1
|
Monaghan NP, Duckett KA, Nguyen SA, Newman JG, Albergotti WG, Kejner AE. Vascular events in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1557-1572. [PMID: 38334324 DOI: 10.1002/hed.27675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To assess the incidence of vascular events in patients with head and neck cancer. REVIEW METHODS Primary studies identified through April 2023. Meta-analysis was performed. RESULTS There were 146 studies included in the systematic review. Rates of events were collected in the overall group, those with chemoprophylaxis, and those that underwent surgery, radiation, or chemotherapy. Of 1 184 160 patients, 4.3% had a vascular event. Radiation therapy had highest risk of overall events and stroke when compared to surgery and chemotherapy. Chemotherapy had a higher risk of stroke and overall events when compared to surgery. CONCLUSIONS Vascular events occur in 4%-5% of patients with head and neck cancer. Our data does not support the use of routine anticoagulation. Patients undergoing radiation therapy had the highest frequency of events.
Collapse
Affiliation(s)
- Neil P Monaghan
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Greer Albergotti
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexandra E Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
2
|
Jia W, Mao Y, Luo Q, Wu J, Guan Q. Targeting neutrophil elastase is a promising direction for future cancer treatment. Discov Oncol 2024; 15:167. [PMID: 38750338 PMCID: PMC11096153 DOI: 10.1007/s12672-024-01010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
Neutrophil elastase (NE) is a proteolytic enzyme released extracellular during the formation of neutrophil extracellular traps (NETs) through degranulation. In addition to participating in the body's inflammatory response, NE also plays an important role in cancer. It can promote tumor proliferation, migration, and invasion, induce epithelial-mesenchymal transition (EMT), and change the tumor microenvironment (TME) to promote tumor progression. Concurrently, NE promotes systemic treatment resistance by inducing EMT. However, it can also selectively kill cancer cells and attenuate tumor development. Sivelestat is a specific NE inhibitor that can be used in the perioperative period of esophageal cancer patients to reduce the incidence of postoperative complications after esophagectomy. In addition, the combination of sivelestat and trastuzumab can enhance the efficacy of human epidermal growth factor receptor 2(HER 2) positive breast cancer patients. Meanwhile, targeting the human antibody domains and fragments of NE is also a new way to treat cancer and inflammation-related diseases. This review provides valuable insights into the role of NE in cancer treatment. Additionally, we discuss the challenges associated with the clinical application of sivelestat. By shedding light on the promising potential of NE, this review contributes to the advancement of cancer treatment strategies.
Collapse
Affiliation(s)
- Wangqiang Jia
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yudong Mao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Qianwen Luo
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jiang Wu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Quanlin Guan
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.
- Department of Oncology Surgery, the First Hospital of Lanzhou University, No. 1, Donggang West Road, Lanzhou, 730000, Gansu Province, China.
| |
Collapse
|
3
|
Eberly HW, Sciscent BY, Lorenz FJ, Rettig EM, Goyal N. Current and Emerging Diagnostic, Prognostic, and Predictive Biomarkers in Head and Neck Cancer. Biomedicines 2024; 12:415. [PMID: 38398017 PMCID: PMC10886579 DOI: 10.3390/biomedicines12020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.
Collapse
Affiliation(s)
- Hänel W. Eberly
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Bao Y. Sciscent
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - F. Jeffrey Lorenz
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Eleni M. Rettig
- Department of Otolaryngology Head and Neck Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02108, USA
| | - Neerav Goyal
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| |
Collapse
|
4
|
Caudell JJ, Torres-Saavedra PA, Rosenthal DI, Axelrod RS, Nguyen-Tan PF, Sherman EJ, Weber RS, Galvin JM, El-Naggar AK, Konski AA, Echevarria MI, Dunlap NE, Shenouda G, Singh AK, Beitler JJ, Garsa A, Bonner JA, Garden AS, Algan O, Harris J, Le QT. Long-Term Update of NRG/RTOG 0522: A Randomized Phase 3 Trial of Concurrent Radiation and Cisplatin With or Without Cetuximab in Locoregionally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 116:533-543. [PMID: 36549347 PMCID: PMC10247515 DOI: 10.1016/j.ijrobp.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The combination of cisplatin and radiation or cetuximab and radiation improves overall survival of patients with locoregionally advanced head and neck carcinoma. NRG Oncology conducted a phase 3 trial to test the hypothesis that adding cetuximab to radiation and cisplatin would improve progression-free survival (PFS). METHODS AND MATERIALS Eligible patients with American Joint Committee on Cancer sixth edition stage T2 N2a-3 M0 or T3-4 N0-3 M0 were accrued from November 2005 to March 2009 and randomized to receive radiation and cisplatin without (arm A) or with (arm B) cetuximab. Outcomes were correlated with patient and tumor features. Late reactions were scored using Common Terminology Criteria for Adverse Events (version 3). RESULTS Of 891 analyzed patients, 452 with a median follow-up of 10.1 years were alive at analysis. The addition of cetuximab did not improve PFS (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.89-1.26; P = .74), with 10-year estimates of 43.6% (95% CI, 38.8- 48.4) for arm A and 40.2% (95% CI, 35.4-45.0) for arm B. Cetuximab did not reduce locoregional failure (HR, 1.21; 95% CI, 0.95-1.53; P = .94) or distant metastasis (HR, 0.79; 95% CI, 0.54-1.14; P = .10) or improve overall survival (HR, 0.97; 95% CI, 0.80-1.16; P = .36). Cetuximab did not appear to improve PFS in either p16-positive oropharynx (HR, 1.30; 95% CI, 0.87-1.93) or p16-negative oropharynx or nonoropharyngeal primary (HR, 0.94; 95% CI, 0.73-1.21). Grade 3 to 4 late toxicity rates were 57.4% in arm A and 61.3% in arm B (P = .26). CONCLUSIONS With a median follow-up of more than 10 years, this updated report confirms the addition of cetuximab to radiation therapy and cisplatin did not improve any measured outcome in the entire cohort or when stratifying by p16 status.
Collapse
Affiliation(s)
- Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL.
| | - Pedro A Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
| | - David I Rosenthal
- Departments of Radiation Oncology, Head and Neck Surger, and Pathology, MD Anderson Cancer Center, Houston, TX
| | - Rita S Axelrod
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Phuc Felix Nguyen-Tan
- Department of Radiology, Radiation Oncology and Nuclear Medicine, CHUM - Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Eric J Sherman
- Head and Neck Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Randal S Weber
- Departments of Radiation Oncology, Head and Neck Surger, and Pathology, MD Anderson Cancer Center, Houston, TX
| | - James M Galvin
- Imaging and Radiation Oncology Core (IROC) Philadelphia, Philadelphia, PA
| | - Adel K El-Naggar
- Departments of Radiation Oncology, Head and Neck Surger, and Pathology, MD Anderson Cancer Center, Houston, TX
| | - Andre A Konski
- Department of Radiation Oncology, Chester County Hospital/University of Pennsylvania, Philadelphia, PA
| | | | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, James Graham Brown Cancer Center, Louisville, KY
| | - George Shenouda
- Department of Radiation Oncology, Research Institute of the McGill University Health Centre (MUHC), Montreal, Canada
| | - Anurag K Singh
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Adam Garsa
- Department of Radiation Oncology, USC Norris Comprehensive Cancer Center LAPS, Los Angeles, CA
| | - James A Bonner
- Department of Radiation Oncology, University of Alabama at Birmingham Cancer Center, Birmingham, AL
| | - Adam S Garden
- Departments of Radiation Oncology, Head and Neck Surger, and Pathology, MD Anderson Cancer Center, Houston, TX
| | - Ozer Algan
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford Cancer Institute, Palo Alto, CA
| |
Collapse
|
5
|
Sutton SR, Taniguchi AN, Nguyen SA, Albergotti WG, Kaczmar JM, Kejner AE, Newman JG. The Inconsistent Assessment of Quality of Life in Patients Treated for Head and Neck Cancer with Anti-EGFR Inhibitors: A Systematic Scoping Review. Cancers (Basel) 2023; 15:cancers15092475. [PMID: 37173942 PMCID: PMC10177329 DOI: 10.3390/cancers15092475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
In patients receiving treatment for head and neck cancer (HNC), there is a correlation between quality of life (QoL) scores and treatment outcomes. Higher QoL scores have been associated with improved survival. Despite this, the assessment of QoL in clinical trials varies considerably. Three databases (Scopus, PubMed, and Cinahl) were queried for articles published in English between 2006 and 2022. Two reviewers (SRS and ANT) performed study screening, data extraction, and risk of bias assessment. The authors identified 21 articles that met the inclusion criteria. A total of 5961 patients were evaluated. QoL was reported as average scores for specific variables across five different surveys in 12 included articles. Supplemental QoL data were available in 10 included studies. Critical appraisal of studies indicated a high risk of bias due to the inclusion of trials. There is no standard method for reporting QoL data in clinical trials for HNC patients undergoing treatment with anti-EGFR inhibitors. Future clinical trials should standardize their method for assessing and reporting quality-of-life data to increase patient-centered care and refine treatment choices to optimize survival.
Collapse
Affiliation(s)
- Sarah R Sutton
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - April N Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - John M Kaczmar
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jason G Newman
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| |
Collapse
|
6
|
Li XL, Han C, Luo M, Xiao S, Li J, Yu C, Cheng S, Jin Y, Han Y, Todoroki K, Shi Q, Min JZ. Relative quantitation of glycans in cetuximab using ultra-high-performance liquid chromatography-high-resolution mass spectrometry by Pronase E digestion. J Chromatogr A 2022; 1677:463302. [PMID: 35820231 DOI: 10.1016/j.chroma.2022.463302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
Glycans play important roles in the activity and function of monoclonal antibodies (mAbs). In this study, an isotope labeling method for the relative quantitative analysis of glycans in cetuximab, a chimeric human/mouse IgG1 monoclonal antibody that specifically targets epidermal growth factor receptor, via hydrophilic interaction LC-ultra-high-performance LC-HRMS was established based on Pronase E digestion. To this aim, novel isotope MS probes, i.e., 3-benzoyl-2-oxothiazolidine-4-carboxylic acid (d0-BOTC) and 3-(2,3,4,5,6-pentadeuterio-benzoyl)-2-oxothiazolidine-4-carboxylate acid (d5-BOTC), which include a carboxyl group to target the amino functional group in glycosylamine, were developed. The nonspecific Pronase E enzyme could simultaneously digest the peptide bound to the N- and O-glycans into glycosylamine having only one amino acid. Since the mass difference between the light- and heavy-labeled glycans was 5.0 Da, the relative abundance of their MS peaks was used to achieve the qualitative and relative quantitative analysis of glycans. Sialylglycopeptide was used as a complex glycan model to validate the accuracy of the method. The results demonstrated the good linearity (R2 ≥ 0.9994) between the experimentally detected MS intensity ratios and the theoretical molar ratios of the d0-BOTC to the corresponding d5-BOTC derivatives in the dynamic range of 0.03-10 and 0.03-20 of three orders magnitude for the d5-BOTC/d0-BOTC ratios. The reproducibility was between 0.16% and 10.70%, and the limit of detection was 13 fmol. The feasibility of the relative quantification method was investigated by analyzing the glycan content in cetuximab, finding good consistency between experimental and theoretical molar ratios (5:1, 3:1, 1:1, 1:3, 1:5) of d0/d5-BOTC-labeled glycans. Finally, 13 glycans were successfully identified in cetuximab by applying this method using an in-house Tracefinder database. This study provides a novel strategy for the high throughput analysis, identification, and functional study of glycans in mAbs.
Collapse
Affiliation(s)
- Xi-Ling Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Chengqiang Han
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Miao Luo
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Shuyun Xiao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Jing Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Chenglong Yu
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Shengyu Cheng
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Yueying Jin
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Yu Han
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China
| | - Kenichiro Todoroki
- Laboratory of Analytical and Bio-Analytical Chemistry, School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Qing Shi
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China.
| | - Jun Zhe Min
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy, Yanbian University, and Department of Pharmacy, Yanbian University Hospital, Yanji, Jilin 133002, China.
| |
Collapse
|
7
|
Ostroumova OD, Chernyaeva MS, Kochetkov AI, Vorobieva AE, Bakhteeva DI, Korchagina SP, Bondarets OV, Boyko ND, Sychev DA. Drug-Induced Atrial Fibrillation / Atrial Flutter. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2021-12-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Drug-induced atrial fibrillation / flutter (DIAF) is a serious and potentially life-threatening complication of pharmacotherapy. Purpose of the work: systematization and analysis of scientific literature data on drugs, the use of which can cause the development of DIAF, as well as on epidemiology, pathophysiological mechanisms, risk factors, clinical picture, diagnosis and differential diagnosis, treatment and prevention of DIAF. Analysis of the literature has shown that many groups of drugs can cause the development of DIAF, with a greater frequency while taking anticancer drugs, drugs for the treatment of the cardiovascular, bronchopulmonary and central nervous systems. The mechanisms and main risk factors for the development of DIAF have not been finally established and are known only for certain drugs, therefore, this section requires further study. The main symptoms of DIAF are due to the severity of tachycardia and their influence on the parameters of central hemodynamics. For diagnosis, it is necessary to conduct an electrocardiogram (ECG) and Holter monitoring of an ECG and echocardiography. Differential diagnosis should be made with AF, which may be caused by other causes, as well as other rhythm and conduction disturbances. Successful treatment of DIAF is based on the principle of rapid recognition and immediate discontinuation of drugs (if possible), the use of which potentially caused the development of adverse drug reactions (ADR). The choice of management strategy: heart rate control or rhythm control, as well as the method of achievement (medication or non-medication), depends on the specific clinical situation. For the prevention of DIAF, it is necessary to instruct patients about possible symptoms and recommend self-monitoring of the pulse. It is important for practitioners to be wary of the risk of DIAF due to the variety of drugs that can potentially cause this ADR.
Collapse
Affiliation(s)
- O. D Ostroumova
- Russian Medical Academy of Continuing Professional Education
| | - M. S. Chernyaeva
- Central State Medical Academy of the Administrative Department of the President; Hospital for War Veterans No. 2
| | - A. I. Kochetkov
- Russian Medical Academy of Continuing Professional Education
| | - A. E. Vorobieva
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimova
| | | | | | - O. V. Bondarets
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimova
| | | | - D. A. Sychev
- Russian Medical Academy of Continuing Professional Education
| |
Collapse
|
8
|
Babu G, Bahl A, Bhattacharya GS, Bhowmik KT, Dattatraya PS, Ghadyalpatil N, Karandikar SM, Kulkarni P, Sridharan N, Parikh P, Prabhash K, Raja T, Rajasundaram S, Subramanian S, Talapatra K, Vaid A. Oncology Gold Standard ® practical consensus recommendations for the use of monoclonal antibodies in the management of squamous cell carcinoma of head and neck. South Asian J Cancer 2020; 6:154-160. [PMID: 29404293 PMCID: PMC5763625 DOI: 10.4103/sajc.sajc_181_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.
Collapse
Affiliation(s)
- Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ankur Bahl
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - G S Bhattacharya
- Department of Medical Oncology, Fortis Hospital, Kolkata, West Bengal, India
| | - K T Bhowmik
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - P S Dattatraya
- Department of Medical Oncology, Omega Hospital, Hyderabad, Telangana, India
| | - Nikhil Ghadyalpatil
- Department of Medical Oncology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - S M Karandikar
- Department of Medical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Padmaj Kulkarni
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Nithya Sridharan
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Purvish Parikh
- Department of Precision Oncology, Asian Cancer Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Raja
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - S Rajasundaram
- Department of Surgical Oncology, Global Institute of Oncology, Chennai, Tamil Nadu, India
| | - S Subramanian
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Kaustav Talapatra
- Department of Radiation Oncology, KDA Hospital, Mumbai, Maharashtra, India
| | - Ashok Vaid
- Department of Medical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | | |
Collapse
|
9
|
Lungulescu CV, Ungureanu BS, Turcu-Stiolica A, Ghimpau V, Artene SA, Cazacu IM, Grecu AF, Dinescu VC, Croitoru A, Volovat SR. The role of IgE specific for galactose-α-1,3-galactose in predicting cetuximab induced hypersensitivity reaction: a systematic review and a diagnostic meta-analysis. Sci Rep 2020; 10:21355. [PMID: 33288791 PMCID: PMC7721698 DOI: 10.1038/s41598-020-78497-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/26/2020] [Indexed: 02/01/2023] Open
Abstract
Recombinant monoclonal antibodies are used for treating various diseases, from asthma, rheumatoid arthritis, and inflammatory bowel disease to cancer. Although monoclonal antibodies are known to have fewer toxic reactions compared with the conventional cytotoxic antineoplastic drugs, the cases of severe systemic hypersensitivity reaction (HSR) should be acknowledged. Our aim was to assess the diagnostic accuracy of the anti-IgE for galactose-α-1,3-galactose in patients with HSRs to cetuximab. We searched in PubMed, Cochrane Library, Scopus, and World of Science databases to July 1st, 2020. We included a total of 6 studies, with 1074 patients. Meta-analysis was performed using bivariate analysis and the random-effect model. The pooled sensitivity was 73% (95% CI 62-81%) and the pooled specificity was 88% (95% CI 79-94%). We had not found significant heterogeneity and, despite some discrepancies in the nature of data available in the analysed studies, we draw the conclusion that the presence of cetuximab specific IgE (anti cetuximab antibody) and/or galactose-α-1,3-galactose shows moderate to high sensitivity and specificity of developing an HSR. More studies are needed to establish a protocol necessary for the proper prediction and avoidance of HSR related to cetuximab.
Collapse
Affiliation(s)
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
| | - Valentina Ghimpau
- Pharmacy of Craiova Doctoral School, University of Medicine, Craiova, Romania
| | | | | | | | - Venera Cristina Dinescu
- Health Promotion and Occupational Medicine Department, University of Medicine & Pharmacy of Craiova, Craiova, Romania
| | - Adina Croitoru
- Fundeni Clinical Institute, Titu Maiorescu University, Bucharest, Romania
| | | |
Collapse
|
10
|
Chawla S, Kim SG, Loevner LA, Wang S, Mohan S, Lin A, Poptani H. Prediction of distant metastases in patients with squamous cell carcinoma of head and neck using DWI and DCE-MRI. Head Neck 2020; 42:3295-3306. [PMID: 32737951 DOI: 10.1002/hed.26386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/30/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The primary purpose was to evaluate the prognostic potential of diffusion imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in predicting distant metastases in squamous cell carcinoma of head and neck (HNSCC) patients. The secondary aim was to examine differences in DWI and DCE-MRI-derived parameters on the basis of human papilloma virus (HPV) status, differentiation grade, and nodal stage of HNSCC. METHODS Fifty-six patients underwent pretreatment DWI and DCE-MRI. Patients were divided into groups who subsequently did (n = 12) or did not develop distant metastases (n = 44). Median values of apparent diffusion coefficient (ADC), volume transfer constant (Ktrans ), and mean intracellular water-lifetime (τi ) and volume were computed from metastatic lymph nodes and were compared between two groups. Prognostic utility of HPV status, differentiation grading, and nodal staging was also evaluated both in isolation or in combination with MRI parameters in distinguishing patients with and without distant metastases. Additionally, MRI parameters were compared between two groups based on dichotomous HPV status, differentiation grade, and nodal stage. RESULTS Lower but not significantly different Ktrans (0.51 ± 0.15 minute-1 vs 0.60 ± 0.05 minute-1 ) and not significantly different τi (0.13 ± 0.03 second vs 0.19 ± 0.02 second) were observed in patients who developed distant metastases than those who did not. Additionally, no significant differences in ADC or volume were found. τi, was the best parameter in discriminating two groups with moderate sensitivity (67%) and specificity (61.4%). Multivariate logistic regression analyses did not improve the overall prognostic performance for combination of all variables. A trend toward higher τi was observed in HPV-positive patients than those with HPV-negative patients. Also, a trend toward higher Ktrans was observed in poorly differentiated HNSCCs than those with moderately differentiated HNSCCs. CONCLUSION Pretreatment DCE-MRI may be useful in predicting distant metastases in HNSCC.
Collapse
Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sungheon G Kim
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Laurie A Loevner
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sumei Wang
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harish Poptani
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK
| |
Collapse
|
11
|
Powell SF, Gold KA, Gitau MM, Sumey CJ, Lohr MM, McGraw SC, Nowak RK, Jensen AW, Blanchard MJ, Fischer CD, Bykowski J, Ellison CA, Black LJ, Thompson PA, Callejas-Valera JL, Lee JH, Cohen EEW, Spanos WC. Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. J Clin Oncol 2020; 38:2427-2437. [PMID: 32479189 DOI: 10.1200/jco.19.03156] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Pembrolizumab is a humanized monoclonal antibody that blocks interaction between programmed death receptor-1 (PD-1) and its ligands (PD-L1, PD-L2). Although pembrolizumab is approved for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), its role in the management of locally advanced (LA) disease is not defined. We report a phase IB study evaluating the safety and efficacy of adding pembrolizumab to cisplatin-based chemoradiotherapy in patients with LA HNSCC. PATIENTS AND METHODS Eligible patients included those with oral cavity (excluding lip), oropharyngeal, hypopharyngeal, or laryngeal stage III to IVB HNSCC (according to American Joint Committee on Cancer, 7th edition, staging system) eligible for cisplatin-based, standard-dose (70 Gy) chemoradiotherapy. Pembrolizumab was administered concurrently with and after chemoradiotherapy with weekly cisplatin. Safety was the primary end point and was determined by incidence of chemoradiotherapy adverse events (AEs) and immune-related AEs (irAEs). Efficacy was defined as complete response (CR) rate on end-of-treatment (EOT) imaging or with pathologic confirmation at 100 days postradiotherapy completion. Key secondary end points included overall (OS) and progression-free survival (PFS). RESULTS The study accrued 59 patients (human papillomavirus [HPV] positive, n = 34; HPV negative, n = 25) from November 2015 to October 2018. Five patients (8.8%) required discontinuation of pembrolizumab because of irAEs, all of which occurred during concurrent chemoradiotherapy; 98.3% of patients completed the full planned treatment dose (70 Gy) of radiotherapy without any delays ≥ 5 days; 88.1% of patients completed the goal cisplatin dose of ≥ 200 mg/m2. EOT CR rates were 85.3% and 78.3% for those with HPV-positive and -negative HNSCC, respectively. CONCLUSION Pembrolizumab in combination with weekly cisplatin-based chemoradiotherapy is safe and does not impair delivery of curative radiotherapy or chemotherapy in HNSCC. Early efficacy data support further investigation of this approach.
Collapse
Affiliation(s)
| | - Kathryn A Gold
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Mark M Gitau
- Roger Maris Cancer Center, Sanford Health, Fargo, ND
| | | | | | | | - Ryan K Nowak
- Sanford Cancer Center, Sanford Health, Sioux Falls, SD
| | | | | | | | - Julie Bykowski
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Lora J Black
- Sanford Research, Sanford Health, Sioux Falls, SD
| | | | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | |
Collapse
|
12
|
Chiang KH, Shieh JM, Shen CJ, Chang TW, Wu PT, Hsu JY, Tsai JP, Chang WC, Chen BK. Epidermal growth factor-induced COX-2 regulates metastasis of head and neck squamous cell carcinoma through upregulation of angiopoietin-like 4. Cancer Sci 2020; 111:2004-2015. [PMID: 32227417 PMCID: PMC7293094 DOI: 10.1111/cas.14400] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) expression and activation are the major causes of metastasis in cancers such as head and neck squamous cell carcinoma (HNSCC). However, the reciprocal effect of EGF‐induced COX‐2 and angiopoietin‐like 4 (ANGPTL4) on HNSCC metastasis remains unclear. In this study, we revealed that the expression of ANGPTL4 is essential for COX‐2‐derived prostaglandin E2 (PGE2)‐induced tumor cell metastasis. We showed that EGF‐induced ANGPTL4 expression was dramatically inhibited with the depletion and inactivation of COX‐2 by knockdown of COX‐2 and celecoxib treatment, respectively. Prostaglandin E2 induced ANGPTL4 expression in a time‐ and dose‐dependent manners in various HNSCC cell lines through the ERK pathway. In addition, the depletion of ANGPTL4 and MMP1 significantly impeded the PGE2‐induced transendothelial invasion ability of HNSCC cells and the binding of tumor cells to endothelial cells. The induction of molecules involved in the regulation of epithelial‐mesenchymal transition was also dependent on ANGPTL4 expression in PGE2‐treated cells. The depletion of ANGPTL4 further blocked PGE2‐primed tumor cell metastatic seeding of lungs. These results indicate that the EGF‐activated PGE2/ANGPTL4 axis enhanced HNSCC metastasis. The concurrent expression of COX‐2 and ANGPTL4 in HNSCC tumor specimens provides insight into potential therapeutic targets for the treatment of EGFR‐associated HNSCC metastasis.
Collapse
Affiliation(s)
- Kuo-Hwa Chiang
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jiunn-Min Shieh
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-Jie Shen
- Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Wei Chang
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Ting Wu
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Jinn-Yuan Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jhih-Peng Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chang Chang
- Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ben-Kuen Chen
- Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
13
|
Advanced cutaneous squamous cell carcinoma: how is it defined and what new therapeutic approaches are available? Curr Opin Oncol 2020; 31:461-468. [PMID: 31394558 DOI: 10.1097/cco.0000000000000566] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Despite the overall excellent survival rates in patients with cutaneous squamous cell carcinoma (cSCC), advanced cutaneous SCCs are associated with high patient morbidity and mortality. Therefore, important unmet clinical needs persist: identifying high risk patients and choosing optimal treatment approaches. RECENT FINDINGS In recent years, a better understanding of the biology of cSCC and its clinical progression have led to improved staging systems and new promising treatments for advanced disease. Such treatments include PD1 inhibitors, such as cemiplimab, which was recently approved for the treatment of cutaneous SCC, and pembrolizumab whose efficacy in the treatment cSCC is still being investigated. Other treatments, such as epidermal growth factor receptor inhibitors have also been used in the treatment of cSCC with moderate success. Several clinical and histological risk factors are considered key in estimating the risk or recurrence or metastasis in cSCCs and, therefore, influence the appropriate treatment choice and patient monitoring. SUMMARY The present study reviews the current definition of advanced cSCC and discusses the new systemic approaches, including checkpoint inhibitors.
Collapse
|
14
|
von der Grün J, Rödel F, Brandts C, Fokas E, Guckenberger M, Rödel C, Balermpas P. Targeted Therapies and Immune-Checkpoint Inhibition in Head and Neck Squamous Cell Carcinoma: Where Do We Stand Today and Where to Go? Cancers (Basel) 2019; 11:E472. [PMID: 30987257 PMCID: PMC6521064 DOI: 10.3390/cancers11040472] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 01/12/2023] Open
Abstract
With an increased understanding of the tumor biology of squamous cell carcinoma of the head and neck (SCCHN), targeted therapies have found their way into the clinical treatment routines against this entity. Nevertheless, to date platinum-based cytostatic agents remain the first line choice and targeting the epidermal growth factor-receptor (EGFR) with combined cetuximab and radiation therapy remains the only targeted therapy approved in the curative setting. Investigation of immune checkpoint inhibitors (ICI), such as antibodies targeting programmed cell death protein 1 (PD-1) and its ligand PD-L1, resulted in a change of paradigms in oncology and in the first approval of new drugs for treating SCCHN. Nivolumab and pembrolizumab, two anti-PD-1 antibodies, were the first agents shown to improve overall survival for patients with metastatic/recurrent tumors in recent years. Currently, several clinical trials investigate the role of ICI in different therapeutic settings. A robust set of biomarkers will be an inevitable tool for future individualized treatment approaches including radiation dose de-escalation and escalation strategies. This review aims to summarize achieved goals, the current status and future perspectives regarding targeted therapies and ICI in the management of SCCHN.
Collapse
Affiliation(s)
- Jens von der Grün
- Department of Radiation Oncology, Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
| | - Franz Rödel
- Department of Radiation Oncology, Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- Frankfurt Cancer Institute (FCI), Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site: Frankfurt a. M., Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
| | - Christian Brandts
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site: Frankfurt a. M., Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- Department of Medicine, Hematology/Oncology, University Cancer Center Frankfurt (UCT), Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
| | - Emmanouil Fokas
- Department of Radiation Oncology, Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- Frankfurt Cancer Institute (FCI), Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site: Frankfurt a. M., Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
| | - Matthias Guckenberger
- Department of Radiation Oncology, Rämistrasse 100, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Claus Rödel
- Department of Radiation Oncology, Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- Frankfurt Cancer Institute (FCI), Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site: Frankfurt a. M., Theodor-Stern-Kai 7, University of Frankfurt, 60590 Frankfurt, Germany.
| | - Panagiotis Balermpas
- Department of Radiation Oncology, Rämistrasse 100, University Hospital Zurich, 8091 Zürich, Switzerland.
| |
Collapse
|
15
|
Rawat S, Tandan H, Patel S, Chaudhari S. Safety and efficacy of nimotuzumab with concurrent chemoradiotherapy in unresectable locally advanced squamous cell carcinoma of head and neck: An Indian rural hospital experience. South Asian J Cancer 2019; 8:52-56. [PMID: 30766856 PMCID: PMC6348788 DOI: 10.4103/sajc.sajc_76_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Context: Nimotuzumab is the only anti-epidermal growth factor receptor monoclonal antibody which can be safely added to concurrent chemoradiotherapy (CRT) to improve efficacy in the management of unresectable, locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). However, the evidence available on this is limited. Aims: We retrospectively investigated efficacy and safety of nimotuzumab when combined with chemoradiation for LA-SCCHN. Settings and Design: Hospital records of 39 patients from January 2012 to December 2016 diagnosed with locally advanced (Stage III-IVb), unresectable SCCHN, and treated with concurrent CRT with weekly nimotuzumab were reviewed retrospectively after fulfilling the inclusion/exclusion criteria. Subjects and Methods: Tumor response was calculated as per response evaluation criteria in solid tumors criteria 1.1. Association of tumor response with independent variables was assessed. Overall survival (OS) and progression-free survival (PFS) were calculated. All patients were assessed for toxicity as per common terminology criteria for adverse events Common Terminology Criteria for Adverse Events v 4.0 (U.S. Department of health and human services, National Institutes of Health, National Cancer Institute). Results: At 6 months after completion of treatment, objective response rate was 97.44% with 26 (66.67%) patients attaining Complete response (CR), 12 (30.77%) patients with Partial response (PR), and one patient (2.56%) had stable disease. Subgroup analysis did not show a significant association of tumor response with independent factors. OS at 1 and 2-year was 100% and 72.9%, while PFS at 1 and 2-year was 87% and 54.40%. The incidence of Grade I, II, III, and IV toxicity was 30%, 18.18%, 41.82%, and 10%, respectively. No grade V toxicity was observed. Common adverse events observed were mucositis (33.64%), skin reaction (24.55%), neutropenia (20.91%), vomiting (18.18%), and diarrhea (2.73%). Conclusions: Nimotuzumab is an efficacious and safe option when added to concurrent CRT in unresectable, LA-SCCHN.
Collapse
Affiliation(s)
- Shyamji Rawat
- Department of Radiation Oncology, NSCB Medical College and Government Hospital, Jabalpur, Madhya Pradesh, India
| | - Hemu Tandan
- Department of Radiation Oncology, NSCB Medical College and Government Hospital, Jabalpur, Madhya Pradesh, India
| | - Sanandan Patel
- Department of Radiation Oncology, NSCB Medical College and Government Hospital, Jabalpur, Madhya Pradesh, India
| | - Sameer Chaudhari
- Department of Radiation Oncology, NSCB Medical College and Government Hospital, Jabalpur, Madhya Pradesh, India
| |
Collapse
|
16
|
Portas J, Corrêa D, Queija D, Arantes LMRB, Viana LDS, Carvalho AL. Effect of Induction Chemotherapy on Swallowing in Head and Neck Cancer Patients. Asian Pac J Cancer Prev 2019; 20:91-96. [PMID: 30678386 PMCID: PMC6485558 DOI: 10.31557/apjcp.2019.20.1.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the effect of induction chemotherapy on swallowing and swallowing-related quality of life of patients with oropharyngeal, laryngeal and hypopharyngeal cancer. Study design: Prospective study of 33 patients with locally advanced tumors who were eligible for treatment with neoadjuvant chemotherapy followed by radiotherapy and concurrent chemotherapy. A multidimensional assessment of swallowing was performed using the following tools: (1) Clinical analysis, numerical scale for general pain and painful swallowing, American Speech and Hearing Association (ASHA) Functional Communication Measures (FCM) swallowing assessment scales, (2) assessment of Swallowing-Related Quality of Life (The MD Anderson Dysphagia Inventory - MDADI), and (3) swallowing videofluoroscopy. Results: There was a reduction in general pain scale (p=0.021), and quality of life (emotional, functional and physical) improved from average limitation (score of 61-80) to minimal limitation (81-100) after induction chemotherapy. According to the swallowing videofluoroscopy results, 26 (78.7%) of the patients had some degree of dysphagia pre-treatment, which decreased to 21 (63.6%) after induction. Conclusion: Our results suggest that induction chemotherapy improves numerous aspects of swallowing and has a positive impact on the quality of life of pre-chemoradiotherapy patients.
Collapse
Affiliation(s)
- Juliana Portas
- SLP Head and Neck Department, Barretos Cancer Hospital, Barretos-SP, Brazil.
| | | | | | | | | | | |
Collapse
|
17
|
Therapeutic Intensification and Induction Chemotherapy for High-Risk Locally Advanced Squamous Cell Carcinoma. Curr Treat Options Oncol 2019; 20:2. [DOI: 10.1007/s11864-019-0599-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Yang X, Li X, Yuan M, Tian C, Yang Y, Wang X, Zhang X, Sun Y, He T, Han S, Chen G, Liu N, Gao Y, Hu D, Xing Y, Shang H. Anticancer Therapy-Induced Atrial Fibrillation: Electrophysiology and Related Mechanisms. Front Pharmacol 2018; 9:1058. [PMID: 30386232 PMCID: PMC6198283 DOI: 10.3389/fphar.2018.01058] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
Some well-established immunotherapy, radiotherapy, postoperation, anticancer drugs such as anthracyclines, antimetabolites, human epidermal growth factor receptor 2 blockers, tyrosine kinase inhibitors, alkylating agents, checkpoint inhibitors, and angiogenesis inhibitors, are significantly linked to cardiotoxicity. Cardiotoxicity is a common complication of several cancer treatments. Some studies observed complications of cardiac arrhythmia associated with the treatment of cancer, including atrial fibrillation (AF), supraventricular arrhythmias, and cardiac repolarization abnormalities. AF increases the risk of cardiovascular morbidity and mortality; it is associated with an almost doubled risk of mortality and a nearly 5-fold increase in the risk of stroke. The occurrence of AF is also usually researched in patients with advanced cancer and those undergoing active cancer treatments. During cancer treatments, the incidence rate of AF affects the prognosis of tumor treatment and challenges the treatment strategy. The present article is mainly focused on the cardiotoxicity of cancer treatments. In our review, we discuss these anticancer therapies and how they induce AF and consequently provide information on the precaution of AF during cancer treatment.
Collapse
Affiliation(s)
- Xinyu Yang
- Guang'an men Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xinye Li
- Guang'an men Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Mengchen Yuan
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Chao Tian
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yihan Yang
- Guang'an men Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaofeng Wang
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Zhang
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yang Sun
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Tianmai He
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Songjie Han
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Guang Chen
- Guang'an men Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing An Zhen Hospital of the Capital University of Medical Sciences, Beijing, China
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yanwei Xing
- Guang'an men Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Institute of Integration of Traditional and Western Medicine of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
19
|
Brøndum L, Alsner J, Sørensen BS, Maare C, Johansen J, Primdahl H, Evensen JF, Kristensen CA, Andersen LJ, Overgaard J, Eriksen JG. Associations between skin rash, treatment outcome, and single nucleotide polymorphisms in head and neck cancer patients receiving the EGFR-inhibitor zalutumumab: results from the DAHANCA 19 trial. Acta Oncol 2018; 57:1159-1164. [PMID: 29771169 DOI: 10.1080/0284186x.2018.1464664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To study the associations between development of moderate to severe skin rash, clinical outcome, and single nucleotide polymorphisms (SNPs) in candidate genes in head and neck cancer patients from the DAHANCA 19 trial receiving the EGFR-inhibitor zalutumumab concurrently with radiation treatment. MATERIAL AND METHODS 310 patients were included from the zalutumumab-arm of the DAHANCA 19 study. Nine SNPs in the candidate genes EGFR, EGF, AREG, FCGR2A, FCGR3A, and CCND1 were successfully determined in 294 patients. Clinical endpoints were moderate to severe skin rash within the first 3 weeks of treatment, loco-regional failure (LRF), disease-specific survival (DSS), and overall survival (OS). RESULTS During the first 3 weeks of treatment, 86% of the patients experienced any grade of rash and 17% experienced a moderate to severe rash. Development of moderate to severe rash was not associated with LRF or DSS but was associated with improved OS, HR 0.40 (95% CI: 0.19-0.82). The effect was similar for patients with p16-negative or p16-positive tumors (p = .90). After adjustment for comorbidity and performance status, the minor alleles of SNPs rs9996584 and rs13104811 located near the AREG gene were significantly associated with increased risk of moderate to severe rash with per-allele odds ratios of 1.61 (1.01-2.54) and 1.56 (1.00-2.44). SNP rs11942466 located close to rs9996584 had a borderline significant association, and none of the other SNPS were significantly associated with risk of skin rash. CONCLUSIONS Moderate to severe skin rash after zalutumumab during radiation treatment was associated with improved OS, independent of HPV/p16-status. Genetic variants in AREG (member of the EGF family) may be associated with increased risk of skin rash.
Collapse
Affiliation(s)
- Line Brøndum
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Maare
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Odense, Denmark
| | - Jan Folkvard Evensen
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | | | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
20
|
Ling DC, Bakkenist CJ, Ferris RL, Clump DA. Role of Immunotherapy in Head and Neck Cancer. Semin Radiat Oncol 2018; 28:12-16. [PMID: 29173750 DOI: 10.1016/j.semradonc.2017.08.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Immune system dysfunction plays a role in both the development and progression of head and neck squamous cell carcinoma (HNSCC), highlighting the potential role for immunotherapy to improve outcomes in this disease. The application of anti-PD-1 therapies for recurrent or metastatic HNSCC has found promising results. This has led to interest in combining immunotherapy with radiation therapy (RT) for the primary treatment of locally advanced HNSCC. RT with concurrent cetuximab is an option for patients who are medically unfit to receive cisplatin, and ongoing trials seek to determine to role of cetuximab-RT in treatment de-intensification for HPV+ oropharyngeal HNSCC. Other ongoing trials are evaluating the use of anti-PD-1 and anti-PD-L1 therapies in the upfront setting for newly diagnosed high-risk, locally advanced HNSCC, in an effort to improve disease control. Finally, early phase I studies are now investigating the use of anti-PD-1 therapy in conjunction with RT for refractory recurrent or metastatic HNSCC.
Collapse
Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chris J Bakkenist
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Immunology, University of Pittsburgh, Pittsburgh, PA; Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| |
Collapse
|
21
|
Peng H, Tang LL, Liu X, Chen L, Li WF, Mao YP, Zhang Y, Liu LZ, Tian L, Guo Y, Sun Y, Ma J. Anti-epidermal growth factor receptor therapy concurrently with induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma. Cancer Sci 2018; 109:1609-1616. [PMID: 29575438 PMCID: PMC5980249 DOI: 10.1111/cas.13589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
Little is known about the efficacy and toxicity of anti-epidermal growth factor receptor therapy concurrently with induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). The present study aimed to address this question. We identified 2848 patients with newly diagnosed LA-NPC receiving IC between January 2012 and May 2015. The propensity score matching (PSM) method was used to balance various factors and to match patients. Survival outcomes and toxicities between different groups were compared. In total, 596 patients were selected at a 1:3 ratio, with 149 in the IC + CTX/NTZ group and 447 in the IC alone group. The 3-year disease-free survival, overall survival, distant metastasis-free survival and locoregional relapse-free survival rates for IC + CTX/NTZ vs IC alone were 84.3% vs 75.2% (P = .059), 94.0% vs 87.9% (P = .053), 88.0% vs 84.9% (P = .412) and 93.3% vs 88.2% (P = .242). Multivariate analysis established a treatment group (IC vs IC + CTX/NTZ) as a prognostic predictor for DFS (hazard ratio [HR], 1.497; 95% confidence interval [CI], 1.016-2.206; P = .041) and OS (HR, 1.984; 95%, CI, 1.023-3.848; P = .043). Grade 3-4 skin reaction (15.4% vs 0.4%, P < .001) and mucositis (10.1% vs 2.7%, P < .001) were more common in the IC + CTX/NTZ group than that in the IC alone group. Our findings suggested that CTX/NTZ in combination with IC may be a more effective and promising strategy for patients with LA-NPC treated with intensity-modulated radiotherapy.
Collapse
Affiliation(s)
- Hao Peng
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ling-Long Tang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xu Liu
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lei Chen
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wen-Fei Li
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan-Ping Mao
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuan Zhang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li-Zhi Liu
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Tian
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Guo
- State Key Laboratory of Oncology in South China, Department of Clinical Trials Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
22
|
Immunoassays for Measuring Serum Concentrations of Monoclonal Antibodies and Anti-biopharmaceutical Antibodies in Patients. Ther Drug Monit 2018; 39:316-321. [PMID: 28570370 DOI: 10.1097/ftd.0000000000000419] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Monoclonal antibodies (mAbs) may be used as biopharmaceuticals to treat various diseases, ranging from oncology to inflammatory and cardiovascular affections. Trustworthy analytical methods are necessary to study their pharmacokinetics, both during their development and in post-marketing studies. Because biopharmaceuticals are macromolecules, ligand-binding assays (both immunoassays and bioassays) are methods of choice to measure their concentrations. Immunoassays are based on the capture of biopharmaceuticals by their target, which may be a circulating or membrane antigen or by an antibody recognizing their structure. Bioassays measure the activity of the biopharmaceutical in a specific in vitro test. A number of techniques have been reported, but their limits of detection and quantification vary widely. Anti-drug antibodies (ADA) against biopharmaceuticals are often formed and sometimes interfere with clinical efficacy. Accurate and reliable detection of ADA is therefore necessary. Binding of ADA is dependent on affinity and avidity, which makes quantification challenging. In this review, we discuss the benefits and limitations of each method to determine mAb levels and carefully compare ADA assays.
Collapse
|
23
|
Peng H, Tang LL, Liu X, Chen L, Li WF, Mao YP, Zhang Y, Liu LZ, Tian L, Guo Y, Sun Y, Ma J. Anti-EGFR targeted therapy delivered before versus during radiotherapy in locoregionally advanced nasopharyngeal carcinoma: a big-data, intelligence platform-based analysis. BMC Cancer 2018; 18:323. [PMID: 29580204 PMCID: PMC5870169 DOI: 10.1186/s12885-018-4268-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the prognostic difference of anti-EGFR therapy, cetuximab (CTX) or nimotuzumab (NTZ), concurrently with induction chemotherapy (IC, investigational arm) or RT (control arm) for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). We conducted this retrospective study to address this. METHODS We identified 296 patients with newly diagnosed LA-NPC at Sun Yat-Sen University Cancer Center between January 2012 and May 2015. Patients were treated by IC with CCRT or RT and CTX/NTZ was delivered during IC or radiotherapy. Survival outcomes and toxicities between different arms were compared. RESULTS In total, there were 149 patients in the investigational arm and 147 in control arm. The 3-year disease-free survival, overall survival, distant metastasis-free survival and locoregional relapse-free survival rates for investigational arm vs. control arm were 84.3% vs. 74.3% (P = 0.027), 94.0% vs. 92.1% (P = 0.673), 88.0% vs. 81.8% (P = 0.147) and 93.3% vs. 88.0% (P = 0.093). Multivariate analysis revealed patients in the control arm achieved significantly worse disease-free survival (HR, 1.497; 95% CI, 1.016-2.206; P = 0.026) compared with those in the investigational arm; however, no significant difference was identified for other endpoints. Patients in the investigational arm experienced more grade 3-4 skin reaction (15.4% vs. 2.0%, P < 0.001) and mucositis (10.1% vs. 3.4%, P = 0.022) during induction phase, but less skin reaction (5.4% vs. 25.9%, P < 0.001) and mucositis (24.8% vs. 36.7%, P = 0.026) during RT. CONCLUSIONS Our findings suggested that CTX/NTZ concurrently with IC may be a more effective and promising strategy for patients with LA-NPC receiving intensity-modulated radiotherapy.
Collapse
Affiliation(s)
- Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Li-Zhi Liu
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Li Tian
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ying Guo
- Department of Clinical Trials Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
| |
Collapse
|
24
|
Zhao Y, Shen L, Huang X, He Y, Fu J, Qian Y, Li S, Zhao N, Shen L. Prognostic analysis of patients with locally advanced nasopharyngeal carcinoma following intensity modulated radiation therapy. Oncol Lett 2018; 15:4445-4450. [PMID: 29552107 DOI: 10.3892/ol.2018.7850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/02/2017] [Indexed: 12/11/2022] Open
Abstract
The present study retrospectively analyzed the prognostic factors of 135 patients with locally advanced nasopharyngeal carcinoma (NPC) who received intensity modulated radiation therapy between August 2008 and January 2012 at Xiangya Hospital of Central South University. Patients were staged from III-IVA according to the 7th American Joint Committee on Cancer staging system. Using Statistical Analysis System 9.3 software, the present study demonstrated that, among these 135 patients, the 5-year overall survival, the 5-year local relapse-free survival, and the 5-year disease metastasis-free survival were 84, 82, and 78%, respectively. Multivariate Cox regression analysis identified that targeted treatment [hazard ratio (95% confidence interval), 2.642 (1.001, 6.972); P=0.0497] served as an independent negative prognostic factor in locally advanced NPC. The results of immunostaining revealed that the staining intensity of the radiation-resistant group was increased compared with that of the radiation-sensitive group. These results demonstrate that a high expression of EGFR may be associated with radiation resistance, and targeted treatment may not be effective in patients with locally advanced nasopharyngeal carcinoma with low expression of EGFR.
Collapse
Affiliation(s)
- Yajie Zhao
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lin Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xinqiong Huang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yuxiang He
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jun Fu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yujie Qian
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Shan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Na Zhao
- Department of Hospital Management Consulting Center, National Institute of Hospital Administration, Beijing 100083, P.R. China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
25
|
Bonomo P, Loi M, Desideri I, Olmetto E, Delli Paoli C, Terziani F, Greto D, Mangoni M, Scoccianti S, Simontacchi G, Francolini G, Meattini I, Caini S, Livi L. Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review. Crit Rev Oncol Hematol 2017; 120:98-110. [DOI: 10.1016/j.critrevonc.2017.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/28/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
|
26
|
Cetuximab for Squamous Cell Carcinoma of the Head and Neck. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
You R, Hua YJ, Liu YP, Yang Q, Zhang YN, Li JB, Li CF, Zou X, Yu T, Cao JY, Zhang MX, Jiang R, Sun R, Mo HY, Guo L, Cao KJ, Lin AH, Sun Y, Qian CN, Ma J, Chen MY. Concurrent Chemoradiotherapy with or without Anti-EGFR-Targeted Treatment for Stage II-IVb Nasopharyngeal Carcinoma: Retrospective Analysis with a Large Cohort and Long Follow-up. Theranostics 2017; 7:2314-2324. [PMID: 28740554 PMCID: PMC5505063 DOI: 10.7150/thno.19710] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/01/2017] [Indexed: 11/21/2022] Open
Abstract
We examined the benefits of the combination of anti-EGFR targeted treatment, cetuximab (CTX) or nimotuzumab (NTZ) and concurrent platinum-based chemoradiotherapy (CCRT) compared with CCRT alone in patients with stage II - IVb nasopharyngeal carcinoma (NPC). A total of 1,628 eligible patients with stage II - IVb NPC, who received CCRT (three cycles of 100 mg/m2 cisplatin every 3 weeks with intensity-modulated radiotherapy) with or without CTX or NTZ between June 2009 and December 2013 were included in the analysis. Using propensity scores to adjust for potential prognostic factors, a well-balanced cohort of 878 patients was created by matching each patient who received CTX or NTZ plus CCRT with no more than four patients who received CCRT alone (1:4). Efficacy and safety were compared between CTX/NTZ plus CCRT and CCRT alone arms. Compared with CCRT alone, treatment with CTX/NTZ plus CCRT was associated with a significantly increased overall survival (3-year OS, 96.6% vs. 92.9%, P = 0.015), improved disease-free survival (3-year DFS, 93.5% vs 86.9%, P = 0.028), and improved distant metastasis-free survival (3-year DMFS, 94.6% vs 89.3%, P = 0.030). Increased rate of CTX related-skin reaction and mucositis was observed in the CTX plus CCRT arm. Multivariate analysis demonstrated the combination of CTX/NTZ was a significant protective factor for OS, DFS, and DMFS in patients treated with CCRT. Our analysis suggests that the addition of CTX/NTZ to CCRT is more effective for maximizing survival in patients with stage II-IVb NPC compared with CCRT alone.
Collapse
|
28
|
Kuhnt T, Schreiber A, Pirnasch A, Hautmann MG, Hass P, Sieker FP, Engenhart-Cabillic R, Richter M, Dellas K, Dunst J. Hyperfractionated accelerated radiation therapy plus cetuximab plus cisplatin chemotherapy in locally advanced inoperable squamous cell carcinoma of the head and neck. Strahlenther Onkol 2017; 193:733-741. [DOI: 10.1007/s00066-017-1145-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/21/2017] [Indexed: 11/30/2022]
|
29
|
Gehrke T, Scherzad A, Ickrath P, Schendzielorz P, Hagen R, Kleinsasser N, Hackenberg S. Zinc oxide nanoparticles antagonize the effect of Cetuximab on head and neck squamous cell carcinoma in vitro. Cancer Biol Ther 2017; 18:513-518. [PMID: 28494171 DOI: 10.1080/15384047.2017.1323598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Zinc oxide nanoparticles (ZnO-NPs) are being used in many cosmetic products and have been shown to induce tumor-selective cell death in human head and neck squamous cell carcinoma (HNSCC) in vitro. Cetuximab is a monoclonal antibody directed against the epidermal growth factor receptor (EGFR), whose effectiveness for HNSCC, alone or in combination with cytostatic drugs, has been demonstrated intensively in the last decades. Nanoparticles are known to interact with protein structures and thus may influence their functionality. The aim of the current study was to evaluate the effect of ZnO-NPs on the antitumor properties of Cetuximab in HNSCC in vitro. Two HNSCC cell lines (FaDu and HLaC-78) were treated with 0.1, 1 or 10 μM Cetuximab as well as 0, 0.1 or 1 μg/ml ZnO-NP. Qualitative assessment of ZnO-NP was conducted via transmission electron microscopy (TEM) and immunofluorescence staining. Evaluation was done via the MTT-assay after 24, 48 and 72 hours of incubation with Cetuximab and ZnO-NPs. ZnO-NPs were shown to antagonize the anti-tumor effects of Cetuximab in a time-dependent as well as dose-dependent way. These findings suggest an inhibitory interaction of ZnO-NPs with Cetuximab, which warrants further investigation.
Collapse
Affiliation(s)
- Thomas Gehrke
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Agmal Scherzad
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Pascal Ickrath
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Philipp Schendzielorz
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Rudolf Hagen
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Norbert Kleinsasser
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| | - Stephan Hackenberg
- a Department of Otorhinolaryngology , Head and Neck Surgery, University Hospital Wuerzburg , Germany
| |
Collapse
|
30
|
|
31
|
Dupont B, Mariotte D, Dugué AE, Clarisse B, Grellard JM, Babin E, Chauffert B, Dakpé S, Moldovan C, Bouhier-Leporrier K, Reimund JM, Di Fiore F, Zanetta S, Mailliez A, Do P, Peytier A, Galais MP, Florescu C, Schott R, Le Mauff B, Gervais R. Utility of serum anti-cetuximab immunoglobulin E levels to identify patients at a high risk of severe hypersensitivity reaction to cetuximab. Br J Clin Pharmacol 2016; 83:623-631. [PMID: 27662818 DOI: 10.1111/bcp.13140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 08/28/2016] [Accepted: 09/18/2016] [Indexed: 12/14/2022] Open
Abstract
AIM Cetuximab is an anti-epidermal growth factor receptor antibody used for the treatment of metastatic colorectal cancer and head and neck cancer. Hypersensitivity reactions (HSRs) are associated with cetuximab use. The aim of the study was to evaluate the utility of anti-cetuximab immunoglobulin E (IgE) detection in order to identify patients at risk of HSR to cetuximab. METHODS We included patients ready to receive a first cetuximab infusion in a prospective cohort carried out at nine French centres. Pretreatment anti-cetuximab IgE levels were measured. We compared the proportion of severe HSRs in the low anti-cetuximab IgE levels (≤29 IgE arbitrary units) subgroup with that in a historical cohort of 213 patients extracted from a previous study. RESULTS Of the 301 assessable patients (mean age: 60.9 ± 9.3 years, head-and-neck cancer: 77%), 66 patients (22%) had high anti-cetuximab IgE levels, and 247 patients received cetuximab (including 38 with high anti-cetuximab levels). Severe HSRs occurred in eight patients (five grade 3 and three grade 4). The proportion of severe HSRs was lower in the low anti-cetuximab IgE levels subgroup vs. the historical cohort (3/209 [1.4%] vs. 11/213 [5.2%], odds ratio, 0.27, 95% confidence interval, 0.07-0.97), and higher in high vs. low anti-cetuximab IgE levels subgroup (5/38 [13.2%] vs. 3/209 [1.4%]; odds ratio, 10.4, 95% confidence interval, 2.4-45.6). Patients with severe HSRs had higher anti-cetuximab IgE levels than patients without reaction (median, 45 vs. 2 IgE arbitrary units, P = 0.006). CONCLUSIONS Detection of pretreatment anti-cetuximab IgE is feasible and helpful to identify patients at risk of severe cetuximab-induced HSRs.
Collapse
Affiliation(s)
- Benoît Dupont
- Department of Hepato-Gastroenterology and Nutrition, CHU de Caen, Caen, France
| | - Delphine Mariotte
- Laboratory of Immunology and Immunopathology, CHU de Caen, Caen, France
| | - Audrey E Dugué
- Clinical Research Department, Centre François Baclesse, Caen, France
| | | | | | - Emmanuel Babin
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Caen, France
| | | | - Stéphanie Dakpé
- Department of Maxillofacial Surgery and Stomatology, CHU d'Amiens, Amiens, France
| | | | | | - Jean-Marie Reimund
- Department of Hepato-Gastroenterology and Nutrition, CHU de Caen, Caen, France.,Department of Hepato-Gastroenterology and Nutritional Support, CHU de Strasbourg, Strasbourg, France
| | - Frederic Di Fiore
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France.,Digestive Oncology Unit, Gastroenterology Department, CHU de Rouen, Rouen, France
| | - Sylvie Zanetta
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - Audrey Mailliez
- Head and Neck Department, Centre Oscar Lambret, Lille, France
| | - Pascal Do
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Annie Peytier
- Gastroenterology Department, Centre Hospitalier de Bayeux, Bayeux, France
| | | | - Carmen Florescu
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Roland Schott
- Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Brigitte Le Mauff
- Laboratory of Immunology and Immunopathology, CHU de Caen, Caen, France
| | - Radj Gervais
- Medical Oncology Department, Centre François Baclesse, Caen, France
| |
Collapse
|
32
|
Anti EGFR therapy in the treatment of non-metastatic head and neck squamous cell carcinoma: The current evidence. J Egypt Natl Canc Inst 2016; 28:141-8. [DOI: 10.1016/j.jnci.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022] Open
|
33
|
Wu X, Huang J, Liu L, Li H, Li P, Zhang J, Xie L. Cetuximab concurrent with IMRT versus cisplatin concurrent with IMRT in locally advanced nasopharyngeal carcinoma: A retrospective matched case-control study. Medicine (Baltimore) 2016; 95:e4926. [PMID: 27684830 PMCID: PMC5265923 DOI: 10.1097/md.0000000000004926] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 02/05/2023] Open
Abstract
To evaluate the treatment efficacies and toxicities of concurrent cetuximab-based bioradiotherapy (BRT) or cisplatin-based chemoradiotherapy (CRT) in locally advanced nasopharyngeal carcinoma. :Patients with previously untreated locally advanced nasopharyngeal carcinoma were matched into pairs, and enrolled into the study. All patients were given either BRT or CRT. Survival outcomes, toxicities, and prognostic factors were evaluated. :A total of 112 patients were enrolled. The 5-year overall survival was 79.3% and 79.5% in CRT and BRT arm, respectively (P = 0.797) and the 5-year DFS was 73.5% and 74.6%, respectively (P = 0.953). In toxicity analysis, CRT arm had more significant decrease in white blood cell, platelet, hemoglobin, and severe vomiting, while more severe skin reactions and mucositis were shown in BRT arm. :BRT was not less efficacious than traditional CRT. They lead to different aspects of toxicities. If patients cannot stand more severe toxicities caused by CRT, BRT could be an ideal alternative.
Collapse
Affiliation(s)
| | | | - Lei Liu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University
| | | | | | | | | |
Collapse
|
34
|
Expression of the chemokine CXCL14 and cetuximab-dependent tumour suppression in head and neck squamous cell carcinoma. Oncogenesis 2016; 5:e240. [PMID: 27399917 PMCID: PMC5399171 DOI: 10.1038/oncsis.2016.43] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/04/2016] [Accepted: 05/18/2016] [Indexed: 12/16/2022] Open
Abstract
Cetuximab, a monoclonal antibody against the epidermal growth factor receptor (EGFR), has been successfully used to treat some patients with colorectal cancer and those with head and neck squamous cell carcinoma (HNSCC). For the effective treatment, it is essential to first identify cetuximab-responsive patients. The level of EGFR expression and/or the presence of mutations in signalling molecules downstream of the EGFR pathway have been reported to be determining factors for cetuximab responsiveness in colorectal cancer patients; however, limited data have been reported for HNSCC patients. We previously reported that the chemokine CXCL14 exhibits tumour-suppressive effects against xenografted HNSCC cells, which may be classified into two groups, CXCL14-expressing and non-expressing cells under serum-starved culture conditions. Here we employed CXCL14-expressing HSC-3 cells and CXCL14-non-expressing YCU-H891 cells as representatives of the two groups and compared their responses to cetuximab and their CXCL14 expression under various conditions. The growth of xenografted tumours initiated by HSC-3 cells, which expressed CXCL14 in vivo and in vitro, was suppressed by the injection of cetuximab into tumour-bearing mice; however, neither the expression of the chemokine nor the cetuximab-dependent suppression of xenograft tumour growth was observed for YCU-H891 cells. Both types of cells expressed EGFR and neither type harboured mutations in signalling molecules downstream of EGFR that have been reported in cetuximab-resistant colon cancer patients. The inhibition of the extracellular signal-regulated kinase (ERK) signalling increased the levels of CXCL14 messenger RNA (mRNA) in HSC-3 cells, but not in YCU-H891 cells. We also observed that the CXCL14 promoter region in YCU-H891 cells was hypermethylated, and that demethylation of the promoter by treatment with 5-aza-2′-deoxycytidine restored CXCL14 mRNA expression and in vivo cetuximab-mediated tumour growth suppression. Finally, we observed in vivo tumour growth suppression when YCU-H891 cells were engineered to express CXCL14 ectopically in the presence of doxycycline. These results indicate that CXCL14 expression may be a good predictive biomarker for cetuximab-dependent tumour suppression.
Collapse
|
35
|
Bibault JE, Morelle M, Perrier L, Pommier P, Boisselier P, Coche-Dequéant B, Gallocher O, Alfonsi M, Bardet É, Rives M, Calugaru V, Chajon E, Noël G, Mecellem H, Pérol D, Dussart S, Giraud P. Toxicity and efficacy of cetuximab associated with several modalities of IMRT for locally advanced head and neck cancer. Cancer Radiother 2016; 20:357-61. [DOI: 10.1016/j.canrad.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
|
36
|
Oral squamous cell carcinoma: Key clinical questions, biomarker discovery, and the role of proteomics. Arch Oral Biol 2016; 63:53-65. [DOI: 10.1016/j.archoralbio.2015.11.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 09/08/2015] [Accepted: 11/20/2015] [Indexed: 12/19/2022]
|
37
|
Echarri MJ, Lopez-Martin A, Hitt R. Targeted Therapy in Locally Advanced and Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (LA-R/M HNSCC). Cancers (Basel) 2016; 8:cancers8030027. [PMID: 26927178 PMCID: PMC4810111 DOI: 10.3390/cancers8030027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 01/07/2023] Open
Abstract
Surgery and radiotherapy are the standard treatment options for patients with squamous cell carcinoma of the head and neck (SCCHN). Chemoradiotherapy is an alternative for patients with locally advanced disease. In recurrent/metastatic disease and after progression to platin-based regimens, no standard treatments other than best supportive care are currently available. Most SCCHN tumours overexpress the epidermal growth factor receptor (EGFR). This receptor is a tyrosine-kinase membrane receptor that has been implicated in angiogenesis, tumour progression and resistance to different cancer treatments. In this review, we analysed the different drugs and pathways under development to treat SCCHN, especially recurrent/metastatic disease. Until now, the EGFR signalling pathway has been considered the most important target with respect to new drugs; however, new drugs, such as immunotherapies, are currently under study. As new treatments for SCCHN are developed, the influence of therapies with respect to overall survival, progression free survival and quality of life in patients with this disease is changing.
Collapse
Affiliation(s)
- María José Echarri
- Department of Medical Oncology, Hospital Universitario Severo Ochoa, Avenida Orellana s/n, Leganés, 28911 Madrid, Spain.
| | - Ana Lopez-Martin
- Department of Medical Oncology, Hospital Universitario Severo Ochoa, Avenida Orellana s/n, Leganés, 28911 Madrid, Spain.
| | - Ricardo Hitt
- Department of Medical Oncology, Hospital Universitario Severo Ochoa, Avenida Orellana s/n, Leganés, 28911 Madrid, Spain.
| |
Collapse
|
38
|
Zhang X, Du L, Zhao F, Wang Q, Yang S, Ma L. A Phase II Clinical Trial of Concurrent Helical Tomotherapy plus Cetuximab Followed by Adjuvant Chemotherapy with Cisplatin and Docetaxel for Locally Advanced Nasopharyngeal Carcinoma. Int J Biol Sci 2016; 12:446-53. [PMID: 27019628 PMCID: PMC4807163 DOI: 10.7150/ijbs.12937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/17/2015] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The present clinical trial was designed to evaluate the efficacy and safety of concurrent helical tomotherapy (HT) with cetuximab followed by adjuvant chemotherapy with docetaxel and cisplatin (TP) in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. MATERIALS AND METHODS This phase II clinical trial included 43 patients with Stage III/IV LANC (33 Stage III and 10 Stage IV). The treatment consisted of concurrent HT with cetuximab (400 mg/m(2) loading dose and weekly 250mg/m(2)), followed by four cycles of chemotherapy [docetaxel (70 mg/m(2) on Day 1) and cisplatin (40 mg/m(2) on Days 1 and 2 every 3 weeks). Side effects were evaluated with CTCAE criteria (Common Terminology Criteria for Adverse Events 3.0). RESULTS The median follow-up duration was 48.0 months [95% confidence interval (CI) 41.7-58.0 months], the 2-year locoregional failure-free rate (LFFR), progression-free survival (PFS), distant failure-free rate (DFFR) and overall survival (OS) were 95.2%, 79.1%, 88.1% and 93.0% respectively; the 3-year LFFR, DFFR, PFS and OS were 92.7%, 85.6%, 72.0% and 85.7% respectively. The most common grade 3 toxicities were oropharyngeal mucositis (81.4%) and RT-related dermatitis (7.0%). No patients had more than grade 3 radiation related toxicities and no patients required nasogastric feeding. One patient experienced grade 3 osteonecrosis at 18 months after treatment. CONCLUSIONS Concurrent HT with cetuximab followed by adjuvant chemotherapy with TP is an effective strategy for the treatment of LANC with encouraging survival rates and minimal side effects.
Collapse
Affiliation(s)
- Xinxin Zhang
- 1. Department of Otolaryngology, Head and Neck Surgery, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Lei Du
- 2. Department of Radiation Oncology, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Feifang Zhao
- 1. Department of Otolaryngology, Head and Neck Surgery, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Qiuju Wang
- 1. Department of Otolaryngology, Head and Neck Surgery, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Shiming Yang
- 1. Department of Otolaryngology, Head and Neck Surgery, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Ma
- 2. Department of Radiation Oncology, Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| |
Collapse
|
39
|
Alorabi M, Shonka NA, Ganti AK. EGFR monoclonal antibodies in locally advanced head and neck squamous cell carcinoma: What is their current role? Crit Rev Oncol Hematol 2015; 99:170-9. [PMID: 26797287 DOI: 10.1016/j.critrevonc.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/25/2015] [Accepted: 12/15/2015] [Indexed: 01/29/2023] Open
Abstract
Treatment options for locally advanced squamous cell carcinoma of the head and neck (SCCHN) include either surgical resection followed by radiation or chemoradiation, or definitive chemoradiation for which single-agent cisplatin is the best studied and established. The increasing understanding of the molecular biology of SCCHN has led to an interest in the development of targeted therapies. The epidermal growth factor receptor (EGFR) is over-expressed in nearly 80-90% of cases of SCCHN and correlates with poor prognosis and resistance to radiation. Preclinical evidence showed that blocking EGFR restores radiation sensitivity and enhances cytotoxicity. This finding led to clinical trials evaluating this class of agents and the approval of cetuximab in combination with radiation for the treatment of locally advanced SCCHN. This review is focused on the anti-EGFR monoclonal antibodies and their role either with radiotherapy or chemoradiation in unresectable LA SCCHN.
Collapse
Affiliation(s)
- Mohamed Alorabi
- Department of Clinical Oncology, Ain Shams University Hospitals, Cairo, Egypt
| | - Nicole A Shonka
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
| |
Collapse
|
40
|
Iberri DJ, Colevas AD. Balancing Safety and Efficacy of Epidermal Growth Factor Receptor Inhibitors in Patients With Squamous Cell Carcinoma of the Head and Neck. Oncologist 2015; 20:1393-403. [PMID: 26446236 PMCID: PMC4679082 DOI: 10.1634/theoncologist.2015-0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/31/2015] [Indexed: 02/06/2023] Open
Abstract
The epidermal growth factor receptor (EGFR) is overexpressed in more than 80% of squamous cell cancers of the head and neck (SCCHN). An evolving understanding of the role of EGFR in tumorigenesis has made the receptor an important therapeutic target in SCCHN. Several EGFR inhibitors (EGFRIs) are active in SCCHN, and their use is associated with improvement in progression-free survival and overall survival in various treatment settings. Nevertheless, EGFR inhibition is associated with significant mucocutaneous toxicity that must be balanced against its anticipated efficacy. This review summarizes the relevant clinical trial experience with EGFRIs, with attention to efficacy, toxicity, and methods of selecting patients most likely to benefit from therapy.
Collapse
Affiliation(s)
- David J Iberri
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford University, Stanford, California, USA
| | - A Dimitrios Colevas
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford University, Stanford, California, USA
| |
Collapse
|
41
|
Möckelmann N, Kriegs M, Lörincz BB, Busch CJ, Knecht R. Molecular targeting in combination with platinum-based chemoradiotherapy in head and neck cancer treatment. Head Neck 2015; 38 Suppl 1:E2173-81. [DOI: 10.1002/hed.24031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 01/13/2023] Open
Affiliation(s)
- Nikolaus Möckelmann
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Malte Kriegs
- Laboratory of Radiobiology and Experimental Radiooncology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Balazs B. Lörincz
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Chia-Jung Busch
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Rainald Knecht
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| |
Collapse
|
42
|
Li J, Zhao Z, Wu X, Yao J, Ma L, Ye R, Niu B, Liang L, Zhao X, Wang Q. Bevacizumab plus cisplatin and helical tomotherapy in treatment of locally advanced nasopharyngeal carcinoma. Onco Targets Ther 2015; 8:1315-9. [PMID: 26082647 PMCID: PMC4459609 DOI: 10.2147/ott.s80159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background In recent years, chemotherapy, radiotherapy, and targeted drugs have been respectively used in nasopharyngeal carcinoma. In our research, we combined all of them for better curative effects. Materials and methods Thirty patients with histologically confirmed stage III~IV (without distant metastasis) nasopharyngeal carcinoma were recruited between December 2013 and October 2014 with strict eligibility requirements and exclusion criteria. Bevacizumab 5 mg/kg, 80 mg/m2 cisplatin and 67.5 Gy radiotherapy (helical tomotherapy [TOMO]) was given according to standard treatment protocols. Results After 3 months, 24 complete responses (80%) and six partial responses (40%) were observed in our research. Twenty-four patients (80%) experienced oropharyngeal mucositis, 26% patients experienced weight loss caused by pharyngeal pain and dysphagia caused by oropharyngeal mucositis. Conclusion Bevacizumab plus cisplatin and TOMO in treatment of locally advanced nasopharyngeal carcinoma can increase curative effects with low side effects and toxicities.
Collapse
Affiliation(s)
- Jianxiong Li
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Zhifei Zhao
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Xuan Wu
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Jie Yao
- Department of Oncology, The People's Liberation Army 161 Hospital, Wuhan, People's Republic of China
| | - Lin Ma
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Rui Ye
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Baolong Niu
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Lanqing Liang
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Xiao Zhao
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Qianqian Wang
- Radiology Department, Cancer Center, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| |
Collapse
|
43
|
Hatakeyama H, Takahashi H, Oridate N, Kuramoto R, Fujiwara K, Homma A, Takeda H, Fukuda S. Hangeshashinto improves the completion rate of chemoradiotherapy and the nutritional status in patients with head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2015; 77:100-8. [PMID: 25896416 DOI: 10.1159/000381026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Severe oral and pharyngeal mucositis is one of the most critical toxicities known to lead to the discontinuation of chemoradiotherapy (CRT) for head and neck cancer (HNC). Hangeshashinto (TJ-14) is a Kampo medicine that relieves chemotherapy-induced oral mucositis. We investigated the effect of TJ-14 on mucositis, nutritional status, and the completion rate of CRT. METHODS The study group comprised patients with advanced HNC who were treated with concomitant weekly cisplatin and 70 Gy of radiotherapy. The primary endpoint was the completion rate of chemotherapy, and the secondary endpoints were the grade of mucositis and the nutritional status. RESULTS A total of 57 patients were included in this study. The completion rate of CRT among patients who were treated with TJ-14 was 91.4%. There was a significant difference in the completion rate of CRT between the groups treated with and without TJ-14 (p = 0.0452). The reduction in body weight was significantly improved from 10.89 to 5.89% with TJ-14 administration (p = 0.003), and the reduction in serum albumin was also significantly decreased from 17.37 to 8.73%. (p = 0.024). CONCLUSION This therapy allowed a high completion rate of CRT as well as significant benefits in terms of nutritional status. We plan to carry out a further large-scale study of TJ-14.
Collapse
Affiliation(s)
- Hiromitsu Hatakeyama
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Amanda Psyrri
- Attikon Hospital, University of Athens Medical School, Athens, Greece
| | | | - Urania Dafni
- School of Health Sciences, University of Athens and Frontier Science Foundation-Hellas, Athens, Greece
| |
Collapse
|
45
|
Axelrod RS, Sherman E, Garden A, Nguyen-Tan PF, Trotti A, Yom SS, Zhang Q. Reply to D. Adkins et al. J Clin Oncol 2015; 33:1224-5. [PMID: 25713438 DOI: 10.1200/jco.2014.59.9431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Eric Sherman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adam Garden
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Andy Trotti
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sue S Yom
- University of California, San Francisco, San Francisco, CA
| | - Qiang Zhang
- Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA
| |
Collapse
|
46
|
Adkins D, Ley J, Wildes TM, Michel L. RTOG 0522: Huge Investment in Patients and Resources and No Benefit With Addition of Cetuximab to Radiotherapy—Why Did This Occur? J Clin Oncol 2015; 33:1223-4. [DOI: 10.1200/jco.2014.59.6908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jessica Ley
- Washington University School of Medicine, St Louis, MO
| | | | - Loren Michel
- Washington University School of Medicine, St Louis, MO
| |
Collapse
|
47
|
Giuliani J, Bonetti A. Cisplatin versus cetuximab given concomitantly with radiotherapy in non-resectable head and neck squamous cell carcinoma: an open question. Eur Arch Otorhinolaryngol 2015; 273:263-5. [PMID: 25711737 DOI: 10.1007/s00405-015-3562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jacopo Giuliani
- Department of Oncology, ASL, 21 della Regione Veneto, Via Gianella, 37045, Legnago (VR), Italy.
| | - Andrea Bonetti
- Department of Oncology, ASL, 21 della Regione Veneto, Via Gianella, 37045, Legnago (VR), Italy
| |
Collapse
|
48
|
Ang KK, Zhang Q, Rosenthal DI, Nguyen-Tan PF, Sherman EJ, Weber RS, Galvin JM, Bonner JA, Harris J, El-Naggar AK, Gillison ML, Jordan RC, Konski AA, Thorstad WL, Trotti A, Beitler JJ, Garden AS, Spanos WJ, Yom SS, Axelrod RS. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol 2015; 32:2940-50. [PMID: 25154822 DOI: 10.1200/jco.2013.53.5633] [Citation(s) in RCA: 581] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Combining cisplatin or cetuximab with radiation improves overall survival (OS) of patients with stage III or IV head and neck carcinoma (HNC). Cetuximab plus platinum regimens also increase OS in metastatic HNC. The Radiation Therapy Oncology Group launched a phase III trial to test the hypothesis that adding cetuximab to the radiation-cisplatin platform improves progression-free survival (PFS). PATIENTS AND METHODS Eligible patients with stage III or IV HNC were randomly assigned to receive radiation and cisplatin without (arm A) or with (arm B) cetuximab. Acute and late reactions were scored using Common Terminology Criteria for Adverse Events (version 3). Outcomes were correlated with patient and tumor features and markers. RESULTS Of 891 analyzed patients, 630 were alive at analysis (median follow-up, 3.8 years). Cetuximab plus cisplatin-radiation, versus cisplatin-radiation alone, resulted in more frequent interruptions in radiation therapy (26.9% v. 15.1%, respectively); similar cisplatin delivery (mean, 185.7 mg/m2 v. 191.1 mg/m2, respectively); and more grade 3 to 4 radiation mucositis (43.2% v. 33.3%, respectively), rash, fatigue, anorexia, and hypokalemia, but not more late toxicity. No differences were found between arms A and B in 30-day mortality (1.8% v. 2.0%, respectively; P = .81), 3-year PFS (61.2% v. 58.9%, respectively; P = .76), 3-year OS (72.9% v. 75.8%, respectively; P = .32), locoregional failure (19.9% v. 25.9%, respectively; P = .97), or distant metastasis (13.0% v. 9.7%, respectively; P = .08). Patients with p16-positive oropharyngeal carcinoma (OPC), compared with patients with p16-negative OPC, had better 3-year probability of PFS (72.8% v. 49.2%, respectively; P < .001) and OS (85.6% v. 60.1%, respectively; P < .001), but tumor epidermal growth factor receptor (EGFR) expression did not distinguish outcome. CONCLUSION Adding cetuximab to radiation-cisplatin did not improve outcome and hence should not be prescribed routinely. PFS and OS were higher in patients with p16-positive OPC, but outcomes did not differ by EGFR expression.
Collapse
|
49
|
Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, Kim H, Silverman C, Raben A, Galloway TJ, Fortin A, Gore E, Westra WH, Chung CH, Jordan RC, Gillison ML, List M, Le QT. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J Clin Oncol 2014; 32:3858-66. [PMID: 25366680 PMCID: PMC4239304 DOI: 10.1200/jco.2014.55.3925] [Citation(s) in RCA: 308] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We tested the efficacy and toxicity of cisplatin plus accelerated fractionation with a concomitant boost (AFX-C) versus standard fractionation (SFX) in locally advanced head and neck carcinoma (LA-HNC). PATIENTS AND METHODS Patients had stage III to IV carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Radiation therapy schedules were 70 Gy in 35 fractions over 7 weeks (SFX) or 72 Gy in 42 fractions over 6 weeks (AFX-C). Cisplatin doses were 100 mg/m(2) once every 3 weeks for two (AFX-C) or three (SFX) cycles. Toxicities were scored by using National Cancer Institute Common Toxicity Criteria 2.0 and the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. Overall survival (OS) and progression-free survival (PFS) rates were estimated by using the Kaplan-Meier method and were compared by using the one-sided log-rank test. Locoregional failure (LRF) and distant metastasis (DM) rates were estimated by using the cumulative incidence method and Gray's test. RESULTS In all, 721 of 743 patients were analyzable (361, SFX; 360, AFX-C). At a median follow-up of 7.9 years (range, 0.3 to 10.1 years) for 355 surviving patients, no differences were observed in OS (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.18; P = .37; 8-year survival, 48% v 48%), PFS (HR, 1.02; 95% CI, 0.84 to 1.24; P = .52; 8-year estimate, 42% v 41%), LRF (HR, 1.08; 95% CI, 0.84 to 1.38; P = .78; 8-year estimate, 37% v 39%), or DM (HR, 0.83; 95% CI, 0.56 to 1.24; P = .16; 8-year estimate, 15% v 13%). For oropharyngeal cancer, p16-positive patients had better OS than p16-negative patients (HR, 0.30; 95% CI, 0.21 to 0.42; P < .001; 8-year survival, 70.9% v 30.2%). There were no statistically significant differences in the grade 3 to 5 acute or late toxicities between the two arms and p-16 status. CONCLUSION When combined with cisplatin, AFX-C neither improved outcome nor increased late toxicity in patients with LA-HNC. Long-term high survival rates in p16-positive patients with oropharyngeal cancer support the ongoing efforts to explore deintensification.
Collapse
Affiliation(s)
- Phuc Felix Nguyen-Tan
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL.
| | - Qiang Zhang
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - K Kian Ang
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Randal S Weber
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - David I Rosenthal
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Denis Soulieres
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Harold Kim
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Craig Silverman
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Adam Raben
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Thomas J Galloway
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - André Fortin
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Elizabeth Gore
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - William H Westra
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Christine H Chung
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Richard C Jordan
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Maura L Gillison
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Marcie List
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Quynh-Thu Le
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| |
Collapse
|
50
|
Egloff AM, Lee JW, Langer CJ, Quon H, Vaezi A, Grandis JR, Seethala RR, Wang L, Shin DM, Argiris A, Yang D, Mehra R, Ridge JA, Patel UA, Burtness BA, Forastiere AA. Phase II study of cetuximab in combination with cisplatin and radiation in unresectable, locally advanced head and neck squamous cell carcinoma: Eastern cooperative oncology group trial E3303. Clin Cancer Res 2014; 20:5041-51. [PMID: 25107914 PMCID: PMC4184913 DOI: 10.1158/1078-0432.ccr-14-0051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Treatment with cisplatin or cetuximab combined with radiotherapy each yield superior survival in locally advanced squamous cell head and neck cancer (LA-SCCHN) compared with radiotherapy alone. Eastern Cooperative Oncology Group Trial E3303 evaluated the triple combination. EXPERIMENTAL DESIGN Patients with stage IV unresectable LA-SCCHN received a loading dose of cetuximab (400 mg/m(2)) followed by 250 mg/m(2)/week and cisplatin 75 mg/m(2) q 3 weeks ×3 cycles concurrent with standard fractionated radiotherapy. In the absence of disease progression or unacceptable toxicity, patients continued maintenance cetuximab for 6 to 12 months. Primary endpoint was 2-year progression-free survival (PFS). Patient tumor and blood correlates, including tumor human papillomavirus (HPV) status, were evaluated for association with survival. RESULTS A total of 69 patients were enrolled; 60 proved eligible and received protocol treatment. Oropharyngeal primaries constituted the majority (66.7%), stage T4 48.3% and N2-3 91.7%. Median radiotherapy dose delivered was 70 Gy, 71.6% received all three cycles of cisplatin, and 74.6% received maintenance cetuximab. Median PFS was 19.4 months, 2-year PFS 47% [95% confidence interval (CI), 33%-61%]. Two-year overall survival (OS) was 66% (95% CI, 53%-77%); median OS was not reached. Response rate was 66.7%. Most common grade ≥3 toxicities included mucositis (55%), dysphagia (46%), and neutropenia (26%); one attributable grade 5 toxicity occurred. Only tumor HPV status was significantly associated with survival. HPV was evaluable in 29 tumors; 10 (all oropharyngeal) were HPV positive. HPV(+) patients had significantly longer OS and PFS (P = 0.004 and P = 0.036, respectively). CONCLUSIONS Concurrent cetuximab, cisplatin, and radiotherapy were well tolerated and yielded promising 2-year PFS and OS in LA-SCCHN with improved survival for patients with HPV(+) tumors.
Collapse
Affiliation(s)
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Harry Quon
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alec Vaezi
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Lin Wang
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Donghua Yang
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Ranee Mehra
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | - Arlene A Forastiere
- Johns Hopkins University School of Medicine and Sydney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| |
Collapse
|