)
- Lynn S Adams
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Jeri L Miller
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Patricia A Grady
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
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78
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Komatsubara KM, Carvajal RD. The promise and challenges of rare cancer research. Lancet Oncol 2016; 17:136-138. [DOI: 10.1016/s1470-2045(15)00485-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 02/07/2023]
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79
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Bradford D, Reilly KM, Widemann BC, Sandler A, Kummar S. Developing therapies for rare tumors: opportunities, challenges and progress. Expert Opin Orphan Drugs 2016; 4:93-103. [PMID: 32765971 DOI: 10.1517/21678707.2016.1120663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Rare tumors account for one fourth of adult tumors; in children, rare tumors represent approximately 15-20% of childhood malignancies, thus accounting for a significant burden of disease. The rarity of these individual diseases creates many challenges, from developing a thorough understanding of the disease pathophysiology, clinical characterization, to the conduct of meaningful clinical trials and eventually the development of effective therapies. Areas covered Despite these challenges, substantial advances have been made in recent years including the development of novel clinical trial designs and endpoints including molecularly driven treatment trials that have resulted in approval of novel therapies for rare diseases. Collaboration amongst basic and clinical researchers, patient advocacy groups, industry and regulatory agencies has proven successful in select cases and holds promise for future progress in the treatment of rare tumors. In this review, we will highlight several examples of trials for rare tumors, with a focus on examples from pediatric oncology, where strong, nationwide collaborative groups have existed for many years. Expert opinion Future progress in developing therapies for rare tumors will depend not only on continued scientific advances, but also on collaboration between investigators from various disciplines, institutions, regulatory agencies and patient advocacy groups.
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Affiliation(s)
- Diana Bradford
- Department of Hematology/Oncology, Children's National Medical Center, Washington, DC 20010, USA.,National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Karlyne M Reilly
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brigitte C Widemann
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Abby Sandler
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shivaani Kummar
- Stanford University School of Medicine, Stanford, CA 94304, USA
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Abstract
The term rare cancers is relatively new in oncology, with significant presence in cancer literature occurring only since the early 2000s. Epidemiologic studies in Europe and the United States show that rare cancers account for about 25% of adult cancers (Eslick, 2012). However, rare cancer types have been traditionally understudied, with an associated lack of progress in survival and challenges in decision making for patients, physicians, and policy makers (Greenlee et al., 2010). Initiatives led within the European Union and with the United States are intended to boost progress in treatment for rare cancers through collective research and shared databases (Keat et al., 2013). Nurses see patients with rare cancers struggle for access to quality, evidence-based care, as well as the isolation they endure as they seek the information and support needed to cope with the diagnosis of a life-threatening illness..
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81
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Schott AF, Welch JJ, Verschraegen CF, Kurzrock R. The National Clinical Trials Network: Conducting Successful Clinical Trials of New Therapies for Rare Cancers. Semin Oncol 2015; 42:731-9. [PMID: 26433554 DOI: 10.1053/j.seminoncol.2015.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rare cancers account for 27% of neoplasms diagnosed each year, and 25% of cancer-related deaths in the United States. However, rare cancers show some of the highest response rates to targeted therapies, probably due to identification of oncogenic drivers with little interpatient variability. Although the low incidence of rare cancers makes large-scale randomized trials involving single histologies difficult to perform, drugs have been successfully developed in rare cancers using clinical trial designs that combine microscopic histologies. Such trials are being pursued within the National Clinical Trials Network (NCTN), which possesses unique qualifications to perform widespread molecular screening of tumors for patient enrollment onto therapeutic clinical trials. When larger clinical trials are needed to determine optimum treatment strategies in rare cancers, the NCTN's broad reach in North America and internationally, and their ability to partner with both United States-based and international research organizations, can make these challenging studies feasible.
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Affiliation(s)
- Anne F Schott
- Department of Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI.
| | - John J Welch
- National Cancer Institute Center for Global Health , Bethesda, MD
| | | | - Razelle Kurzrock
- Division of Hematology and Oncology, Center for Personalized Therapy and Clinical Trials Office UC San Diego-Moores Cancer Center, San Diego, CA
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82
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Ashley D, Thomas D, Gore L, Carter R, Zalcberg JR, Otmar R, Savulescu J. Accepting risk in the acceleration of drug development for rare cancers. Lancet Oncol 2015; 16:e190-4. [PMID: 25846099 DOI: 10.1016/s1470-2045(14)71153-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rare cancers collectively contribute a disproportionate fraction of the total burden of cancer. The oncology community is increasingly facing small numbers of patients with each cancer subtype, requiring cooperation and collaboration to complete multicentre trials that advance knowledge and patient care. At the same time, new insights into the biology of rare cancers have led to an explosion in knowledge and development of targeted agents. These insights and techniques are set to revolutionise the care of patients with cancer. However, drug development strategies and the availability of new agents for rare cancers are at risk of stalling owing to the ever-increasing complexity and costs of clinical trials. Finding solutions to these problems is imperative to the future of cancer care. We propose that a greater degree of risk sharing is needed than is currently accepted to enable the use of new methods with confidence, and to keep pace with scientific advancement.
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Affiliation(s)
- David Ashley
- School of Medicine, Deakin University, Geelong, VIC, Australia; Andrew Love Cancer Centre, Barwon Health, Geelong, VIC, Australia.
| | - David Thomas
- Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Lia Gore
- Children's Hospital Colorado, Aurora, CO, USA; Center for Cancer and Blood Disorders, Aurora, CO, USA
| | - Rob Carter
- Deakin Health Economics, Deakin University, Burwood, VIC, Australia
| | - John R Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Renée Otmar
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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83
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Abstract
The Human Genome Project not only provided the essential reference map for the human genome but also stimulated the development of technology and analytic tools to process massive quantities of genomic data. As a result of this project, new technologies for DNA sequencing have improved in efficiency and cost by more than a millionfold over the past decade, and these technologies can now be routinely applied at a cost of less than $5,000 per genome. Although the application of these technologies in cancer genomics research has continued to contribute to basic discoveries, opportunities for translating them for individual patients have also emerged. This is especially important in clinical cancer research, where genetic alterations in a patient's tumor may be matched to molecularly targeted therapies. In this review, we discuss the integration of cancer genomics and clinical oncology and the opportunity to deliver precision cancer medicine.
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Affiliation(s)
- Sameek Roychowdhury
- Department of Internal Medicine, Division of Medical Oncology, and Comprehensive Cancer Center, Ohio State University, Columbus, Ohio 43210;
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84
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Shin DW, Cho J, Yang HK, Kim SY, Lee SH, Suh B, Shin HY, Lee HJ, Kim DG, Park JH. Oncologist Perspectives on Rare Cancer Care: A Nationwide Survey. Cancer Res Treat 2015; 47:591-9. [PMID: 25672585 PMCID: PMC4614206 DOI: 10.4143/crt.2014.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/01/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In response to the challenges and difficulties imposed by rare cancers, multi-stakeholder initiatives dedicated to improving rare cancer care was launched, and several recommendations were made by professional societies. However, these primarily reflect the view of the advocates and supporters, and may not represent the views of the "average" clinician or researcher. In this study, we sought to investigate perceived difficulties with regard to rare cancer care and potential solutions endorsed by oncologists. MATERIALS AND METHODS A representative sample of 420 oncologists recruited in 13 cancer centers participated in a nationwide survey. RESULTS Oncologists faced various difficulties in treatment of patients with rare cancers, including the lack of clinical practice guidelines (65.7%) and personal experience (65.2%), lack of approved treatment options (39.8%), and reimbursement issues (44.5%). They were generally supportive of recent recommendations by multi-stakeholder initiatives as well as professional societies for development of clear clinical practice guidelines (66.0%), flexible reimbursement guidelines (52.9%), and a national rare cancer registry (47.4%). However, there was only moderate endorsement for referrals to high-volume centers (35.5%) and encouragement of off-label treatments (21.0%). CONCLUSION Insights into the general attitudes of oncologists gained through our nationwide survey of representative samples would be helpful in development of clinical practices and public health policies in rare cancer treatment and research.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Juhee Cho
- Department of Health, Behavior and Society & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Cancer Education Center, Samsung Comprehensive Cancer Center, SAHIST and Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So Young Kim
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| | - Su Hyun Lee
- Department of Hemato-Oncology, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School and Clinical Trial Center, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Joo Lee
- Department of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dae Ghon Kim
- Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jong Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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85
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Tamaki T, Dong Y, Ohno Y, Sobue T, Nishimoto H, Shibata A. The burden of rare cancer in Japan: application of the RARECARE definition. Cancer Epidemiol 2014; 38:490-5. [PMID: 25155209 DOI: 10.1016/j.canep.2014.07.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the fact that rare cancer is a new target of cancer control in Japan, the incidence of rare cancers is unknown and there is no generally accepted definition of rare cancers in this country. With the aim of calculating incidences of rare cancers in Japan, we therefore adopted a definition and classification of rare cancers that had been published in the European Union (EU) in 2011. METHODS Using incidence data between 1998 and 2007 submitted by 12 of population based cancer registries in Japan that met our quality criteria and drawing on the EU definition (incidence <6 per 100,000 per year), we estimated the incidences of 845 combinations of tumor sites and histological groups and thus identified the cancers that are rare in Japan. RESULTS After identifying 193 combinations of tumor sites and histological groups that fit our criteria for rare cancers, we estimated their incidence to be about 75 per 100,000, which corresponds to about 94,800 new diagnoses in 2012 or approximately 15% of all cancer diagnoses. The categorization of rare and common cancers was almost the same in Japan as in EU. CONCLUSIONS The present study provides an indication of the size of the rare cancer burden in Japan and epidemiological information to explore this. We are expecting further discussion based on our results with stakeholders in order to construct a Japanese definition of rare cancers.
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Affiliation(s)
- Tomoko Tamaki
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita 565-0871, Osaka, Japan.
| | - Yiqi Dong
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita 565-0871, Osaka, Japan.
| | - Yuko Ohno
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita 565-0871, Osaka, Japan.
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan.
| | - Hiroshi Nishimoto
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan.
| | - Akiko Shibata
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan.
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86
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Loggers ET, Prigerson HG. The End-of-Life Experience of Patients With Rare Cancers and Their Caregivers. Rare Tumors 2014; 6:5281. [PMID: 24711910 PMCID: PMC3977173 DOI: 10.4081/rt.2014.5281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/06/2014] [Indexed: 02/03/2023] Open
Abstract
Little is known about the end-of-life (EOL) experience of patients with rare cancers (PRC) or their caregivers. From September 2002 to August 2008, 618 stage IV cancer patients [195 PRC and 423 patients with common cancers (PCC)] and their caregivers participated in an interview-based cohort study. Patients were interviewed about EOL preferences, planning, medical care, and followed until death. Interviews with caregivers at baseline assessed caregiver mental and physical health; and postmortem, assessed EOL patient care. PRC were four times more likely than PCC to be receiving both radiation and chemotherapy at study entry (10.3% vs 3.3%, respectively, adjusted odds ratio 4.31, P=0.003). PRC's caregivers were more likely to report declining health (22.1% vs 15.7%, P=0.05) and marginally more likely to report using mental health services to cope than PCC's caregivers. PRC were as likely to acknowledge their illness was terminal, have EOL discussions, and participate in advance care planning as PCC. Future research should investigate terminal care for PRC and how providing care affects caregivers' physical and mental health.
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Affiliation(s)
- Elizabeth Trice Loggers
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Holly G. Prigerson
- Center for Psychosocial Epidemiology and Outcomes, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
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87
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Raghavan D. A structured approach to uncommon cancers: what should a clinician do? Ann Oncol 2013; 24:2932-4. [DOI: 10.1093/annonc/mdt432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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88
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Keat N, Law K, Seymour M, Welch J, Trimble T, Lascombe D, Negrouk A. International rare cancers initiative. Lancet Oncol 2013; 14:109-10. [PMID: 23369681 DOI: 10.1016/s1470-2045(12)70570-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Nicola Keat
- Cancer Research UK, Angel Building, 407 St John Street, London, UK EC1V 4AD.
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89
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Abstract
Many rare cancers are essentially an enigma, with little to no information in the medical literature. Defining a rare cancer is not as easy as it might seem. As a guide, generally an incidence of fewer than 6/100,000 is considered rare. Much of the research regarding rare diseases is in its infancy.
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Affiliation(s)
- Guy D Eslick
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, New South Wales 2751, Australia.
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90
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91
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Gatta G, van der Zwan JM, Casali PG, Siesling S, Dei Tos AP, Kunkler I, Otter R, Licitra L, Mallone S, Tavilla A, Trama A, Capocaccia R. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer 2011; 47:2493-511. [PMID: 22033323 DOI: 10.1016/j.ejca.2011.08.008] [Citation(s) in RCA: 473] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/13/2011] [Accepted: 08/15/2011] [Indexed: 02/03/2023]
Abstract
PURPOSE Epidemiologic information on rare cancers is scarce. The project Surveillance of Rare Cancers in Europe (RARECARE) provides estimates of the incidence, prevalence and survival of rare cancers in Europe based on a new and comprehensive list of these diseases. MATERIALS AND METHODS RARECARE analysed population-based cancer registry (CR) data on European patients diagnosed from 1988 to 2002, with vital status information available up to 31st December 2003 (latest date for which most CRs had verified data). The mean population covered was about 162,000,000. Cancer incidence and survival rates for 1995-2002 and prevalence at 1st January 2003 were estimated. RESULTS Based on the RARECARE definition (incidence <6/100,000/year), the estimated annual incidence rate of all rare cancers in Europe was about 108 per 100,000, corresponding to 541,000 new diagnoses annually or 22% of all cancer diagnoses. Five-year relative survival was on average worse for rare cancers (47%) than common cancers (65%). About 4,300,000 patients are living today in the European Union with a diagnosis of a rare cancer, 24% of the total cancer prevalence. CONCLUSION Our estimates of the rare cancer burden in Europe provide the first indication of the size of the public health problem due to these diseases and constitute a useful base for further research. Centres of excellence for rare cancers or groups of rare cancers could provide the necessary organisational structure and critical mass for carrying out clinical trials and developing alternative approaches to clinical experimentation for these cancers.
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Affiliation(s)
- Gemma Gatta
- Department of Preventive and Predictive Medicine, Fondazione IRCSS, Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy.
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92
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Mano MS, Arai RJ, Hoff PMG. Rare tumors research in emerging countries. Rare Tumors 2010; 2:e49. [PMID: 21139964 PMCID: PMC2994521 DOI: 10.4081/rt.2010.e49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 07/21/2010] [Indexed: 12/28/2022] Open
Abstract
Rare tumors, when considered as a group, represent a significant burden to society as they may account for up to 25% of the mortality by cancer in nations like the United States. In contrast with the current scenario in highly incident cancer types, little progress has been achieved in the treatment of the most rare cancers. The reasons for this apparent stagnation are mostly intrinsic to logistical difficulties in performing large clinical trials in rare diseases and will be addressed further in this article. Because both cancer incidence and clinical research are booming in emerging nations, we also aim to address the current and future role of these countries in research and the drug development process in rare tumor types.
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Affiliation(s)
- Max S Mano
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicine da Universidade de São Paulo (FMUSP), Brazil
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