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Lin Z, Wang H, Zhang Y, Li G, Pi G, Yu X, Chen Y, Jin K, Chen L, Yang S, Zhu Y, Wu G, Chen J, Zhang T. Development and Validation of a Prognostic Nomogram to Guide Decision-Making for High-Grade Digestive Neuroendocrine Neoplasms. Oncologist 2019; 25:e659-e667. [PMID: 32297441 DOI: 10.1634/theoncologist.2019-0566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The objective of this study was to develop and validate a nomogram to predict 1-year overall survival (OS) and 2-year OS in patients with high-grade digestive neuroendocrine neoplasms (NENs) as well as to guide selection of subgroups that could benefit from systemic chemotherapy. SUBJECTS, MATERIALS, AND METHODS We performed a retrospective analysis of 223 patients with NENs of the gut and hepato-biliary-pancreatic system from four centers included in the development cohort. The nomogram was externally validated in a cohort of 90 patients from another one. RESULTS The final model included lactate dehydrogenase, performance status, stage, Ki67, and site of primary tumor, all of which had a significant effect on OS. The uncorrected C-index was 0.761 for OS, and the bias-corrected C-index was 0.744. Predictions correlated well with observed 1-year and 2-year outcomes (judged by eye). The area under the time-dependent receiver operating characteristic curve at 12 months and 24 months was 0.876 and 0.838, respectively. The nomogram performed well in terms of both discrimination and calibration when applied to the validation cohort, and OS was significantly different between the two groups classified by nomogram score (log-rank p < .001). CONCLUSION The validated nomogram provided useful prediction of OS, which can be offered for clinicians to improve their abilities to assess patient prognosis, to create clinical risk groups for informing treatment or for patient stratification by disease severity in clinical trials. IMPLICATIONS FOR PRACTICE The high-grade neuroendocrine neoplasms of the digestive system are rare malignancies with great heterogeneity. An overall survival nomogram was developed and externally validated in this study. Two subgroups were classified by the nomogram score, and platinum-based chemotherapy may not bring clinical benefit for the low-risk patients.
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Affiliation(s)
- Zhenyu Lin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Haihong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yixuan Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Guiling Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guoliang Pi
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xianjun Yu
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yaobing Chen
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Kaizhou Jin
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shengli Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ying Zhu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jie Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tao Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Impact of Baseline Nutrition and Exercise Status on Toxicity and Outcomes in Phase I and II Oncology Clinical Trial Participants. Oncologist 2019; 25:161-169. [PMID: 31748339 DOI: 10.1634/theoncologist.2019-0289] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malnutrition and physical inactivity are common in patients with advanced cancer and are associated with poor outcomes. There are increasing data that altered body composition is related to the pharmacokinetic properties of cancer therapies. These adverse conditions may impact outcomes in early-phase oncology clinical trials. MATERIALS AND METHODS We aimed to understand the relationships between baseline nutrition and exercise status with important trial endpoints including treatment-related toxicity and survival. Baseline assessments of nutrition and exercise status were conducted in patients prior to initiation of phase I and II oncology clinical trials. Patients were followed prospectively for the onset of adverse events. Tumor response and survival data were also obtained. Fisher's exact test and chi-square analysis were used to determine statistical significance. Kaplan-Meier curves were used to compare patient duration on study and survival. RESULTS One hundred patients were recruited, of whom 87 were initiating a phase I trial. Sixty percent were initiating trials studying immunotherapeutic agents. Critical malnutrition was found in 39% of patients, and 52% were sedentary. Patients who were malnourished had significantly increased rates of grade ≥ 3 toxicity (p = .001), hospitalizations (p = .001), and inferior disease control rate (p = .019). Six-month overall survival was significantly reduced in malnourished patients versus nonmalnourished patients (47% vs. 84%; p = .0003), as was median duration on study (48 days vs. 105 days; p = .047). Being sedentary at baseline was associated with decreased duration on study (57 days vs. 105 days; p = .019). CONCLUSION Malnutrition and sedentary lifestyle are highly prevalent in patients enrolling on early-phase oncology clinical trials and are associated with poor outcomes. The quality of data from these studies may be compromised as a result of these pre-existing conditions. IMPLICATIONS FOR PRACTICE Phase I and II trials are critical steps in the development of effective cancer therapeutics, yet only a small percentage of agents are ultimately approved for human cancer care. Despite increasing awareness of the interactions between malnutrition, sarcopenia, and treatment-related outcomes such as toxicity and response, these factors are not commonly incorporated into therapeutic decision making at the time of clinical trial consideration. Nutritional status and physical performance may be key biomarkers of mechanisms mediating treatment-related toxicity, dose modifications, risk of hospitalizations, and success of novel agents. This study advocates that a baseline nutritional assessment and early nutritional support may improve tolerability and response to experimental therapies.
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Anwar S, Tan W, Hong CC, Admane S, Dozier A, Siedlecki F, Whitworth A, DiRaddo AM, DePaolo D, Jacob SM, Ma WW, Miller A, Adjei AA, Dy GK. Quality-of-Life (QOL) during Screening for Phase 1 Trial Studies in Patients with Advanced Solid Tumors and Its Impact on Risk for Serious Adverse Events. Cancers (Basel) 2017; 9:E73. [PMID: 28672850 PMCID: PMC5532609 DOI: 10.3390/cancers9070073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Serious adverse events (SAEs) and subject replacements occur frequently in phase 1 oncology clinical trials. Whether baseline quality-of-life (QOL) or social support can predict risk for SAEs or subject replacement among these patients is not known. Methods: Between 2011-2013, 92 patients undergoing screening for enrollment into one of 22 phase 1 solid tumor clinical trials at Roswell Park Cancer Institute were included in this study. QOL Questionnaires (EORTC QLQ-C30 and FACT-G), Medical Outcomes Study Social Support Survey (MOSSSS), Charlson comorbidity scores (CCS) and Royal Marsden scores (RMS) were obtained at baseline. Frequency of dose limiting toxicities (DLTs), subject replacement and SAEs that occurred within the first 4 cycles of treatment were recorded. Fisher's exact test and Mann-Whitney-Wilcoxon test were used to study the association between categorical and continuous variables, respectively. A linear transformation was used to standardize QOL scores. p-value ≤ 0.05 was considered statistically significant. Results: Baseline QOL, MOSSSS, CCS and RMS were not associated with subject replacement nor DLTs. Baseline EORTC QLQ-C30 scores were significantly lower among patients who encountered SAEs within the first 4 cycles (p = 0.04). Conclusions: Lower (worse) EORTC QLQ-C30 score at baseline is associated with SAE occurrence during phase 1 oncology trials.
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Affiliation(s)
- Sidra Anwar
- State University of New York at Buffalo, 12 Capen Hall, Buffalo, NY 14260, USA.
| | - Wei Tan
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Chi-Chen Hong
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | | | - Askia Dozier
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Francine Siedlecki
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Amy Whitworth
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Ann Marie DiRaddo
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Dawn DePaolo
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Sandra M Jacob
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Wen Wee Ma
- Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
| | - Austin Miller
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
| | - Alex A Adjei
- Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
| | - Grace K Dy
- Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.
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Abstract
BACKGROUND Prognosis is a key driver of clinical decision-making. However, available prognostication tools have limited accuracy and variable levels of validation. METHODS Principles of survival prediction and literature on clinician prediction of survival, prognostic factors, and prognostic models were reviewed, with a focus on patients with advanced cancer and a survival rate of a few months or less. RESULTS The 4 principles of survival prediction are (a) prognostication is a process instead of an event, (b) prognostic factors may evolve over the course of the disease, (c) prognostic accuracy for a given prognostic factor/ tool varies by the definition of accuracy, the patient population, and the time frame of prediction, and (d) the exact timing of death cannot be predicted with certainty. Clinician prediction of survival is the most commonly used approach to formulate prognosis. However, clinicians often overestimate survival rates with the temporal question. Other clinician prediction of survival approaches, such as surprise and probabilistic questions, have higher rates of accuracy. Established prognostic factors in the advanced cancer setting include decreased performance status, delirium, dysphagia, cancer anorexia-cachexia, dyspnea, inflammation, and malnutrition. Novel prognostic factors, such as phase angle, may improve rates of accuracy. Many prognostic models are available, including the Palliative Prognostic Score, the Palliative Prognostic Index, and the Glasgow Prognostic Score. CONCLUSIONS Despite the uncertainty in survival prediction, existing prognostic tools can facilitate clinical decision-making by providing approximated time frames (months, weeks, or days). Future research should focus on clarifying and comparing the rates of accuracy for existing prognostic tools, identifying and validating novel prognostic factors, and linking prognostication to decision-making.
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Affiliation(s)
- David Hui
- MD Anderson Cancer Center, Houston, TX.
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Pond G, Bellmunt J, Rosenberg J, Bajorin D, Regazzi A, Choueiri T, Qu A, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Wong YN, Sridhar S, Ko YJ, Milowsky M, Galsky M, Sonpavde G. Impact of the Number of Prior Lines of Therapy and Prior Perioperative Chemotherapy in Patients Receiving Salvage Therapy for Advanced Urothelial Carcinoma: Implications for Trial Design. Clin Genitourin Cancer 2015; 13:71-9. [DOI: 10.1016/j.clgc.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
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Basu B, Vitfell-Pedersen J, Moreno Garcia V, Puglisi M, Tjokrowidjaja A, Shah K, Malvankar S, Anghan B, de Bono JS, Kaye SB, Molife LR, Banerji U. Creatinine clearance is associated with toxicity from molecularly targeted agents in phase I trials. Oncology 2012; 83:177-82. [PMID: 22889980 PMCID: PMC5079100 DOI: 10.1159/000341152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/18/2012] [Indexed: 11/19/2022]
Abstract
Objectives This study aimed to evaluate any correlations between baseline creatinine clearance and the development of grade 3/4 toxicities during treatment within oncology phase I trials of molecularly targeted agents where entry criteria mandate a serum creatinine of ≤1.5 × the upper limit of normal. Methods Documented toxicity and creatinine clearance (calculated by the Cockcroft-Gault formula) from all patients treated with molecularly targeted agents in the context of phase I trials within our centre over a 5-year period were analyzed. Results Data from 722 patients were analyzed; 116 (16%) developed at least one episode of grade 3/4 toxicity. Patients who developed a late-onset (>1 cycle) grade 3/4 toxicity had a lower creatinine clearance than those who did not (82.69 ml/min vs. 98.97 ml/min; p = < 0.001). Conclusion Creatinine clearance (even when within normal limits) should be studied as a potential factor influencing late toxicities in the clinical trials of molecularly targeted anti-cancer drugs.
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Affiliation(s)
- B Basu
- Drug Development Unit, Division of Clinical Studies, The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, Sutton, UK
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Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome. Int J Radiat Oncol Biol Phys 2011; 82:1957-66. [PMID: 21640511 DOI: 10.1016/j.ijrobp.2011.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/21/2011] [Accepted: 03/24/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. METHODS AND MATERIALS This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). RESULTS Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. CONCLUSIONS We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.
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Lee SM, Hershman DL, Martin P, Leonard JP, Cheung YK. Toxicity burden score: a novel approach to summarize multiple toxic effects. Ann Oncol 2011; 23:537-41. [PMID: 21536663 DOI: 10.1093/annonc/mdr146] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Toxicity data from cancer trials are summarized into a single outcome, dose-limiting toxicity (DLT), which does not account for multiple lower grade toxic effects nor differentiates between toxicity types and gradations within DLT. METHODS Toxicity data were summarized into a toxicity burden score (TBS) using a weighted sum. The severity weights were estimated via regression using historical data. We demonstrated the method using historical data from a bortezomib trial and illustrated the advantages of defining DLT based on TBS in a simulated dose-finding trial. RESULTS The estimated weights were 0.17, 0.40 and 0.85 for grade 1/2, grade 3 and grade 4 platelets, respectively; 0.19, 0.64, 1.03 and 2.53 for grade 1, 2, 3 and 4 neuropathy, respectively and 0.17 for each grade 3 or higher nonhematologic toxic effects unrelated to treatment. In the simulated trial, the probability of selecting doses above the maximum tolerated dose decreased when using the DLT defined based on TBS. CONCLUSIONS TBS is a feasible approach to summarize toxicity. It includes information from the grades and types of multiple toxic effects and can be applied in all phases of drug development. Further efforts should focus on validating the method in a large prospective study before applying it in practice.
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Affiliation(s)
- S M Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York 10032, USA.
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Abstract
Elderly urologic patients require the same cautions as used in development of treatment programs for them in other disciplines. Because of potential interference with poor renal function or crossover effects with central or peripheral nervous system, however, many urologic drugs must be titrated appropriately. In treating cancer, erectile dysfunction, incontinence or urinary infection, patient quality of life and life span become dominant factors in making therapeutic decisions, by behavioral change, medication, or surgical intervention.
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Affiliation(s)
- Thomas J Guzzo
- Division of Urology, Department of Surgery, The Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Penn Tower, Philadelphia, PA 19104, USA.
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Abstract
OBJECTIVES To compare the quality of informed consent forms (ICF) for different trial phases, funding sources, oncology subspecialties, disease settings, and intervention modalities. METHODS ICF for prospectively conducted clinical trials were examined for their descriptions of benefits and risks, study alternatives, voluntary participation, and confidentiality. Readability was assessed with Flesch Reading Ease (FRE) score and Flesch-Kincaid Reading Grade Level. RESULTS Among 262 evaluable trials, ICF contained an average of 3982 words, 379 sentences, and 10.5 pages. The mean FRE score and Reading Grade Level were 61.2 and 7.4, respectively. All ICF explicitly stated that the intervention was investigational. Only 2 (1%) promised direct personal benefits, 16 (6%) suggested the chance of cure or prolonged survival, and 89 (34%) indicated a potential for tumor response. Conversely, 239 (91%) mentioned the risk of serious harms, 217 (83%) admitted that some side effects could be unknown or unpredictable, and 126 (48%) reported hospitalization or death as a possibility. Alternatives to participation, right to withdraw from study, and data confidentiality were addressed in 242 (92%), 254 (97%), and 260 (99%) ICF, respectively. Hematology, industry-funded, metastatic, and systemic therapy trials were most likely to highlight major risks (P < 0.05). Readability was better in phase I trials and in studies, which were performed by medical oncologists, sponsored by governmental agencies, conducted in the metastatic setting, and involved systemic therapy (P < 0.05). CONCLUSIONS ICF had acceptable readability and provided a realistic overview of the benefits and risks of clinical trials, but the potential for hospitalization or fatality was underreported.
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Cang S, Ma Y, Liu D. New clinical developments in histone deacetylase inhibitors for epigenetic therapy of cancer. J Hematol Oncol 2009; 2:22. [PMID: 19486511 PMCID: PMC2695818 DOI: 10.1186/1756-8722-2-22] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 06/01/2009] [Indexed: 02/08/2023] Open
Abstract
DNA methylation and histone acetylation are two well known epigenetic chromatin modifications. Epigenetic agents leading to DNA hypomethylation and histone hyperacetylation have been approved for treatment of hematological disorders. The first histone deacetylase inhibitor, vorinostat, has been licensed for cutaneous T cell lymphoma treatment. More than 11 new epigenetic agents are in various stages of clinical development for therapy of multiple cancer types. In this review we summarize novel histone deacetylase inhibitors and new regimens from clinical trials for epigenetic therapy of cancer.
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Affiliation(s)
- Shundong Cang
- Division of Hematology/Oncology, New York Medical College, Valhalla, NY 10595, USA
- Henan Province People's Hospital, Zhengzhou, PR China
| | - Yuehua Ma
- Division of Hematology/Oncology, New York Medical College, Valhalla, NY 10595, USA
- Henan Province People's Hospital, Zhengzhou, PR China
| | - Delong Liu
- Division of Hematology/Oncology, New York Medical College, Valhalla, NY 10595, USA
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Matsubara J, Ono M, Negishi A, Ueno H, Okusaka T, Furuse J, Furuta K, Sugiyama E, Saito Y, Kaniwa N, Sawada J, Honda K, Sakuma T, Chiba T, Saijo N, Hirohashi S, Yamada T. Identification of a Predictive Biomarker for Hematologic Toxicities of Gemcitabine. J Clin Oncol 2009; 27:2261-8. [DOI: 10.1200/jco.2008.19.9745] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeGemcitabine monotherapy is the current standard for patients with advanced pancreatic cancer, but the occurrence of severe neutropenia and thrombocytopenia can sometimes be life threatening. This study aimed to discover a new diagnostic method for predicting the hematologic toxicities of gemcitabine.Patients and MethodsUsing quantitative mass spectrometry (MS), we compared the baseline plasma proteomes of 25 patients who had developed severe hematologic adverse events (grade 3 to 4 neutropenia and/or grade 2 to 4 thrombocytopenia) within the first two cycles of gemcitabine with those of 22 patients who had not (grade 0).ResultsWe identified 757 peptide peaks whose intensities were significantly different (P < .001, Welch t test) among a total of 60,888. The MS peak with the highest statistical significance (P = .0000282) was revealed to be derived from haptoglobin by tandem MS. A scoring system (nomogram) based on the values of haptoglobin, haptoglobin phenotype, neutrophil count, platelet count, and body-surface area was constructed to estimate the risk of hematologic adverse events (grade 3 to 4 neutropenia and/or grade 2 to 4 thrombocytopenia) with an area under curve value of 0.782 in a cohort of 166 patients with pancreatic cancer. Predictive ability of the system was confirmed in two independent validation cohorts consisting of 87 and 52 patients with area under the curve values of 0.655 and 0.747, respectively.ConclusionAlthough the precise mechanism responsible for the correlation of haptoglobin with the future onset of hematologic toxicities remains to be clarified, our prediction model seems to have high practical utility for tailoring the treatment of patients receiving gemcitabine.
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Affiliation(s)
- Junichi Matsubara
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Masaya Ono
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Ayako Negishi
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Hideki Ueno
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Takuji Okusaka
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Junji Furuse
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Koh Furuta
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Emiko Sugiyama
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Yoshiro Saito
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Nahoko Kaniwa
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Junichi Sawada
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Kazufumi Honda
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Tomohiro Sakuma
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Tsutomu Chiba
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Nagahiro Saijo
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Setsuo Hirohashi
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
| | - Tesshi Yamada
- From the Chemotherapy Division, National Cancer Center Research Institute; Hepatobiliary and Pancreatic Oncology Division and Clinical Laboratory Division, National Cancer Center Hospital; Project Team for Pharmacogenetics, National Institute of Health Sciences; BioBusiness Group, Mitsui Knowledge Industry, Tokyo; Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Kashiwa; and Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine,
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