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Colombino M, Capone M, Lissia A, Cossu A, Rubino C, De Giorgi V, Massi D, Fonsatti E, Staibano S, Nappi O, Pagani E, Casula M, Manca A, Sini M, Franco R, Botti G, Caracò C, Mozzillo N, Ascierto PA, Palmieri G. BRAF/NRAS Mutation Frequencies Among Primary Tumors and Metastases in Patients With Melanoma. J Clin Oncol 2012; 30:2522-9. [DOI: 10.1200/jco.2011.41.2452] [Citation(s) in RCA: 359] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose The prevalence of BRAF, NRAS, and p16CDKN2A mutations during melanoma progression remains inconclusive. We investigated the prevalence and distribution of mutations in these genes in different melanoma tissues. Patients and Methods In all, 291 tumor tissues from 132 patients with melanoma were screened. Paired samples of primary melanomas (n = 102) and synchronous or asynchronous metastases from the same patients (n = 165) were included. Tissue samples underwent mutation analysis (automated DNA sequencing). Secondary lesions included lymph nodes (n = 84), and skin (n = 36), visceral (n = 25), and brain (n = 44) sites. Results BRAF/NRAS mutations were identified in 58% of primary melanomas (43% BRAF; 15% NRAS); 62% in lymph nodes, 61% subcutaneous, 56% visceral, and 70% in brain sites. Mutations were observed in 63% of metastases (48% BRAF; 15% NRAS), a nonsignificant increase in mutation frequency after progression from primary melanoma. Of the paired samples, lymph nodes (93% consistency) and visceral metastases (96% consistency) presented a highly similar distribution of BRAF/NRAS mutations versus primary melanomas, with a significantly less consistent pattern in brain (80%) and skin metastases (75%). This suggests that independent subclones are generated in some patients. p16CDKN2A mutations were identified in 7% and 14% of primary melanomas and metastases, with a low consistency (31%) between secondary and primary tumor samples. Conclusion In the era of targeted therapies, assessment of the spectrum and distribution of alterations in molecular targets among patients with melanoma is needed. Our findings about the prevalence of BRAF/NRAS/p16CDKN2A mutations in paired tumor lesions from patients with melanoma may be useful in the management of this disease.
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Affiliation(s)
- Maria Colombino
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Mariaelena Capone
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Amelia Lissia
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Antonio Cossu
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Corrado Rubino
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Vincenzo De Giorgi
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Daniela Massi
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Ester Fonsatti
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Stefania Staibano
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Oscar Nappi
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Elena Pagani
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Milena Casula
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Antonella Manca
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - MariaCristina Sini
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Renato Franco
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Gerardo Botti
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Corrado Caracò
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Nicola Mozzillo
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Paolo A. Ascierto
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
| | - Giuseppe Palmieri
- Maria Colombino, Milena Casula, Antonella Manca, MariaCristina Sini, and Giuseppe Palmieri, Istituto Chimica Biomolecolare, Consiglio Nazionale delle Ricerche; Amelia Lissia and Antonio Cossu, Azienda Ospedaliero Universitaria; Corrado Rubino, Università di Sassari, Sassari; Mariaelena Capone, Renato Franco, Gerardo Botti, Corrado Caracò, Nicola Mozzillo, and Paolo A. Ascierto, Istituto Nazionale Tumori Fondazione Pascale; Stefania Staibano, Università Federico II di Napoli; Oscar Nappi, Ospedale
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Gianni L, Norton L, Wolmark N, Suter TM, Bonadonna G, Hortobagyi GN. Role of Anthracyclines in the Treatment of Early Breast Cancer. J Clin Oncol 2009; 27:4798-808. [DOI: 10.1200/jco.2008.21.4791] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To review data relating to anthracyclines in the adjuvant treatment of early breast cancer. Design This is a report from a seminar in which the future of anthracyclines in the adjuvant treatment of breast cancer was considered. In particular, the question of whether anthracyclines should now be discarded and replaced by taxanes was addressed. Results Accumulating data from large randomized trials indicate that genetic markers may have a role in predicting sensitivity to cytotoxic drugs. However, no reliable, validated test is available for predicting sensitivity to anthracyclines in particular. Topoisomerase IIα amplification and/or deletion, especially in conjunction with human epidermal growth factor receptor-2 amplification, has been proposed to fulfill this role but more data are needed. Currently, only one published trial has shown that a taxane-based regimen may be superior to an anthracycline-based regimen, but several trials indicate that combinations including both anthracyclines and taxanes may be better still. Further studies aimed at optimizing anthracyclines and taxanes in combination, and integrating biologic agents, seem to be the way forward. There is no validated test that can determine whether anthracyclines can be of greater benefit than other agents for individual patients. Conclusion Anthracyclines have been extensively tested in clinical trials spanning several decades; currently, there are insufficient data to recommend replacing them in the adjuvant treatment of breast cancer.
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Affiliation(s)
- Luca Gianni
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Larry Norton
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Norman Wolmark
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Thomas M. Suter
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Gianni Bonadonna
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Gabriel N. Hortobagyi
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Ludwig H, Crawford J, Österborg A, Vansteenkiste J, Henry DH, Fleishman A, Bridges K, Glaspy JA. Pooled Analysis of Individual Patient-Level Data From All Randomized, Double-Blind, Placebo-Controlled Trials of Darbepoetin Alfa in the Treatment of Patients With Chemotherapy-Induced Anemia. J Clin Oncol 2009; 27:2838-47. [DOI: 10.1200/jco.2008.19.1130] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Although numerous clinical trials have demonstrated the efficacy and tolerability of erythropoiesis-stimulating agents (ESAs) in patients with chemotherapy-induced anemia (CIA), results of some recent trials and one meta-analysis have suggested that ESAs may negatively impact survival and/or disease control in patients with cancer. Methods To assess the benefits and risks of ESAs in CIA, we conducted a pooled analysis of individual patient-level data from all randomized, double-blind, placebo-controlled trials in 2,122 patients with CIA receiving darbepoetin alfa (DA; n = 1,200) or placebo (n = 912). Results DA did not increase mortality (hazard ratio = 0.97; 95% CI, 0.85 to 1.1) and had no effect on progression-free survival (hazard ratio = 0.93; 95% CI, 0.84 to 1.04) and disease progression (hazard ratio = 0.92; 95% CI, 0.82 to 1.03), but, as expected, increased the risk for thromboembolic events (hazard ratio = 1.57; 95% CI, 1.10 to 2.26). Overall and progression-free survival were not affected by baseline hemoglobin and seemed better in patients who achieved hemoglobin more than 12 or more than 13 g/dL. Transfusions and rates of hemoglobin increase (> 1 g/dL in 14 days; > 2 g/dL in 28 days) owing to transfusions were associated with an increased risk for death and disease progression in both treatment groups; in the absence of transfusions, rates of hemoglobin increase did not appear to increase the risk for adverse outcomes. Compared with placebo, DA significantly reduced the risk of receiving one or more transfusion. Conclusion There seemed to be no association between DA and risk of death or disease progression in this meta-analysis of individual patient data from DA studies conducted in CIA, the approved indication for ESAs in oncology.
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Affiliation(s)
- Heinz Ludwig
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - Jeffrey Crawford
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - Anders Österborg
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - Johan Vansteenkiste
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - David H. Henry
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - Alex Fleishman
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - Ken Bridges
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
| | - John A. Glaspy
- From the Wilhelminenspital, Department of Medicine I, Center for Oncology and Hematology, Vienna, Austria; Duke University Medical Center, Durham, NC; Departments of Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden; Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Leuven, Belgium; Pennsylvania Oncology Hematology Associates, Philadelphia, PA; Amgen Inc, Thousand Oaks; and University of California, Los Angeles, School of Medicine, Los
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