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Sun Y, Cheng Y, Hertz DL. Using maximum plasma concentration (C max) to personalize taxane treatment and reduce toxicity. Cancer Chemother Pharmacol 2024; 93:525-539. [PMID: 38734836 DOI: 10.1007/s00280-024-04677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Taxanes are a widely used class of anticancer agents that play a vital role in the treatment of a variety of cancers. However, toxicity remains a major concern of using taxane drugs as some toxicities are highly prevalent, they can not only adversely affect patient prognosis but also compromise the overall treatment plan. Among all kinds of factors that associated with taxane toxicity, taxane exposure has been extensively studied, with different pharmacokinetic (PK) parameters being used as toxicity predictors. Compared to other widely used predictors such as the area under the drug plasma concentration curve versus time (AUC) and time above threshold plasma drug concentration, maximum plasma concentration (Cmax) is easier to collect and shows promise for use in clinical practice. In this article, we review the previous research on using Cmax to predict taxane treatment outcomes. While Cmax and toxicity have been extensively studied, research on the relationship between Cmax and efficacy is lacking. Most of the articles find a positive relationship between Cmax and toxicity but several articles have contradictory findings. Future clinical trials are needed to validate the relationship between Cmax and treatment outcome and determine whether Cmax can serve as a useful surrogate endpoint of taxane treatment efficacy.
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Affiliation(s)
- Yuchen Sun
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Yue Cheng
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
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2
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Lang N, Ayme A, Ming C, Combes JD, Chappuis VN, Friedlaender A, Vuilleumier A, Sandoval JL, Viassolo V, Chappuis PO, Labidi-Galy SI. Chemotherapy-related agranulocytosis as a predictive factor for germline BRCA1 pathogenic variants in breast cancer patients: a retrospective cohort study. Swiss Med Wkly 2023; 153:40055. [PMID: 37011610 DOI: 10.57187/smw.2023.40055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Carriers of germline pathogenic variants of the BRCA1 gene (gBRCA1) tend to have a higher incidence of haematological toxicity upon exposure to chemotherapy. We hypothesised that the occurrence of agranulocytosis during the first cycle of (neo-)adjuvant chemotherapy (C1) in breast cancer (BC) patients could predict gBRCA1 pathogenic variants. PATIENTS AND METHODS The study population included non-metastatic BC patients selected for genetic counselling at Hôpitaux Universitaires de Genève (Jan. 1998 to Dec. 2017) with available mid-cycle blood counts performed during C1. The BOADICEA and Manchester scoring system risk-prediction models were applied. The primary outcome was the predicted likelihood of harbouring gBRCA1 pathogenic variants among patients presenting agranulocytosis during C1. RESULTS Three hundred seven BC patients were included: 32 (10.4%) gBRCA1, 27 (8.8%) gBRCA2, and 248 (81.1%) non-heterozygotes. Mean age at diagnosis was 40 years. Compared with non-heterozygotes, gBRCA1 heterozygotes more frequently had grade 3 BC (78.1%; p = 0.014), triple-negative subtype (68.8%; p <0.001), bilateral BC (25%; p = 0.004), and agranulocytosis following the first cycle of (neo-)adjuvant chemotherapy (45.8%; p = 0.002). Agranulocytosis and febrile neutropenia that developed following the first cycle of chemotherapy were independently predictive for gBRCA1 pathogenic variants (odds ratio: 6.1; p = 0.002). The sensitivity, specificity, positive predictive value, and negative predictive value for agranulocytosis predicting gBRCA1 were 45.8% (25.6-67.2%), 82.8% (77.5-87.3%), 22.9% (6.1-37.3%), and 93.4% (88.9-96.4%), respectively. Agranulocytosis substantially improved the positive predictive value of the risk-prediction models used for gBRCA1 evaluation. CONCLUSION Agranulocytosis following the first cycle of (neo-)adjuvant chemotherapy is an independent predictive factor for gBRCA1 detection in non-metastatic BC patients.
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Affiliation(s)
- Noémie Lang
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Aurélie Ayme
- Department of Diagnostics, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Chang Ming
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jean-Damien Combes
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Victor N Chappuis
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alex Friedlaender
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Aurélie Vuilleumier
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - José L Sandoval
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Valeria Viassolo
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pierre O Chappuis
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Diagnostics, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - S Intidhar Labidi-Galy
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Diagnostics, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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3
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Guijosa A, Freyria A, Espinosa‐Fernandez JR, Estrada‐Mena FJ, Armenta‐Quiroga AS, Ortega‐Treviño MF, Catalán R, Antonio‐Aguirre B, Villarreal‐Garza C, Perez‐Ortiz AC. Pharmacogenetics of taxane-induced neurotoxicity in breast cancer: Systematic review and meta-analysis. Clin Transl Sci 2022; 15:2403-2436. [PMID: 35892315 PMCID: PMC9579387 DOI: 10.1111/cts.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023] Open
Abstract
Taxane-based chemotherapy regimens are used as first-line treatment for breast cancer. Neurotoxicity, mainly taxane-induced peripheral neuropathy (TIPN), remains the most important dose-limiting adverse event. Multiple genes may be associated with TIPN; however, the strength and direction of the association remain unclear. For this reason, we systematically reviewed observational studies of TIPN pharmacogenetic markers in breast cancer treatment. We conducted a systematic search of terms alluding to breast cancer, genetic markers, taxanes, and neurotoxicity in Ovid, ProQuest, PubMed, Scopus, Virtual Health, and Web of Science. We assessed the quality of evidence and bias profile. We extracted relevant variables and effect measures. Whenever possible, we performed random-effects gene meta-analyses and examined interstudy heterogeneity with meta-regression models and subgroup analyses. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and STrengthening the REporting of Genetic Association Studies (STREGA) reporting guidance. A total of 42 studies with 19,431 participants were included. These evaluated 262 single-nucleotide polymorphisms (SNPs) across 121 genes. We conducted meta-analyses on 23 genes with 60 SNPs (19 studies and 6246 participants). Thirteen individual SNPs (ABCB1-rs2032582, ABCB1-rs3213619, BCL6/-rs1903216, /CAND1-rs17781082, CYP1B1-rs1056836, CYP2C8-rs10509681, CYP2C8-rs11572080, EPHA5-rs7349683, EPHA6-rs301927, FZD3-rs7001034, GSTP1-rs1138272, TUBB2A-rs9501929, and XKR4-rs4737264) and the overall SNPs' effect in four genes (CYP3A4, EphA5, GSTP1, and SLCO1B1) were statistically significantly associated with TIPN through meta-analysis. In conclusion, through systematic review and meta-analysis, we found that polymorphisms, and particularly 13 SNPs, are associated with TIPN, suggesting that genetics does play a role in interindividual predisposition. Further studies could potentially use these findings to develop individual risk profiles and guide decision making.
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Affiliation(s)
| | - Ana Freyria
- School of MedicineUniversidad PanamericanaMexico CityMexico
| | | | | | | | | | - Rodrigo Catalán
- School of MedicineUniversidad PanamericanaMexico CityMexico,Thoracic Oncology UnitInstituto Nacional de CancerologíaMexico CityMexico
| | | | - Cynthia Villarreal‐Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de MonterreySan Pedro Garza GarcíaNuevo LeónMexico
| | - Andric C. Perez‐Ortiz
- School of MedicineUniversidad PanamericanaMexico CityMexico,Transplant CenterMassachusetts General HospitalBostonMassachusettsUSA
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4
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Lei L, Wang XJ, Tang SC. Novel taxanes in development: hopes or hypes? Crit Rev Oncol Hematol 2022; 176:103727. [DOI: 10.1016/j.critrevonc.2022.103727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022] Open
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La Verde N, Damia G, Garrone O, Santini D, Fabi A, Ciccarese M, Generali DG, Nunzi M, Poletto E, Ferraris E, Cretella E, Scandurra G, Meattini I, Bertolini AS, Cavanna L, Collovà E, Romagnoli E, Rulli E, Legramandi L, Guffanti F, Bramati A, Moretti A, Cassano A, Vici P, Torri V, Farina G. Tolerability of Eribulin and correlation between polymorphisms and neuropathy in an unselected population of female patients with metastatic breast cancer: results of the multicenter, single arm, phase IV PAINTER study. Breast Cancer Res 2022; 24:71. [PMID: 36307826 PMCID: PMC9615373 DOI: 10.1186/s13058-022-01560-w] [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] [Received: 02/02/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) is an incurable disease and its treatment focuses on prolonging patients' (pts) overall survival (OS) and improving their quality of life. Eribulin is a microtubule inhibitor that increases OS in pre-treated MBC pts. The most common adverse events (AEs) are asthenia, neutropenia and peripheral neuropathy (PN). METHODS PAINTER is a single arm, phase IV study, aimed at evaluating the tolerability of eribulin in MBC pts. Secondary objectives were the description of treatment efficacy and safety, the assessment of the incidence and severity of PN and its association with genetic polymorphisms. Genomic DNA was isolated from blood samples and 15 Single Nucleotide Polymorphisms (SNPs) were genotyped by Taqman specific assays. The association between PN and SNPs were evaluated by Fisher exact test. RESULTS Starting from May 2014 until June 2018 180 pts were enrolled in this study by 20 Italian centers. 170 of these pts could be evaluated for efficacy and toxicity and 159 for polymorphisms analysis. The median age of pts was 60 years old and the biological subtypes were luminal type (64.7%), Her2 positive (18.3%) and triple negative (17%). Pts were pretreated with a median of 5 lines for MBC. The median follow up of this study was 15.4 months with a median number of 4.5 cycles administered (minimum-maximum 1-23). The median overall survival was 12 months. 48.8% of pts experienced a dose reduction, mainly for neutropenia (23.9%) and liver toxicity (12%). 65 pts (38.2%) reported at least one severe toxicity. Neutropenia and neurotoxicity were the most frequent severe AEs (15.3% and 14.7%, respectively); other reported toxicities were osteo-muscular, abdominal or tumor site pain (19.4%), liver toxicity (6.6%), pulmonary toxicity (6.5%) and dermatological toxicity (3.6%). Among the 15 evaluated SNPs, an association with PN was found for rs2233335 and rs7214723. CONCLUSIONS Eribulin is a well-tolerated treatment option in MBC. Schedule and dosage modifications were common, but toxicity rarely led to treatment discontinuation. SNPs rs2233335 (G/T and T/T) in the NDRG1 gene and rs7214723 (CC and CT) in the CAMKK1 gene were associated with PN. These findings, if validated, could allow a tailored treatment with eribulin in cancer patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02864030.
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Affiliation(s)
- Nicla La Verde
- grid.144767.70000 0004 4682 2907Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanna Damia
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ornella Garrone
- grid.414818.00000 0004 1757 8749Medical Oncology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Santini
- grid.9657.d0000 0004 1757 5329Oncologia Medica Università Campus Biomedico, Rome, Italy ,grid.7841.aUOC Oncologia Universitaria, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Alessandra Fabi
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mariangela Ciccarese
- grid.417011.20000 0004 1769 6825Dept of Oncology Vito Fazzi Hospital, Lecce, Italy
| | - Daniele Giulio Generali
- U.O. Multidisciplinare Di Patologia Mammaria E Ricerca, Traslazionale Azienda Socio-Sanitaria Territoriale Di Cremona, Cremona, Italy
| | - Martina Nunzi
- grid.416377.00000 0004 1760 672XDept. of Oncology Medical and Translational Oncology Unit, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Elena Poletto
- ASUFC Presidio Ospedaliero Universitario S.M. Misericordia, Udine, Italy
| | - Elisa Ferraris
- grid.419425.f0000 0004 1760 3027Division of Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Elisabetta Cretella
- grid.415844.80000 0004 1759 7181Oncologia Medica Ospedale Di Bolzano, AS Alto Adige, Bolzano, Italy
| | - Giuseppa Scandurra
- grid.413340.10000 0004 1759 8037Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Icro Meattini
- grid.24704.350000 0004 1759 9494Radiation Oncology Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Luigi Cavanna
- Oncology Haematology Department, ASL Piacenza, Piacenza, Italy
| | - Elena Collovà
- ASST Ovest Milanese, Ospedale Di Legnano, Legnano, MI Italy
| | | | - Eliana Rulli
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lorenzo Legramandi
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Guffanti
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annalisa Bramati
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Anna Moretti
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Patrizia Vici
- grid.417520.50000 0004 1760 5276Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valter Torri
- Department of Oncology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gabriella Farina
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
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Sharma A, Johnson KB, Bie B, Rhoades EE, Sen A, Kida Y, Hockings J, Gatta A, Davenport J, Arcangelini C, Ritzu J, DeVecchio J, Hughen R, Wei M, Thomas Budd G, Lynn Henry N, Eng C, Foss J, Rotroff DM. A Multimodal Approach to Discover Biomarkers for Taxane-Induced Peripheral Neuropathy (TIPN): A Study Protocol. Technol Cancer Res Treat 2022; 21:15330338221127169. [PMID: 36172750 PMCID: PMC9523841 DOI: 10.1177/15330338221127169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Taxanes are a class of chemotherapeutics commonly used to treat various solid tumors, including breast and ovarian cancers. Taxane-induced peripheral neuropathy (TIPN) occurs in up to 70% of patients, impacting quality of life both during and after treatment. TIPN typically manifests as tingling and numbness in the hands and feet and can cause irreversible loss of function of peripheral nerves. TIPN can be dose-limiting, potentially impacting clinical outcomes. The mechanisms underlying TIPN are poorly understood. As such, there are limited treatment options and no tools to provide early detection of those who will develop TIPN. Although some patients may have a genetic predisposition, genetic biomarkers have been inconsistent in predicting chemotherapy-induced peripheral neuropathy (CIPN). Moreover, other molecular markers (eg, metabolites, mRNA, miRNA, proteins) may be informative for predicting CIPN, but remain largely unexplored. We anticipate that combinations of multiple biomarkers will be required to consistently predict those who will develop TIPN. Methods: To address this clinical gap of identifying patients at risk of TIPN, we initiated the Genetics and Inflammatory Markers for CIPN (GENIE) study. This longitudinal multicenter observational study uses a novel, multimodal approach to evaluate genomic variation, metabolites, DNA methylation, gene expression, and circulating cytokines/chemokines prior to, during, and after taxane treatment in 400 patients with breast cancer. Molecular and patient reported data will be collected prior to, during, and after taxane therapy. Multi-modal data will be used to develop a set of comprehensive predictive biomarker signatures of TIPN. Conclusion: The goal of this study is to enable early detection of patients at risk of developing TIPN, provide a tool to modify taxane treatment to minimize morbidity from TIPN, and improved patient quality of life. Here we provide a brief review of the current state of research into CIPN and TIPN and introduce the GENIE study design.
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Affiliation(s)
- Anukriti Sharma
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Ken B. Johnson
- Department of Anesthesiology, University of Utah, UT, USA
| | - Bihua Bie
- Department of Anesthesiology, Cleveland Clinic, OH, USA
| | | | - Alper Sen
- Department of Anesthesiology, University of Utah, UT, USA
| | - Yuri Kida
- Department of Anesthesiology, University of Utah, UT, USA
| | - Jennifer Hockings
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, OH, USA
- Department of Pharmacy, Cleveland Clinic, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alycia Gatta
- Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | | | | | | | - Jennifer DeVecchio
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Ron Hughen
- Department of Anesthesiology, University of Utah, UT, USA
| | - Mei Wei
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - G. Thomas Budd
- Taussig Cancer Institute, Cleveland Clinic, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - N. Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Charis Eng
- Taussig Cancer Institute, Cleveland Clinic, OH, USA
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph Foss
- Department of Anesthesiology, Cleveland Clinic, OH, USA
| | - Daniel M. Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
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7
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Thomaier L, Darst BF, Jewett P, Hoffmann C, Brown K, Makaram A, Blaes A, Argenta P, Teoh D, Vogel RI. Genetic variants predictive of chemotherapy-induced peripheral neuropathy symptoms in gynecologic cancer survivors. Gynecol Oncol 2021; 163:578-582. [PMID: 34674889 DOI: 10.1016/j.ygyno.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify genetic variants associated with chemotherapy-induced peripheral neuropathy (CIPN) symptoms among gynecologic cancer survivors and determine the variants' predictive power in addition to age and clinical factors at time of diagnosis. METHODS Participants of a prospective cohort study on gynecologic cancers provided a DNA saliva sample and reported CIPN symptoms (FACT/GOG-Ntx). Genotyping of 23 single nucleotide polymorphisms (SNPs) previously identified as related to platinum- or taxane-induced neuropathy was performed using iPLEX Gold method. Risk allele carrier frequencies of 19 SNPs that passed quality checks were compared between those with/without high CIPN symptoms using logistic regression, adjusting for age. Receiver operating characteristic (ROC) curves using clinical risk factors (age, diabetes, BMI, Charlson Comorbidity Index, previous cancer diagnosis) with and without the identified SNPs were compared. RESULTS 107 individuals received platinum or taxane-based chemotherapy and provided sufficient DNA for analysis. Median age was 65.1 years; 39.6% had obesity and 8.4% diabetes; most had ovarian (58.9%) or uterine cancer (29.0%). Two SNPs were significantly associated with high CIPN symptomatology: rs3753753 in GPX7, OR = 2.55 (1.13, 5.72) and rs139887 in SOX10, 2.66 (1.18, 6.00). Including these two SNPs in a model with clinical characteristics led to an improved AUC for CIPN symptomatology (0.65 vs. 0.74, p = 0.04). CONCLUSIONS Genetic and clinical characteristics were predictive of higher CIPN symptomatology in gynecologic cancer survivors, and combining these factors resulted in superior predictive power compared with a model with clinical factors only. Prospective validation and assessment of clinical utility are warranted.
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Affiliation(s)
- Lauren Thomaier
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America.
| | - Burcu F Darst
- University of Southern California, Center for Genetic Epidemiology, Keck School of Medicine, Los Angeles, CA, United States of America
| | - Patricia Jewett
- University of Minnesota, Division of Hematology and Oncology, Minneapolis, MN, United States of America
| | - Cody Hoffmann
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, MN, United States of America
| | - Katherine Brown
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
| | - Aditi Makaram
- University of Minnesota, College of Biological Sciences, Minneapolis, MN, United States of America
| | - Anne Blaes
- University of Minnesota, Division of Hematology and Oncology, Minneapolis, MN, United States of America
| | - Peter Argenta
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
| | - Deanna Teoh
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
| | - Rachel I Vogel
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
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8
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Gillen J, Miller A, Bell-McGuinn KM, Schilder RJ, Walker JL, Mathews CA, Duska LR, Guntupalli SR, O'Cearbhaill R, Hays J, Hagemann AR, Gray HJ, Gordon SW, Armstrong DK, Chen A, Fracasso PM, Aghajanian C, Moore KN. Post hoc analyses of GOG 9923: Does BRCA status affect toxicities?: An NRG oncology study. Gynecol Oncol 2021; 161:512-515. [PMID: 33610319 DOI: 10.1016/j.ygyno.2021.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate how women with epithelial ovarian cancer (EOC), dichotomized by BRCA status, tolerate intravenous (IV) or intraperitoneal (IP) chemotherapy given with veliparib and bevacizumab (bev) on a GOG phase I study (GOG 9923, NCT00989651). METHODS This is an unplanned, post hoc analysis of an IRB approved, multi-institutional, prospective study (GOG 9923). Clinical characteristics and toxicity data based on BRCA status were evaluated and descriptive statistics were used to summarize baseline patient characteristics and toxicities. The Kaplan Meier method was used to generate survival estimates. RESULTS Four hundred twenty-four patients were evaluable. Patients were treated with IV carboplatin, paclitaxel, and bev every 21 days (regimen 1), weekly IV paclitaxel with carboplatin and bev (regimen 2) or IV paclitaxel and bev with IP cisplatin (regimen 3). Bev was continued as maintenance in all arms. Within each of these regimens, veliparib was given either twice daily for the entirety of each cycle (continuous) or on days -2 to 5 (intermittent). Ten percent of patients treated on regimen 1, 12% on regimen 2, and 19.8% on regimen 3 had BRCA-associated tumors. Patients with BRCA-associated tumors, when compared to wild type, experienced similar rates of anemia, febrile neutropenia (, abdominal pain, colonic perforation, nausea, vomiting, and peripheral sensory neuropathy. Median progression free survival (PFS) was not significantly different between BRCA-associated and wild type cancers (HR 0.96, CI 0.65-1.42), though this study's primary aim was not to evaluate outcomes. CONCLUSIONS Germline BRCA mutations positively affect chemosensitivity in EOC, but whether differences in toxicities among BRCA-associated and BRCA wild type tumors existed was previously not reported. In this population with newly diagnosed ovarian cancer no differences in reported toxicity between the two groups was observed.
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Affiliation(s)
- Jessica Gillen
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Austin Miller
- NRG Oncology SDMC, CTD Division, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
| | - Katherine M Bell-McGuinn
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Joan L Walker
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Cara A Mathews
- Women and Infants Hospital of Rhode Island, Providence, RI, United States of America.
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | | | - Roisin O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - John Hays
- The Ohio State University, Columbus, OH, United States of America.
| | | | - Heidi J Gray
- University of Washington, Seattle, WA, United States of America.
| | - Sarah W Gordon
- Virginia Commonwealth University, Richmond, VA, United States of America.
| | | | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, United States of America.
| | - Paula M Fracasso
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
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9
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Hertz DL. Exploring pharmacogenetics of paclitaxel- and docetaxel-induced peripheral neuropathy by evaluating the direct pharmacogenetic-pharmacokinetic and pharmacokinetic-neuropathy relationships. Expert Opin Drug Metab Toxicol 2021; 17:227-239. [PMID: 33401943 DOI: 10.1080/17425255.2021.1856367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Peripheral neuropathy (PN) is an adverse effect of several classes of chemotherapy including the taxanes. Predictive PN biomarkers could inform individualized taxane treatment to reduce PN and enhance therapeutic outcomes. Pharmacogenetics studies of taxane-induced PN have focused on genes involved in pharmacokinetics, including enzymes and transporters. Contradictory findings from these studies prevent translation of genetic biomarkers into clinical practice. Areas covered: This review discusses the progress toward identifying pharmacogenetic predictors of PN by assessing the evidence for two independent associations; the effect of pharmacogenetics on taxane pharmacokinetics and the evidence that taxane pharmacokinetics affects PN. Assessing these direct relationships allows the reader to understand the progress toward individualized taxane treatment and future research opportunities. Expert opinion: Paclitaxel pharmacokinetics is a major determinant of PN. Additional clinical trials are needed to confirm the clinical benefit of individualized dosing to achieve target paclitaxel exposure. Genetics does not meaningfully contribute to paclitaxel pharmacokinetics and may not be useful to inform dosing. However, genetics may contribute to PN sensitivity and could be useful for estimating patients' optimal paclitaxel exposure. For docetaxel, genetics has not been demonstrated to have a meaningful effect on pharmacokinetics and there is no evidence that pharmacokinetics determines PN.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy , Ann Arbor, MI, United States
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10
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Zheng Y, Deng Z, Tang M, Xiao D, Cai P. Impact of genetic factors on platinum-induced gastrointestinal toxicity. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2020; 786:108324. [PMID: 33339576 DOI: 10.1016/j.mrrev.2020.108324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023]
Abstract
Severe gastrointestinal (GI) toxicity is a common side effect after platinum-based chemotherapy. The incidence and severity of GI toxicity vary among patients with the same chemotherapy. Genetic factors involved in platinum transport, metabolism, detoxification, DNA repair, cell cycle control, and apoptosis pathways may account for the interindividual difference in GI toxicity. The influence of gene polymorphisms in the platinum pathway on GI toxicity has been extensively analyzed. Variations in study sample size, ethnicity, design, treatment schedule, dosing, endpoint definition, and assessment of toxicity make it difficult to precisely interpret the results. Hence, we conducted a review to summarize the most recent pharmacogenomics studies of GI toxicity in platinum-based chemotherapy and identify the most promising avenues for further research.
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Affiliation(s)
- Yi Zheng
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, People's Republic of China
| | - Zheng Deng
- Hunan Institute for Tuberculosis Control, Changsha, 410008, People's Republic of China; Hunan Chest Hospital, Changsha, 410008, People's Republic of China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Di Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Pei Cai
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, People's Republic of China.
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11
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Neurotoxicity of antineoplastic drugs: Mechanisms, susceptibility, and neuroprotective strategies. Adv Med Sci 2020; 65:265-285. [PMID: 32361484 DOI: 10.1016/j.advms.2020.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/22/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
This review summarizes the adverse effects on the central and/or peripheral nervous systems that may occur in response to antineoplastic drugs. In particular, we describe the neurotoxic side effects of the most commonly used drugs, such as platinum compounds, doxorubicin, ifosfamide, 5-fluorouracil, vinca alkaloids, taxanes, methotrexate, bortezomib and thalidomide. Neurotoxicity may result from direct action of compounds on the nervous system or from metabolic alterations produced indirectly by these drugs, and either the central nervous system or the peripheral nervous system, or both, may be affected. The incidence and severity of neurotoxicity are principally related to the dose, to the duration of treatment, and to the dose intensity, though other factors, such as age, concurrent pathologies, and genetic predisposition may enhance the occurrence of side effects. To avoid or reduce the onset and severity of these neurotoxic effects, the use of neuroprotective compounds and/or strategies may be helpful, thereby enhancing the therapeutic effectiveness of antineoplastic drug.
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12
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St. Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy‐induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer 2020; 126:4602-4613. [DOI: 10.1002/cncr.33108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Ann M. O’Mara
- Division of Cancer Prevention National Cancer Institute Bethesda Maryland
| | - Jennifer L. Robinson
- Department of Behavioral and Community Health University of Maryland College Park Maryland
| | | | - Lori M. Minasian
- Division of Cancer Prevention National Cancer Institute Bethesda Maryland
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13
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Bayraktar S, Zhou JZ, Bassett R, Gutierrez Barrera AM, Layman RM, Valero V, Arun B. Clinical outcome and toxicity from taxanes in breast cancer patients with BRCA1 and BRCA2 pathogenic germline mutations. Breast J 2020; 26:1572-1582. [PMID: 32497289 DOI: 10.1111/tbj.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
Germline variations in genes coding for proteins involved in the oxidative stress and DNA repair greatly influence drug response and toxicity. Because BRCA1 and BRCA2 proteins play a role in DNA damage repair, we postulated that taxane-related toxicity is potentially higher and clinical outcome in different in patients with BRCA pathogenic variants (PV). Seven hundred nineteen women who underwent BRCA genetic testing and were treated with taxane-containing chemotherapy for early-stage breast cancer between 1997 and 2018 were included in the study. Patients with BRCA variants of uncertain significance were excluded. The Kaplan-Meier product-limit method was used to estimate recurrence-free survival (RFS) and overall survival (OS) rates. Logistic regression models were used to assess the association between chemotherapy toxicity and factors of interest. Cox regression models were used to assess the association between RFS and OS and factors of interest. Ninety-four (13%) and 54 (7%) patients had BRCA1 and BRCA2-PVs, respectively. While anemia (P = .0025) and leukopenia (P = .001) were more frequently seen in BRCA noncarriers, there was no difference in regards to peripheral neuropathy or other toxicities between the groups. Increasing doses of taxane were associated with increased risk of neutropenia, stomatitis, nausea, vomiting, acne/rash, and peripheral neuropathy across all groups. In a multivariate logistic regression model, BRCA2 status remained as an independent significant predictor for decreased hematologic toxicity (HR: 0.36; 95% CI: 0.20-0.67; P = .001) and increased gastrointestinal toxicity (HR: 1.93; 95% CI: 1.02-3.67; P = .04). Being overweight, obese and African-American race were significant predictors for peripheral neuropathy (P = .04; P = .03; P = .06, respectively). Total taxane dose received did not have any impact on survival outcomes. Our study demonstrates that taxane-containing chemotherapy regimens do not increase risk of peripheral neuropathy or hematologic toxicity in patients with BRCA PVs. The mechanisms for this finding need to be further investigated as it may provide an opportunity to combine taxanes with other agents, such as platinum salts or PARP inhibitors, with less anticipated toxicity.
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Affiliation(s)
- Soley Bayraktar
- Division of Medical Oncology and Hematology, Department of Medicine, Biruni University School of Medicine, Istanbul, Turkey
- Departments of Cancer Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jade Z Zhou
- Departments of Cancer Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Roland Bassett
- Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Rachel M Layman
- Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Banu Arun
- Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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14
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Al-Mahayri ZN, Patrinos GP, Ali BR. Toxicity and Pharmacogenomic Biomarkers in Breast Cancer Chemotherapy. Front Pharmacol 2020; 11:445. [PMID: 32351390 PMCID: PMC7174767 DOI: 10.3389/fphar.2020.00445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/20/2020] [Indexed: 02/05/2023] Open
Abstract
Breast cancer (BC) is one of the most prevalent types of cancer worldwide with high morbidity and mortality rates. Treatment modalities include systemic therapy, in which chemotherapy is a major component in many cases. Several chemotherapeutic agents are used in combinations or as single agents with many adverse events occurring in variable frequencies. These events can be a significant barrier in completing the treatment regimens. Germline genomic variants are thought of as potential determinants in chemotherapy response and the development of side effects. Some pharmacogenomic studies were designed to explore germline variants that can be used as biomarkers for predicting developing toxicity or adverse events during chemotherapy in BC. In this review, we reassess and summarize the major findings of pharmacogenomic studies of chemotherapy toxicity during BC management. In addition, deficiencies hampering utilizing these findings and the potential targets of future research are emphasized. Main insufficiencies in toxicity pharmacogenomics studies originate from study design, sample limitations, heterogeneity of selected genes, variants, and toxicity definitions. With the advent of high throughput genotyping techniques, researchers are expected to explore the identified as well as the potential genetic biomarkers of toxicity and efficacy to improve BC management. However, to achieve this, the limitations of previous work should be evaluated and avoided to reach more conclusive and translatable evidence for personalizing BC chemotherapy.
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Affiliation(s)
- Zeina N Al-Mahayri
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - George P Patrinos
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece.,Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Bassam R Ali
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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15
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Staff NP, Fehrenbacher JC, Caillaud M, Damaj MI, Segal RA, Rieger S. Pathogenesis of paclitaxel-induced peripheral neuropathy: A current review of in vitro and in vivo findings using rodent and human model systems. Exp Neurol 2020; 324:113121. [PMID: 31758983 PMCID: PMC6993945 DOI: 10.1016/j.expneurol.2019.113121] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Abstract
Paclitaxel (Brand name Taxol) is widely used in the treatment of common cancers like breast, ovarian and lung cancer. Although highly effective in blocking tumor progression, paclitaxel also causes peripheral neuropathy as a side effect in 60-70% of chemotherapy patients. Recent efforts by numerous labs have aimed at defining the underlying mechanisms of paclitaxel-induced peripheral neuropathy (PIPN). In vitro models using rodent dorsal root ganglion neurons, human induced pluripotent stem cells, and rodent in vivo models have revealed a number of molecular pathways affected by paclitaxel within axons of sensory neurons and within other cell types, such as the immune system and peripheral glia, as well skin. These studies revealed that paclitaxel induces altered calcium signaling, neuropeptide and growth factor release, mitochondrial damage and reactive oxygen species formation, and can activate ion channels that mediate responses to extracellular cues. Recent studies also suggest a role for the matrix-metalloproteinase 13 (MMP-13) in mediating neuropathy. These diverse changes may be secondary to paclitaxel-induced microtubule transport impairment. Human genetic studies, although still limited, also highlight the involvement of cytoskeletal changes in PIPN. Newly identified molecular targets resulting from these studies could provide the basis for the development of therapies with which to either prevent or reverse paclitaxel-induced peripheral neuropathy in chemotherapy patients.
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Affiliation(s)
- Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jill C Fehrenbacher
- Department of Pharmacology and Toxicology, University School of Medicine, Indianapolis, IN 46202, USA
| | - Martial Caillaud
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - Rosalind A Segal
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Sandra Rieger
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA.
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16
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Anderson JT, Huang KM, Lustberg MB, Sparreboom A, Hu S. Solute Carrier Transportome in Chemotherapy-Induced Adverse Drug Reactions. Rev Physiol Biochem Pharmacol 2020; 183:177-215. [PMID: 32761456 DOI: 10.1007/112_2020_30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Members of the solute carrier (SLC) family of transporters are responsible for the cellular influx of a broad range of endogenous compounds and xenobiotics. These proteins are highly expressed in the gastrointestinal tract and eliminating organs such as the liver and kidney, and are considered to be of particular importance in governing drug absorption and elimination. Many of the same transporters are also expressed in a wide variety of organs targeted by clinically important anticancer drugs, directly affect cellular sensitivity to these agents, and indirectly influence treatment-related side effects. Furthermore, targeted intervention strategies involving the use of transport inhibitors have been recently developed, and have provided promising lead candidates for combinatorial therapies associated with decreased toxicity. Gaining a better understanding of the complex interplay between transporter-mediated on-target and off-target drug disposition will help guide the further development of these novel treatment strategies to prevent drug accumulation in toxicity-associated organs, and improve the safety of currently available treatment modalities. In this report, we provide an update on this rapidly emerging field with particular emphasis on anticancer drugs belonging to the classes of taxanes, platinum derivatives, nucleoside analogs, and anthracyclines.
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Affiliation(s)
- Jason T Anderson
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kevin M Huang
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Maryam B Lustberg
- Department of Medical Oncology, The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Shuiying Hu
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
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17
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Weitzner O, Yagur Y, Kadan Y, Beiner ME, Fishman A, Ben Ezry E, Amitai Komem D, Helpman L. Chemotherapy Toxicity in BRCA Mutation Carriers Undergoing First-Line Platinum-Based Chemotherapy. Oncologist 2019; 24:e1471-e1475. [PMID: 31346131 PMCID: PMC6975939 DOI: 10.1634/theoncologist.2019-0272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/08/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE BRCA mutations are the most frequent mutations causing homologous recombination defects in epithelial ovarian cancers (EOC). Germline mutation carriers are heterozygous for the mutation and harbor one defective allele in all cells. This has been hypothesized to cause increased susceptibility to DNA damage in healthy cells as well as neoplastic ones. Our objective was to assess chemotherapy-associated toxicities in patients with epithelial ovarian cancer with and without a germline BRCA mutation. MATEIALS AND METHODS A retrospective cohort study of patients with EOC receiving first-line platinum-based chemotherapy at a single center between 2006 and 2016. Indices of chemotoxicity, including blood counts, transfusion requirements, granulocyte colony-stimulating factor (gCSF) prescriptions, episodes of febrile neutropenia, and treatment delays were compared for BRCA mutation carriers and noncarriers. RESULTS A total of 90 women met the inclusion criteria, including 31 BRCA mutation carriers (34%) and 59 noncarriers (66%). Mean hemoglobin, neutrophil count, and platelet counts during treatment were comparable for the two patient groups. There was a trend toward a higher frequency of hematological events in BRCA mutation carriers (neutropenia <1500 per mL: 6% vs. 0%, p = .12; thrombocytopenia <100,000 per mL: 23% vs. 9%, p = .07), but these differences were not statistically significant. Similarly, no significant differences were found in surrogates of bone marrow toxicity such as blood transfusions, use of gCSF, episodes of febrile neutropenia, or treatment delays. CONCLUSION BRCA mutation carriers and noncarriers receiving first-line platinum-based chemotherapy for EOC have similar hematologic toxicity profiles. Clinicians treating these patients can be reassured that chemotherapy dosing or schedule do not require adjustment in patients carrying BRCA mutations. IMPLICATIONS FOR PRACTICE Patients with ovarian cancer carrying BRCA mutations are more likely to have serous tumors and present with higher CA125 levels. Germline BRCA mutation status is not associated with increased frequency of adverse hematologic events among patients with ovarian cancer being treated with first-line platinum-based chemotherapy. Germline BRCA mutations are also not associated with more treatment delays or a lower number of courses completed in this patient population. These findings should reassure practitioners engaged in care for patients with ovarian cancer that BRCA mutation status most likely will not affect chemotherapy dosing or schedule.
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Affiliation(s)
- Omer Weitzner
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagur
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yfat Kadan
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario E Beiner
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ami Fishman
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Ben Ezry
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Amitai Komem
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Helpman
- Meir Medical Center, Clalit Health Services and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Friedlaender A, Vuilleumier A, Viassolo V, Ayme A, De Talhouet S, Combes JD, Peron J, Bodmer A, Giraud S, Buisson A, Bonadona V, Gauchat-Bouchardy I, Tredan O, Chappuis PO, Labidi-Galy SI. BRCA1/BRCA2 germline mutations and chemotherapy-related hematological toxicity in breast cancer patients. Breast Cancer Res Treat 2019; 174:775-783. [PMID: 30635808 DOI: 10.1007/s10549-018-05127-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/31/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE BRCA1 and BRCA2 proteins are central to DNA repair process through homologous recombination. We hypothesize that BRCA1/BRCA2 mutation carriers may exhibit increased hematological toxicity when receiving genotoxic chemotherapy. METHODS We included women with primary breast cancers screened for BRCA1/BRCA2 germline mutations and treated with (neo)adjuvant chemotherapy in Geneva (Swiss cohort). The primary endpoint was the incidence of febrile neutropenia following the first chemotherapy cycle (C1). Secondary endpoints were the incidence of grade 3-4 neutropenia, grade 4 neutropenia and hospitalization during C1, G-CSF use and chemotherapy dose reduction during the entire chemotherapy regimen. Long-term toxicities (hematological, cardiac and neuropathy) were assessed in the Swiss cohort and a second cohort of patients from Lyon (French cohort). RESULTS Overall, 221 patients were assessed for acute hematological toxicity, including 23 BRCA1 and 22 BRCA2 carriers. Following the C1, febrile neutropenia had an incidence of 35% (p = 0.002), 14% (p = 0.562) and 10% among BRCA1, BRCA2 and non-carriers, respectively. Grade 4 neutropenia was found in 57% of BRCA1 (p < 0.001), 14% of BRCA2 (p = 0.861) and 18% of non-carriers. G-CSF support was necessary in 86% of BRCA1 (p = 0.005), 64% of BRCA2 (p = 0.285) and 51% of non-carriers. For long-term toxicity analysis, 898 patients were included (167 BRCA1-, 91 BRCA2- and 640 non-carriers). There was no difference between the 3 groups. CONCLUSIONS BRCA1 germline mutations is associated with greater acute hematological toxicity in breast cancer patients. These observations could have implication for primary prophylaxis with G-CSF.
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Affiliation(s)
- Alex Friedlaender
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Aurélie Vuilleumier
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Valeria Viassolo
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Aurélie Ayme
- Department of Genetic Medicine, Laboratory and Clinical Pathology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Solène De Talhouet
- Department of Medical Oncology, Centre Léon Bérard, 8 Rue Laennec, 69008, Lyon, France
| | - Jean-Damien Combes
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Julien Peron
- Departement of Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- UMR CNRS 5558, Université Lyon 1, Lyon, France
| | - Alexandre Bodmer
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Sophie Giraud
- Division of Molecular Genetics, Hospices Civils de Lyon, Groupe Hospitalier Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Adrien Buisson
- Division of Molecular Genetics, Hospices Civils de Lyon, Groupe Hospitalier Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Valerie Bonadona
- Unit of Prevention and Genetic Epidemiology, UMR CNRS 5558, Centre Léon Bérard, 8 Rue Laennec, 69008, Lyon, France
| | - Isabelle Gauchat-Bouchardy
- Department of Genetic Medicine, Laboratory and Clinical Pathology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, 8 Rue Laennec, 69008, Lyon, France
| | - Pierre O Chappuis
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
- Department of Genetic Medicine, Laboratory and Clinical Pathology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - S Intidhar Labidi-Galy
- Department of Oncology, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.
- Department of Internal Medecine Specialities, Faculty of Medecine, Université de Genève, Rue Michel Servet 1, 1206, Geneva, Switzerland.
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19
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Zirpoli GR, McCann SE, Sucheston-Campbell LE, Hershman DL, Ciupak G, Davis W, Unger JM, Moore HCF, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Budd GT, Albain KS, Ambrosone CB. Supplement Use and Chemotherapy-Induced Peripheral Neuropathy in a Cooperative Group Trial (S0221): The DELCaP Study. J Natl Cancer Inst 2019; 109:4098262. [PMID: 29546345 DOI: 10.1093/jnci/djx098] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/24/2017] [Indexed: 12/24/2022] Open
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) can interfere with daily function and quality of life, and there are no known preventive approaches. In a cohort of breast cancer patients receiving paclitaxel as part of a clinical trial (SWOG 0221), we examined the use of dietary supplements both before diagnosis and during treatment in relation to CIPN. Methods At registration to S0221, 1225 breast cancer patients completed questionnaires regarding the use of multivitamins and supplements before and at diagnosis. A second questionnaire at six months queried use during treatment. Supplement use was evaluated in relation to CIPN, assessed via the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE v. 3.0) and the self-reported Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity (FACT/GOG-Ntx) subscale. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed with logistic regression for the CTCAE analyses and ordinal regression for the FACT/GOG-Ntx analyses. Results Multivitamin use before diagnosis was associated with reduced symptoms of CIPN (CTCAE-adjusted OR = 0.60, 95% CI = 0.42 to 0.87; FACT/GOG-Ntx-adjusted OR = 0.78, 95% CI = 0.61 to 1.00). Use during treatment was marginally inversely associated with CIPN (CTCAE-adjusted OR = 0.73, 95% CI = 0.49 to 1.08; FACT/GOG-Ntx-adjusted OR = 0.77, 95% CI = 0.60 to 0.99). Other supplement use, either before diagnosis or during treatment, was not statistically significantly associated with CIPN. Conclusions Multivitamin use may be associated with reduced risk of CIPN, although individual dietary supplement use did not appreciably affect risk. Multivitamin use could be a surrogate for other related behaviors that are the actual drivers of the association with reduced CIPN. Without prospective randomized trials of vitamin supplementation, recommendations for use or changes to clinical practice are clearly not warranted.
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Affiliation(s)
- Gary R Zirpoli
- Roswell Park Cancer Institute, Buffalo, NY.,Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | - Joseph M Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | | | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Chicago, IL
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20
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Morton LM, Kerns SL, Dolan ME. Role of Germline Genetics in Identifying Survivors at Risk for Adverse Effects of Cancer Treatment. Am Soc Clin Oncol Educ Book 2018; 38:775-786. [PMID: 30231410 DOI: 10.1200/edbk_201391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The growing population of cancer survivors often faces adverse effects of treatment, which have a substantial impact on morbidity and mortality. Although certain adverse effects are thought to have a significant heritable component, much work remains to be done to understand the role of germline genetic factors in the development of treatment-related toxicities. In this article, we review current understanding of genetic susceptibility to a range of adverse outcomes among cancer survivors (e.g., fibrosis, urinary and rectal toxicities, ototoxicity, chemotherapy-induced peripheral neuropathy, subsequent malignancies). Most previous research has been narrowly focused, investigating variation in candidate genes and pathways such as drug metabolism, DNA damage and repair, and inflammation. Few of the findings from these earlier candidate gene studies have been replicated in independent populations. Advances in understanding of the genome, improvements in technology, and reduction in laboratory costs have led to recent genome-wide studies, which agnostically interrogate common and/or rare variants across the entire genome. Larger cohorts of patients with homogeneous treatment exposures and systematic ascertainment of well-defined outcomes as well as replication in independent study populations are essential aspects of the study design and are increasingly leading to the discovery of variants associated with each of the adverse outcomes considered in this review. In the long-term, validated germline genetic associations hold tremendous promise for more precisely identifying patients at highest risk for developing adverse treatment effects, with implications for frontline therapy decision-making, personalization of long-term follow-up guidelines, and potential identification of targets for prevention or treatment of the toxicity.
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Affiliation(s)
- Lindsay M Morton
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
| | - Sarah L Kerns
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
| | - M Eileen Dolan
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
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Genome-wide meta-analyses identifies novel taxane-induced peripheral neuropathy-associated loci. Pharmacogenet Genomics 2018; 28:49-55. [PMID: 29278617 DOI: 10.1097/fpc.0000000000000318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Taxane containing chemotherapy extends survival for breast cancer patients. However, taxane-induced peripheral neuropathy (TIPN) cannot be predicted, prevented or effectively treated. Using genome-wide analyses, we sought to identify common risk variants for TIPN. PATIENTS AND METHODS Women with high-risk breast cancer enrolled in SWOG 0221 were genotyped using the Illumina 1M chip. Genome-wide analyses were performed in relation to ≥grade 3 Common Terminology Criteria for Adverse Events (CTCAE) neuropathy in European and African Americans. Data were meta-analyzed with GW associations of CTCAE ≥grade 3 versus <grade 3 in CALGB 40101 assuming a fixed effects model. RESULTS The percentage of ≥grade 3 TIPN in 1269 European Americans and 139 African Americans in S0221, was 11.6 and 22.3%, respectively. CALGB 40101 ≥grade 3 TOPN was 7.2%. The most significant association with ≥grade 3 TIPN was the G allele of rs1858826 in GNGT1 (Pmeta=1.1×10), which showed a decrease in risk of ≥grade 3 TIPN (odds ratio=0.29, 95% confidence interval: 0.18-0.46). CONCLUSION The genetic variants associated with ≥grade 3 TIPN are hypothesized to have biochemical functions and reside in and near genes involved in diabetes and diabetic neuropathy. This finding is consistent with results from CALGB 40101 pathway analyses. Larger homogeneous trials with similar dosing and criteria for defining neuropathy are needed to properly assess the relationship of genomics with the neuropathy spectrum.
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Bandos H, Melnikow J, Rivera DR, Swain SM, Sturtz K, Fehrenbacher L, Wade JL, Brufsky AM, Julian TB, Margolese RG, McCarron EC, Ganz PA. Long-term Peripheral Neuropathy in Breast Cancer Patients Treated With Adjuvant Chemotherapy: NRG Oncology/NSABP B-30. J Natl Cancer Inst 2018; 110:4093779. [PMID: 28954297 PMCID: PMC5825682 DOI: 10.1093/jnci/djx162] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/02/2017] [Accepted: 07/07/2017] [Indexed: 01/10/2023] Open
Abstract
Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (AC→T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The AC→T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with AC→T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95% CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (Ptrend < .001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.
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Affiliation(s)
- Hanna Bandos
- NRG Oncology and The University of Pittsburgh, Pittsburgh, PA
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California
Davis, Sacramento, CA
| | - Donna R. Rivera
- Division of Cancer Control and Population Sciences, National Cancer
Institute, Rockville, MD
| | - Sandra M. Swain
- NRG Oncology and The Washington Cancer Institute at Washington Hospital
Center, Washington, DC and current: Georgetown University, Washington, DC
| | - Keren Sturtz
- NRG Oncology and The Colorado Cancer Research Program, Denver, CO
| | | | - James L. Wade
- NRG Oncology and The Central Illinois CCOP Heartland NCORP, Decatur,
IL
| | - Adam M. Brufsky
- NRG Oncology and The University of Pittsburgh/Magee Womens Hospital,
Pittsburgh, PA
| | | | - Richard G. Margolese
- NRG Oncology and The Jewish General Hospital, McGill University,
Montréal, QC, Canada
| | - Edward C. McCarron
- NRG Oncology and The MedStar Franklin Square Medical Center/Harry and
Jeanette Weinberg Cancer Institute, Baltimore, MD
| | - Patricia A. Ganz
- NRG Oncology and The University of California Los Angeles, Schools of
Medicine and Public Health, Los Angeles, CA
- Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA
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Miglietta F, Dieci M, Griguolo G, Guarneri V, Conte P. Chemotherapy for advanced HER2-negative breast cancer: Can one algorithm fit all? Cancer Treat Rev 2017; 60:100-108. [DOI: 10.1016/j.ctrv.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 12/28/2022]
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Cliff J, Jorgensen AL, Lord R, Azam F, Cossar L, Carr DF, Pirmohamed M. The molecular genetics of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 120:127-140. [PMID: 29198326 DOI: 10.1016/j.critrevonc.2017.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/12/2017] [Accepted: 09/11/2017] [Indexed: 01/13/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) can adversely affect completion of systemic anti-cancer treatment and cause long-term morbidity. Increasingly pharmacogenetic studies have been performed to explore susceptibility to this important adverse effect. A systematic review was conducted to identify pharmacogenetic studies, assess their quality and findings and undertake meta-analysis where possible. 93 studies were included. Notable methodological issues included lack of standardisation and detail in phenotype definition and acknowledgement of potential confounding factors. Insufficient data was presented in many studies meaning only a minority could be included in meta-analysis showing mainly non-significant effects. Nonetheless, SNPs in CYP2C8, CYP3A4, ARHGEF10, EPHA and TUBB2A genes (taxanes), FARS2, ACYP2 and TAC1 (oxaliplatin), and CEP75 and CYP3A5 (vincristine) are of potential interest. These require exploration in large cohort studies with robust methodology and well-defined phenotypes. Seeking standardisation of phenotype, collaboration and subsequently, individual-patient-data meta-analysis may facilitate identifying contributory SNPs which could be combined in a polygenic risk score to predict those most at risk of CIPN.
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Affiliation(s)
- J Cliff
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | | | - R Lord
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - F Azam
- Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - L Cossar
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - D F Carr
- University of Liverpool, Liverpool, L69 3BX, UK.
| | - M Pirmohamed
- University of Liverpool, Liverpool, L69 3BX, UK.
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Bakogeorgos M, Georgoulias V. Risk-reduction and treatment of chemotherapy-induced peripheral neuropathy. Expert Rev Anticancer Ther 2017; 17:1045-1060. [PMID: 28868935 DOI: 10.1080/14737140.2017.1374856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy (CIPN), a common adverse effect of several chemotherapeutic agents, has a significant impact on quality of life and may even compromise treatment efficacy, requiring chemotherapy dose reduction or discontinuation. CIPN is predominantly related with sensory rather than motor symptoms and the most common related cytotoxic agents are platinum compounds, taxanes and vinca alkaloids. CIPN symptoms may resolve after treatment cessation, but they can also be permanent and continue for years. Areas covered: We present an overview of CIPN pathophysiology, clinical assessment, prevention and treatment identified through a Pubmed search. Expert commentary: No substantial progress has been made in the last few years within the field of prevention and/or treatment of CIPN, in spite of remarkable efforts. Continuous research could expand our knowledge about chemotherapeutic-specific neuropathic pathways and eventually lead to the conception of innovative and targeted agents for the prevention and/or treatment of this debilitating chemotherapy adverse effect.
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Zheng Y, Deng Z, Yin J, Wang S, Lu D, Wen X, Li X, Xiao D, Hu C, Chen X, Zhang W, Zhou H, Liu Z. The association of genetic variations in DNA repair pathways with severe toxicities in NSCLC patients undergoing platinum‐based chemotherapy. Int J Cancer 2017; 141:2336-2347. [PMID: 28791697 DOI: 10.1002/ijc.30921] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/25/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Yi Zheng
- Department of Clinical PharmacologyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
- Hunan Key Laboratory of PharmacogeneticsInstitute of Clinical Pharmacology, Central South UniversityChangsha410078 People's Republic of China
- Key Laboratory of Hunan Province for Traditional Chinese Medicine in Obstetrics and Gynecology Research, Hunan Provincial Maternal and Child Health Care HospitalChangsha410008 People's Republic of China
| | - Zheng Deng
- Department of Respiratory MedicineXiangya Hospital, Central South UniversityChangsha Hunan410008 People's Republic of China
| | - Jiye Yin
- Department of Clinical PharmacologyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
- Hunan Key Laboratory of PharmacogeneticsInstitute of Clinical Pharmacology, Central South UniversityChangsha410078 People's Republic of China
| | - Shiming Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary AnthropologyInstitute of Genetics, School of Life Sciences, Fudan UniversityShanghai20000 People's Republic of China
| | - Daru Lu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary AnthropologyInstitute of Genetics, School of Life Sciences, Fudan UniversityShanghai20000 People's Republic of China
| | - Xiaoke Wen
- Key Laboratory of Hunan Province for Traditional Chinese Medicine in Obstetrics and Gynecology Research, Hunan Provincial Maternal and Child Health Care HospitalChangsha410008 People's Republic of China
| | - Xiangping Li
- Department of PharmacyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
| | - Di Xiao
- Department of PharmacyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
| | - Chengping Hu
- Department of Respiratory MedicineXiangya Hospital, Central South UniversityChangsha Hunan410008 People's Republic of China
| | - Xiang Chen
- Department of DermatologyXiangya Hospital, Central South UniversityChangsha Hunan410008 People's Republic of China
| | - Wei Zhang
- Department of Clinical PharmacologyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
- Hunan Key Laboratory of PharmacogeneticsInstitute of Clinical Pharmacology, Central South UniversityChangsha410078 People's Republic of China
| | - Honghao Zhou
- Department of Clinical PharmacologyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
- Hunan Key Laboratory of PharmacogeneticsInstitute of Clinical Pharmacology, Central South UniversityChangsha410078 People's Republic of China
| | - Zhaoqian Liu
- Department of Clinical PharmacologyXiangya Hospital, Central South UniversityChangsha410008 People's Republic of China
- Hunan Key Laboratory of PharmacogeneticsInstitute of Clinical Pharmacology, Central South UniversityChangsha410078 People's Republic of China
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Schneider BP, Lai D, Shen F, Jiang G, Radovich M, Li L, Gardner L, Miller KD, O'Neill A, Sparano JA, Xue G, Foroud T, Sledge GW. Charcot-Marie-Tooth gene, SBF2, associated with taxane-induced peripheral neuropathy in African Americans. Oncotarget 2016; 7:82244-82253. [PMID: 27732968 PMCID: PMC5347688 DOI: 10.18632/oncotarget.12545] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/18/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Taxane-induced peripheral neuropathy (TIPN) is one of the most important survivorship issues for cancer patients. African Americans (AA) have previously been shown to have an increased risk for this toxicity. Germline predictive biomarkers were evaluated to help identify a priori which patients might be at extraordinarily high risk for this toxicity. EXPERIMENTAL DESIGN Whole exome sequencing was performed using germline DNA from 213 AA patients who received a standard dose and schedule of paclitaxel in the adjuvant, randomized phase III breast cancer trial, E5103. Cases were defined as those with either grade 3-4 (n=64) or grade 2-4 (n=151) TIPN and were compared to controls (n=62) that were not reported to have experienced TIPN. We retained for analysis rare variants with a minor allele frequency <3% and which were predicted to be deleterious by protein prediction programs. A gene-based, case-control analysis using SKAT was performed to identify genes that harbored an imbalance of deleterious variants associated with increased risk of TIPN. RESULTS Five genes had a p-value < 10-4 for grade 3-4 TIPN analysis and three genes had a p-value < 10-4 for the grade 2-4 TIPN analysis. For the grade 3-4 TIPN analysis, SET binding factor 2 (SBF2) was significantly associated with TIPN (p-value=4.35 x10-6). Five variants were predicted to be deleterious in SBF2. Inherited mutations in SBF2 have previously been associated with autosomal recessive, Type 4B2 Charcot-Marie-Tooth (CMT) disease. CONCLUSION Rare variants in SBF2, a CMT gene, predict an increased risk of TIPN in AA patients receiving paclitaxel.
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Affiliation(s)
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Fei Shen
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Milan Radovich
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lang Li
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kathy D. Miller
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anne O'Neill
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts, USA
| | - Joseph A. Sparano
- Albert Einstein University, Montefiore Medical Center, Bronx, New York, USA
| | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - George W. Sledge
- Stanford University School of Medicine, Stanford, California, USA
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Egloff H, Jatoi A. Do Ovarian Cancer Patients with a Family History of Cancer (Suspected BRCA1 or BRCA2 Mutation) Suffer Greater Chemotherapy Toxicity? Cancer Invest 2016; 34:531-535. [DOI: 10.1080/07357907.2016.1242011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heidi Egloff
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Hershman DL, Till C, Wright JD, Awad D, Ramsey SD, Barlow WE, Minasian LM, Unger J. Comorbidities and Risk of Chemotherapy-Induced Peripheral Neuropathy Among Participants 65 Years or Older in Southwest Oncology Group Clinical Trials. J Clin Oncol 2016; 34:3014-22. [PMID: 27325863 DOI: 10.1200/jco.2015.66.2346] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Neuropathy is a debilitating toxicity associated with various chemotherapy agents. We evaluated the association between common comorbid conditions and the development of peripheral neuropathy in patients treated with taxane-based chemotherapy. METHODS We examined the Southwest Oncology Group database to identify phase II and III trials that included taxane therapy from 1999 to 2011. We linked the Southwest Oncology Group clinical records to Medicare claims data according to Social Security number, sex, and date of birth. The following disease conditions potentially associated with peripheral neuropathy were evaluated: diabetes, hypothyroidism, hypercholesterolemia, hypertension, varicella zoster, peripheral vascular disease, and autoimmune diseases. Multivariate logistic regression was used to model the odds of experiencing grade 2 to 4 neuropathy. RESULTS A total of 1,401 patients from 23 studies were included in the analysis. Patients receiving paclitaxel were more likely to experience grade 2 to 4 neuropathy compared with docetaxel (25% v 12%, respectively; OR, 2.20; 95% CI, 1.52 to 3.18; P < .001). The inclusion of a platinum agent was also associated with greater neuropathy (OR, 1.68; 95% CI, 1.18 to 2.40; P = .004). For each increase in age of 1 year, the odds of neuropathy increased 4% (P = .006). Patients with complications from diabetes had more than twice the odds of having neuropathy (OR, 2.13; 95% CI, 1.31 to 3.46; P = .002) compared with patients with no diabetes. In contrast, patients with autoimmune disease were half as likely to experience neuropathy (OR, 0.49; 95% CI, 0.24 to 1.02; P = .06). The other conditions were not associated with neuropathy. CONCLUSION We found that in addition to drug-related factors, age and history of diabetes were independent predictors of the development of chemotherapy-induced peripheral neuropathy. Interestingly, we also observed that a history of autoimmune disease was associated with reduced odds of neuropathy. Patients with diabetic complications may choose to avoid paclitaxel or taxane plus platinum combination therapies if other efficacious options exist.
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Affiliation(s)
- Dawn L Hershman
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
| | - Cathee Till
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - Jason D Wright
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - Danielle Awad
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - Scott D Ramsey
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - William E Barlow
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - Lori M Minasian
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
| | - Joseph Unger
- Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD
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Chen EI, Crew KD, Trivedi M, Awad D, Maurer M, Kalinsky K, Koller A, Patel P, Kim Kim J, Hershman DL. Identifying Predictors of Taxane-Induced Peripheral Neuropathy Using Mass Spectrometry-Based Proteomics Technology. PLoS One 2015; 10:e0145816. [PMID: 26710119 PMCID: PMC4692419 DOI: 10.1371/journal.pone.0145816] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022] Open
Abstract
Major advances in early detection and therapy have significantly increased the survival of breast cancer patients. Unfortunately, most cancer therapies are known to carry a substantial risk of adverse long-term treatment-related effects. Little is known about patient susceptibility to severe side effects after chemotherapy. Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of taxanes. Recent advances in genome-wide genotyping and sequencing technologies have supported the discoveries of a number of pharmacogenetic markers that predict response to chemotherapy. However, effectively implementing these pharmacogenetic markers in the clinic remains a major challenge. On the other hand, recent advances in proteomic technologies incorporating mass spectrometry (MS) for biomarker discovery show great promise to provide clinically relevant protein biomarkers. In this study, we evaluated the association between protein content in serum exosomes and severity of CIPN. Women with early stage breast cancer receiving adjuvant taxane chemotherapy were assessed with the FACT-Ntx score and serum was collected before and after the taxane treatment. Based on the change in FACT-Ntx score from baseline to 12 month follow-up, we separated patients into two groups: those who had no change (Group 1, N = 9) and those who had a ≥20% worsening (Group 1, N = 8). MS-based proteomics technology was used to identify proteins present in serum exosomes to determine potential biomarkers. Mann-Whitney-Wilcoxon analysis was applied and maximum FDR was controlled at 20%. From the serum exosomes derived from this cohort, we identified over 700 proteins known to be in different subcellular locations and have different functions. Statistical analysis revealed a 12-protein signature that resulted in a distinct separation between baseline serum samples of both groups (q<0.2) suggesting that the baseline samples can predict subsequent neurotoxicity. These toxicity-associated biomarkers can be further validated in larger retrospective cohorts for their utility in identifying patients at high risk for CIPN.
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Affiliation(s)
- Emily I. Chen
- Department of Pharmacology, Columbia University Medical Center, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Katherine D. Crew
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Medical Center, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Meghna Trivedi
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Danielle Awad
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Mathew Maurer
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Kevin Kalinsky
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Antonius Koller
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Purvi Patel
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Jenny Kim Kim
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
| | - Dawn L. Hershman
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Medical Center, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Proteomics Shared Resource, Columbia University Medical Center, New York, New York, United States of America
- * E-mail:
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Frederiks C, Lam S, Guchelaar H, Boven E. Genetic polymorphisms and paclitaxel- or docetaxel-induced toxicities: A systematic review. Cancer Treat Rev 2015; 41:935-50. [DOI: 10.1016/j.ctrv.2015.10.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 12/28/2022]
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Schneider BP, Li L, Radovich M, Shen F, Miller KD, Flockhart DA, Jiang G, Vance G, Gardner L, Vatta M, Bai S, Lai D, Koller D, Zhao F, O'Neill A, Smith ML, Railey E, White C, Partridge A, Sparano J, Davidson NE, Foroud T, Sledge GW. Genome-Wide Association Studies for Taxane-Induced Peripheral Neuropathy in ECOG-5103 and ECOG-1199. Clin Cancer Res 2015; 21:5082-5091. [PMID: 26138065 PMCID: PMC4717479 DOI: 10.1158/1078-0432.ccr-15-0586] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/08/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Taxane-induced peripheral neuropathy (TIPN) is an important survivorship issue for many cancer patients. Currently, there are no clinically implemented biomarkers to predict which patients might be at increased risk for TIPN. We present a comprehensive approach to identification of genetic variants to predict TIPN. EXPERIMENTAL DESIGN We performed a genome-wide association study (GWAS) in 3,431 patients from the phase III adjuvant breast cancer trial, ECOG-5103 to compare genotypes with TIPN. We performed candidate validation of top SNPs for TIPN in another phase III adjuvant breast cancer trial, ECOG-1199. RESULTS When evaluating for grade 3-4 TIPN, 120 SNPs had a P value of <10(-4) from patients of European descent (EA) in ECOG-5103. Thirty candidate SNPs were subsequently tested in ECOG-1199 and SNP rs3125923 was found to be significantly associated with grade 3-4 TIPN (P = 1.7 × 10(-3); OR, 1.8). Race was also a major predictor of TIPN, with patients of African descent (AA) experiencing increased risk of grade 2-4 TIPN (HR, 2.1; P = 5.6 × 10(-16)) and grade 3-4 TIPN (HR, 2.6; P = 1.1 × 10(-11)) compared with others. An SNP in FCAMR, rs1856746, had a trend toward an association with grade 2-4 TIPN in AA patients from the GWAS in ECOG-5103 (OR, 5.5; P = 1.6 × 10(-7)). CONCLUSIONS rs3125923 represents a validated SNP to predict grade 3-4 TIPN. Genetically determined AA race represents the most significant predictor of TIPN.
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Affiliation(s)
| | - Lang Li
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Milan Radovich
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Fei Shen
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Kathy D. Miller
- Indiana University School of Medicine, Indianapolis,
Indiana
| | | | - Guanglong Jiang
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Gail Vance
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Laura Gardner
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Matteo Vatta
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Shaochun Bai
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Daniel Koller
- Indiana University School of Medicine, Indianapolis,
Indiana
| | - Fengmin Zhao
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Anne O'Neill
- Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Joseph Sparano
- Albert Einstein university, Montefiore Medical Center,
Bronx, New York
| | | | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis,
Indiana
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Abstract
Adjuvant chemotherapy continues to play an important role in breast cancer management. Exposure to chemotherapy can lead to a variety of early and late long-term toxicities, including ovarian failure (with resultant infertility and sexual dysfunction), bone loss, weight gain, neurotoxicity, neurocognitive changes, cardiac toxicity and secondary malignancy. Although chemotherapy effects may vary in medical severity, all effects have the potential to lead to a decrease in quality of life and a decrement on overall health status. Improved understanding of the etiology and management of chemotherapy-related toxicity may allow optimization of patient selection for treatment and ameliorate the concerns of patients who are considering embarking on a chemotherapy program. This article presents an overview of relevant early and late long-term toxicities, with a focus on recent advances and clinical management.
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Affiliation(s)
- Erica L Mayer
- From the Breast Oncology Center, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA
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Reyes-Gibby CC, Wang J, Yeung SCJ, Shete S. Informative gene network for chemotherapy-induced peripheral neuropathy. BioData Min 2015; 8:24. [PMID: 26269716 PMCID: PMC4534051 DOI: 10.1186/s13040-015-0058-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/04/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Host genetic variability has been implicated in chemotherapy-induced peripheral neuropathy (CIPN). A dose-limiting toxicity for chemotherapy agents, CIPN is also a debilitating condition that may progress to chronic neuropathic pain. We utilized a bioinformatics approach, which captures the complexity of intracellular and intercellular interactions, to identify genes for CIPN. METHODS Using genes pooled from the literature as a starting point, we used Ingenuity Pathway Analysis (IPA) to generate gene networks for CIPN. RESULTS We performed IPA core analysis for genes associated with platinum-, taxane- and platinum-taxane-induced neuropathy. We found that IL6, TNF, CXCL8, IL1B and ERK1/2 were the top genes in terms of the number of connections in platinum-induced neuropathy and TP53, MYC, PARP1, P38 MAPK and TNF for combined taxane-platinum-induced neuropathy. CONCLUSION Neurotoxicity is common in cancer patients treated with platinum compounds and anti-microtubule agents and CIPN is one of the debilitating sequela. The bioinformatic approach helped identify genes associated with CIPN in cancer patients.
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Affiliation(s)
- Cielito C. Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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35
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Abstract
Breast cancer is a heterogeneous disease that necessitates proper patient classification to direct surgery, pharmacotherapy, and radiotherapy. Despite patients within the same subgroup receiving similar pharmacotherapy, substantial variation in clinical outcomes is observed. Pharmacogenetic variations with direct effect on pharmacokinetics and pharmacodynamics play a central role in clinical outcomes. Pharmacogenetic markers associated with clinical outcome are known as biomarkers. They are termed prognostic biomarkers when their presence is associated with a specific clinical outcome. If the presence of such biomarkers guides treatment, they are termed predictive biomarkers. A number of pharmacogenetic markers have been described in relation to breast cancer pharmacotherapy both in the adjuvant and neoadjuvant setting. CYP2D6 allelic variants produce variable rates of tamoxifen metabolism and are associated with survival outcomes. Other biomarkers have been described in relation to other forms of endocrine therapy and trastuzumab. In neoadjuvant and adjuvant breast cancer chemotherapy, specific biomarkers were correlated with clinical outcomes and risk of drug toxicity. This review highlights key biomarkers in breast cancer pharmacotherapy with the potential of translating such study outcomes into clinical practice.
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36
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Therapeutic strategies for cancer treatment related peripheral neuropathies. Curr Treat Options Oncol 2015; 15:567-80. [PMID: 25119581 DOI: 10.1007/s11864-014-0303-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with multiple chemotherapeutic agents. CIPN may have a detrimental impact on patients' quality of life and functional ability, as well as result in chemotherapy dose reductions. Although symptoms of CIPN can improve with treatment completion, symptoms may persist. Currently, the treatment options for CIPN are quite limited. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has the most evidence supporting its use in the treatment of CIPN. Other agents with potential benefit for the treatment of established CIPN include gabapentinoids, venlafaxine, tricyclic antidepressants, and a topical gel consisting of the combination of amitriptyline, ketamine, and baclofen; none of these, however, has been proven to be helpful and ongoing/future studies may well show that they are not beneficial. The use of these agents is often based on their efficacy in the treatment of non-CIPN neuropathic pain, but this does not necessarily mean that they will be helpful for CIPN-related symptoms. Other nonpharmacologic interventions including acupuncture and Scrambler therapy are supported by positive preliminary data; however, further larger, placebo-controlled trial data are needed to confirm or refute their effectiveness.
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37
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De Iuliis F, Taglieri L, Salerno G, Lanza R, Scarpa S. Taxane induced neuropathy in patients affected by breast cancer: Literature review. Crit Rev Oncol Hematol 2015; 96:34-45. [PMID: 26004917 DOI: 10.1016/j.critrevonc.2015.04.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/10/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022] Open
Abstract
Taxane induced neuropathy (TIN) is the most limiting side effect of taxane based chemotherapy, relative to the majority of breast cancer patients undergoing therapy with both docetaxel and paclitaxel. The symptoms begin symmetrically from the toes, because the tips of the longest nerves are affected for first. The patients report sensory symptoms such as paresthesia, dysesthesia, numbness, electric shock-like sensation, motor impairment and neuropathic pain. There is a great inter-individual variability among breast cancer women treated with taxanes, in fact 20-30% of them don't develop neurotoxicity. Actually, there is no standard therapy for TIN, although many medications, antioxidants and natural substances have been tested in vitro and in vivo. We will summarize all most recent literature data on TIN prevention and treatment, in order to reach an improvement in TIN management. Further studies are needed to evaluate new therapies that restore neuronal function and improve life quality of patients.
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Affiliation(s)
- Francesca De Iuliis
- Experimental Medicine Department, Sapienza University, viale Regina Elena 324, 00161 Rome, Italy
| | - Ludovica Taglieri
- Experimental Medicine Department, Sapienza University, viale Regina Elena 324, 00161 Rome, Italy
| | - Gerardo Salerno
- Experimental Medicine Department, Sapienza University, viale Regina Elena 324, 00161 Rome, Italy
| | - Rosina Lanza
- Ginecology and Obstetrics Department, Sapienza University, viale Regina Elena 324, 00161 Rome, Italy
| | - Susanna Scarpa
- Experimental Medicine Department, Sapienza University, viale Regina Elena 324, 00161 Rome, Italy.
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38
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Schneider BP, Hershman DL, Loprinzi C. Symptoms: Chemotherapy-Induced Peripheral Neuropathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:77-87. [PMID: 26059930 DOI: 10.1007/978-3-319-16366-6_6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a problematic, treatment-induced toxicity that has the potential to impact quality of life and limit the doses of curative intent therapy. This therapy-induced side effect is one of the most troublesome in oncology clinical practices, considering the morbidity, the frequency, and the potential irreversibility of this problem. Patients with breast cancer are particularly impacted by this side effect as multiple agents commonly used for this disease can cause neuropathy. In this chapter, we provide an overview of CIPN, including: clinical predictors, frequency, and its impact on quality of life. Further, we highlight the pathophysiology and review the literature to date for agents designed to prevent or treat CIPN. We also highlight the most important ongoing clinical and translational research questions that hope to help better predict and prevent this toxicity. This includes optimizing the methods of assessment, using host specific factors (Race and genetics) to predict those more likely to experience CIPN, and determining how CIPN might impact clinical decisions toward therapy.
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Affiliation(s)
- Bryan P Schneider
- Medicine & Medical/Molecular Genetics, Indiana University Simon Cancer Center, Indianapolis, IN, USA,
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Park SB, Kwok JB, Loy CT, Friedlander ML, Lin CSY, Krishnan AV, Lewis CR, Kiernan MC. Paclitaxel-induced neuropathy: potential association of MAPT and GSK3B genotypes. BMC Cancer 2014; 14:993. [PMID: 25535399 PMCID: PMC4364586 DOI: 10.1186/1471-2407-14-993] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Background Paclitaxel treatment produces dose-limiting peripheral neurotoxicity, which adversely affects treatment and long-term outcomes. In the present study, the contribution of genetic polymorphisms to paclitaxel-induced neurotoxicity were assessed in 21 patients, focusing on polymorphisms involved in the tau-microtubule pathway, an important target of paclitaxel involved in neurotoxicity development. Methods Polymorphisms in the microtubule-associated protein tau (MAPT) gene (haplotype 1 and rs242557 polymorphism) and the glycogen synthase kinase-3β (GSK3β) gene (rs6438552 polymorphism) were investigated. Neurotoxicity was assessed using neuropathy grading scales, neurophysiological studies and patient questionnaires. Results A significant relationship between the GSK-3B rs6438552 polymorphism and paclitaxel-induced neurotoxicity was evident. Conclusions Polymorphisms in tau-associated genes may contribute to the development of paclitaxel-induced neurotoxicity, although larger series will be necessary to confirm these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Matthew C Kiernan
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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40
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn KJ, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew DL, Gralow JR, Hortobagyi GN. SWOG S0221: a phase III trial comparing chemotherapy schedules in high-risk early-stage breast cancer. J Clin Oncol 2014; 33:58-64. [PMID: 25422488 DOI: 10.1200/jco.2014.56.3296] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the optimal dose and schedule of anthracycline and taxane administration as adjuvant therapy for early-stage breast cancer. PATIENTS AND METHODS A 2 × 2 factorial design was used to test two hypotheses: (1) that a novel continuous schedule of doxorubicin-cyclophosphamide was superior to six cycles of doxorubicin-cyclophosphamide once every 2 weeks and (2) that paclitaxel once per week was superior to six cycles of paclitaxel once every 2 weeks in patients with node-positive or high-risk node-negative early-stage breast cancer. With 3,250 patients, a disease-free survival (DFS) hazard ratio of 0.82 for each randomization could be detected with 90% power with two-sided α = .05. Overall survival (OS) was a secondary outcome. RESULTS Interim analyses crossed the futility boundaries for demonstrating superiority of both once-per-week regimens and once-every-2-weeks regimens. After a median follow-up of 6 years, a significant interaction developed between the two randomization factors (DFS P = .024; OS P = .010) in the 2,716 patients randomly assigned in the original design, which precluded interpretation of the two factors separately. Comparing all four arms showed a significant difference in OS (P = .040) but not in DFS (P = .11), with all treatments given once every 2 weeks associated with the highest OS. This difference in OS seemed confined to patients with hormone receptor-negative/human epidermal growth factor receptor 2 (HER2) -negative tumors (P = .067), with no differences seen with hormone receptor-positive/HER2-negative (P = .90) or HER2-positive tumors (P = .40). CONCLUSION Patients achieved a similar DFS with any of these regimens. Subset analysis suggests the hypothesis that once-every-2-weeks dosing may be best for patients with hormone receptor-negative/HER2-negative tumors.
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Affiliation(s)
- George T Budd
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ.
| | - William E Barlow
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Halle C F Moore
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Timothy J Hobday
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - James A Stewart
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Claudine Isaacs
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Muhammad Salim
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Jonathan K Cho
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Kristine J Rinn
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Kathy S Albain
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Helen K Chew
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gary V Burton
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Timothy D Moore
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gordan Srkalovic
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Bradley A McGregor
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Lawrence E Flaherty
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Robert B Livingston
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Danika L Lew
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Julie R Gralow
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gabriel N Hortobagyi
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
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Ng T, Chan M, Khor CC, Ho HK, Chan A. The genetic variants underlying breast cancer treatment-induced chronic and late toxicities: a systematic review. Cancer Treat Rev 2014; 40:1199-214. [PMID: 25458605 DOI: 10.1016/j.ctrv.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/06/2014] [Indexed: 01/15/2023]
Abstract
A systematic review was performed to describe the findings from 19 genetic association studies that have examined the genetic variants underlying four common treatment-induced chronic and late toxicities in breast cancer patients, and to evaluate the quality of reporting. Three out of 5 studies found an association between HER2 lle655Val polymorphisms and trastuzumab-induced cardiotoxicity. Two studies found a positive association between cognitive impairment and the Val allele of the COMT gene and the ε4 allele of the apolipoprotein E gene. Genetic associations were established between fatigue and the G/G genotype of IL6-174 and TNF-308, and the Met allele of the COMT gene in 4 studies. Among studies (N=8) that evaluated the genetic associations underlying peripheral neuropathy, CYP2C8∗3 variant is commonly reported as the associated gene. Most studies failed to conform to the major criteria listed in the STREGA guidelines, with a lack of transparent reporting of methods and results.
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Affiliation(s)
- Terence Ng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Mint Chan
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore; Department of Pharmacy, National Cancer Centre Singapore, Singapore.
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42
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Chemotherapy-induced neuropathy: A comprehensive survey. Cancer Treat Rev 2014; 40:872-82. [DOI: 10.1016/j.ctrv.2014.04.004] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 12/11/2022]
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Yao S, Sucheston LE, Zhao H, Barlow WE, Zirpoli G, Liu S, Moore HC, Budd GT, Hershman DL, Davis W, Ciupak GL, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Livingston RB, Albain KS, Hayes DF, Ambrosone CB. Germline genetic variants in ABCB1, ABCC1 and ALDH1A1, and risk of hematological and gastrointestinal toxicities in a SWOG Phase III trial S0221 for breast cancer. THE PHARMACOGENOMICS JOURNAL 2014; 14:241-7. [PMID: 23999597 PMCID: PMC3940691 DOI: 10.1038/tpj.2013.32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/25/2013] [Accepted: 07/31/2013] [Indexed: 01/29/2023]
Abstract
Hematological and gastrointestinal toxicities are common among patients treated with cyclophosphamide and doxorubicin for breast cancer. To examine whether single-nucleotide polymorphisms (SNPs) in key pharmacokinetic genes were associated with risk of hematological or gastrointestinal toxicity, we analyzed 78 SNPs in ABCB1, ABCC1 and ALDH1A1 in 882 breast cancer patients enrolled in the SWOG trial S0221 and treated with cyclophosphamide and doxorubicin. A two-SNP haplotype in ALDH1A1 was associated with an increased risk of grade 3 and 4 hematological toxicity (odds ratio=1.44, 95% confidence interval=1.16-1.78), which remained significant after correction for multiple comparisons. In addition, four SNPs in ABCC1 were associated with gastrointestinal toxicity. Our findings provide evidence that SNPs in pharmacokinetic genes may have an impact on the development of chemotherapy-related toxicities. This is a necessary first step toward building a clinical tool that will help assess risk of adverse outcomes before undergoing chemotherapy.
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Affiliation(s)
- Song Yao
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Hua Zhao
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Song Liu
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kathy S. Albain
- Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL, USA
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Abraham JE, Guo Q, Dorling L, Tyrer J, Ingle S, Hardy R, Vallier AL, Hiller L, Burns R, Jones L, Bowden SJ, Dunn JA, Poole CJ, Caldas C, Pharoah PPD, Earl HM. Replication of genetic polymorphisms reported to be associated with taxane-related sensory neuropathy in patients with early breast cancer treated with Paclitaxel. Clin Cancer Res 2014; 20:2466-75. [PMID: 24599932 DOI: 10.1158/1078-0432.ccr-13-3232] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Associations between taxane-related sensory neuropathy (TRSN) and single-nucleotide polymorphisms (SNP) have previously been reported, but few have been replicated in large, independent validation studies. This study evaluates the association between previously investigated SNPs and TRSN, using genotype data from a study of chemotherapy-related toxicity in patients with breast cancer. EXPERIMENTAL DESIGN We investigated 73 SNPs in 50 genes for their contribution to TRSN risk, using genotype data from 1,303 European patients. TRSN was assessed using National Cancer Institute common toxicity criteria for adverse events classification. Unconditional logistic regression evaluated the association between each SNP and TRSN risk (primary analysis). Cox regression analysis assessed the association between each SNP and cumulative taxane dose causing the first reported moderate/severe TRSN (secondary analysis). The admixture likelihood (AML) test, which considers all SNPs with a prior probability of association with TRSN together, tested the hypothesis that certain SNPs are truly associated. RESULTS The AML test provided strong evidence for the association of some SNPs with TRSN (P = 0.023). The two most significantly associated SNPs were rs3213619(ABCB1) [OR = 0.47; 95% confidence interval (CI), 0.28-0.79; P = 0.004] and rs9501929(TUBB2A) (OR = 1.80; 95% CI, 1.20-2.72; P = 0.005). A further 9 SNPs were significant at P-value ≤ 0.05. CONCLUSION This is currently the largest study investigating SNPs associated with TRSN. We found strong evidence that SNPs within genes in taxane pharmacokinetic and pharmacodynamic pathways contribute to TRSN risk. However, a large proportion of the inter-individual variability in TRSN remains unexplained. Further validated results from GWAS will help to identify new pathways, genes, and SNPs involved in TRSN susceptibility.
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Affiliation(s)
- Jean E Abraham
- Authors' Affiliations: Department of Oncology and Strangeways Research Laboratory, University of Cambridge; Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, University of Cambridge NHS Foundation Hospitals; Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way; Cambridge Experimental Cancer Medicine Centre, Cambridge; Warwick Clinical Trials Unit, University of Warwick; and Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
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Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2014; 32:1941-67. [PMID: 24733808 DOI: 10.1200/jco.2013.54.0914] [Citation(s) in RCA: 802] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To provide evidence-based guidance on the optimum prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathies (CIPN) in adult cancer survivors. METHODS A systematic literature search identified relevant, randomized controlled trials (RCTs) for the treatment of CIPN. Primary outcomes included incidence and severity of neuropathy as measured by neurophysiologic changes, patient-reported outcomes, and quality of life. RESULTS A total of 48 RCTs met eligibility criteria and comprise the evidentiary basis for the recommendations. Trials tended to be small and heterogeneous, many with insufficient sample sizes to detect clinically important differences in outcomes. Primary outcomes varied across the trials, and in most cases, studies were not directly comparable because of different outcomes, measurements, and instruments used at different time points. The strength of the recommendations is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. RECOMMENDATIONS On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with duloxetine. Although the CIPN trials are inconclusive regarding tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions given the limited other CIPN treatment options. Further research on these agents is warranted.
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Affiliation(s)
- Dawn L Hershman
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Christina Lacchetti
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Robert H Dworkin
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Ellen M Lavoie Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Jonathan Bleeker
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Guido Cavaletti
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Cynthia Chauhan
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Patrick Gavin
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Antoinette Lavino
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Maryam B Lustberg
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Judith Paice
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Bryan Schneider
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Mary Lou Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Tom Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Shelby Terstriep
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Nina Wagner-Johnston
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Kate Bak
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Charles L Loprinzi
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
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Hertz DL, Roy S, Jack J, Motsinger-Reif AA, Drobish A, Clark LS, Carey LA, Dees EC, McLeod HL. Genetic heterogeneity beyond CYP2C8*3 does not explain differential sensitivity to paclitaxel-induced neuropathy. Breast Cancer Res Treat 2014; 145:245-54. [PMID: 24706167 DOI: 10.1007/s10549-014-2910-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 12/16/2022]
Abstract
The development of paclitaxel-induced peripheral neuropathy (PIPN) is influenced by drug exposure and patient genetics. The purpose of this analysis was to expand on a previous reported association of CYP2C8*3 and PIPN risk by investigating additional polymorphisms in CYP2C8 and in hundreds of other genes potentially relevant to paclitaxel pharmacokinetics. Clinical data was collected prospectively in an observational registry of newly diagnosed breast cancer patients. Patients treated with paclitaxel-containing regimens were genotyped using the Affymetrix DMET™ Plus chip. Patients who carried the CYP2C8*2, *3, or *4 variant were collapsed into a low-metabolizer CYP2C8 phenotype for association with PIPN. Separately, all SNPs that surpassed quality control were assessed individually and as a composite of genetic ancestry for associations with PIPN. 412 paclitaxel-treated patients and 564 genetic markers were included in the analysis. The risk of PIPN was significantly greater in the CYP2C8 low-metabolizer group (HR = 1.722, p = 0.018); however, the influences of the *2 and *4 SNPs were not independently significant (*2: p = 0.847, *4: p = 0.408). One intronic SNP in ABCG1 (rs492338) surpassed the exploratory significance threshold for an association with PIPN in the Caucasian cohort (p = 0.0008) but not in the non-Caucasian replication group (p = 0.54). Substantial genetic variability was observed within self-reported racial groups but this genetic variability was not associated with risk of grade 2+ PIPN. The pharmacogenetic heterogeneity within a cohort of breast cancer patients is dramatic, though we did not find evidence that this heterogeneity directly influences the risk of PIPN beyond the contribution of CYP2C8*3.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI, 48109, USA,
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47
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Hertz DL. Germline pharmacogenetics of paclitaxel for cancer treatment. Pharmacogenomics 2014; 14:1065-84. [PMID: 23837481 DOI: 10.2217/pgs.13.90] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Paclitaxel is a highly effective chemotherapeutic agent used in a variety of solid tumors. Some paclitaxel-treated patients experience the intended therapeutic response with manageable side effects, while others have minimal response and/or severe toxicity. This variability in treatment outcome is partially determined by variability in drug exposure (pharmacokinetics) and by patient and tumor sensitivity (pharmacodynamics). Both pharmacokinetics and pharmacodynamics are dictated in part by common variants in the germline genome, known as SNPs. This article reviews the published literature on paclitaxel pharmacogenetics in cancer, focusing primarily on polymorphisms in genes relevant to paclitaxel pharmacokinetics and discusses preliminary work on pharmacodynamic genes and genome-wide association studies.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical, Social, & Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
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48
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Eckhoff L, Knoop AS, Jensen MB, Ejlertsen B, Ewertz M. Risk of docetaxel-induced peripheral neuropathy among 1,725 Danish patients with early stage breast cancer. Breast Cancer Res Treat 2013; 142:109-18. [DOI: 10.1007/s10549-013-2728-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
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49
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Krens SD, McLeod HL, Hertz DL. Pharmacogenetics, enzyme probes and therapeutic drug monitoring as potential tools for individualizing taxane therapy. Pharmacogenomics 2013; 14:555-74. [PMID: 23556452 DOI: 10.2217/pgs.13.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The taxanes are a class of chemotherapeutic agents that are widely used in the treatment of various solid tumors. Although taxanes are highly effective in cancer treatment, their use is associated with serious complications attributable to large interindividual variability in pharmacokinetics and a narrow therapeutic window. Unpredictable toxicity occurrence necessitates close patient monitoring while on therapy and adverse effects frequently require decreasing, delaying or even discontinuing taxane treatment. Currently, taxane dosing is based primarily on body surface area, ignoring other factors that are known to dictate variability in pharmacokinetics or outcome. This article discusses three potential strategies for individualizing taxane treatment based on patient information that can be collected before or during care. The clinical implementation of pharmacogenetics, enzyme probes or therapeutic drug monitoring could enable clinicians to personalize taxane treatment to enhance efficacy and/or limit toxicity.
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Affiliation(s)
- Stefanie D Krens
- UNC Institute for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, 120 Mason Farm Road, CB 7361, Chapel Hill, NC 27599, USA
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50
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Use of pharmacogenetics for predicting cancer prognosis and treatment exposure, response and toxicity. J Hum Genet 2013; 58:346-52. [PMID: 23677053 DOI: 10.1038/jhg.2013.42] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer treatment is complicated because of a multitude of treatment options and little patient-specific information to help clinicians choose appropriate therapy. There are two genomes relevant in cancer treatment: the tumor (somatic) and the patient (germline). Together, these two genomes dictate treatment outcome through four processes: the somatic genome primarily determines tumor prognosis and response while the germline genome modulates treatment exposure and toxicity. In this review, we describe the influence of these genomes on treatment outcomes by highlighting examples of genetic variation that are predictors of each of these four factors, prognosis, response, toxicity and exposure, and discuss the translation and clinical implementation of each. Use of pre-treatment pharmacogenetic testing will someday enable clinicians to make individualized therapy decisions about aggressiveness, drug selection and dose, improving treatment outcomes for cancer patients.
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