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Marmarelis MG, Littman R, Battaglin F, Niedzwiecki D, Venook A, Ambite JL, Galstyan A, Lenz HJ, Ver Steeg G. q-Diffusion leverages the full dimensionality of gene coexpression in single-cell transcriptomics. Commun Biol 2024; 7:400. [PMID: 38565955 DOI: 10.1038/s42003-024-06104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Unlocking the full dimensionality of single-cell RNA sequencing data (scRNAseq) is the next frontier to a richer, fuller understanding of cell biology. We introduce q-diffusion, a framework for capturing the coexpression structure of an entire library of genes, improving on state-of-the-art analysis tools. The method is demonstrated via three case studies. In the first, q-diffusion helps gain statistical significance for differential effects on patient outcomes when analyzing the CALGB/SWOG 80405 randomized phase III clinical trial, suggesting precision guidance for the treatment of metastatic colorectal cancer. Secondly, q-diffusion is benchmarked against existing scRNAseq classification methods using an in vitro PBMC dataset, in which the proposed method discriminates IFN-γ stimulation more accurately. The same case study demonstrates improvements in unsupervised cell clustering with the recent Tabula Sapiens human atlas. Finally, a local distributional segmentation approach for spatial scRNAseq, driven by q-diffusion, yields interpretable structures of human cortical tissue.
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Affiliation(s)
- Myrl G Marmarelis
- Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA, 90292, USA.
| | - Russell Littman
- University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Francesca Battaglin
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | | | - Alan Venook
- University of California San Francisco, San Francisco, CA, 94143, USA
| | - Jose-Luis Ambite
- Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA, 90292, USA
| | - Aram Galstyan
- Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA, 90292, USA
| | - Heinz-Josef Lenz
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Greg Ver Steeg
- Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Marina del Rey, CA, 90292, USA
- University of California Riverside, Riverside, CA, 92521, USA
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Yazdani A, Yazdani A, Mendez-Giraldez R, Pillonetto G, Samiei E, Hadi R, Lenz HJ, Venook A, Samiei A, Nixon A, Lucci J, Kopetz S, Bertagnolli M, Perou C, Innocenti F. Gene expression biomarkers differentiate overall survival of colorectal cancer upon targeted therapies. Res Sq 2024:rs.3.rs-4047331. [PMID: 38559223 PMCID: PMC10980102 DOI: 10.21203/rs.3.rs-4047331/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
While monoclonal antibody-based targeted therapies have substantially improved progression-free survival in cancer patients, the variability in individual responses poses a significant challenge in patient care. Therefore, identifying cancer subtypes and their associated biomarkers is required for assigning effective treatment. In this study, we integrated genotype and pre-treatment tissue RNA-seq data and identified biomarkers causally associated with the overall survival (OS) of colorectal cancer (CRC) patients treated with either cetuximab or bevacizumab. We performed enrichment analysis for specific consensus molecular subtypes (CMS) of colorectal cancer and evaluated differential expression of identified genes using paired tumor and normal tissue from an external cohort. In addition, we replicated the causal effect of these genes on OS using validation cohort and assessed their association with the Cancer Genome Atlas Program data as an external cohort. One of the replicated findings was WDR62, whose overexpression shortened OS of patients treated with cetuximab. Enrichment of its over expression in CMS1 and low expression in CMS4 suggests that patients with CMS4 subtype may drive greater benefit from cetuximab. In summary, this study highlights the importance of integrating different omics data for identifying promising biomarkers specific to a treatment or a cancer subtype.
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Affiliation(s)
| | | | | | | | | | - Reza Hadi
- University of Science and Technology of Iran
| | | | | | | | | | | | - Scott Kopetz
- The University of Texas MD Anderson Cancer Center
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Quintanilha JC, Sibley AB, Liu Y, Niedzwiecki D, Halabi S, Rogers L, O’Neil B, Kindler H, Kelly W, Venook A, McLeod HL, Ratain MJ, Nixon AB, Innocenti F, Owzar K. Common variation in a long non-coding RNA gene modulates variation of circulating TGF- β2 levels in metastatic colorectal cancer patients (Alliance). medRxiv 2023:2023.12.04.23298815. [PMID: 38106038 PMCID: PMC10723514 DOI: 10.1101/2023.12.04.23298815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Herein, we report results from a genome-wide study conducted to identify protein quantitative trait loci (pQTL) for circulating angiogenic and inflammatory protein markers in patients with metastatic colorectal cancer (mCRC).The study was conducted using genotype, protein marker, and baseline clinical and demographic data from CALGB/SWOG 80405 (Alliance), a randomized phase III study designed to assess outcomes of adding VEGF or EGFR inhibitors to systemic chemotherapy in mCRC patients. Germline DNA derived from blood was genotyped on whole-genome array platforms. The abundance of protein markers was quantified using a multiplex enzyme-linked immunosorbent assay from plasma derived from peripheral venous blood collected at baseline. A robust rank-based method was used to assess the statistical significance of each variant and protein pair against a strict genome-wide level. A given pQTL was tested for validation in two external datasets of prostate (CALGB 90401) and pancreatic cancer (CALGB 80303) patients. Bioinformatics analyses were conducted to further establish biological bases for these findings. Results The final analysis was carried out based on data from 540,021 common typed genetic variants and 23 protein markers from 869 genetically estimated European patients with mCRC. Correcting for multiple testing, the analysis discovered a novel cis-pQTL in LINC02869, a long non-coding RNA gene, for circulating TGF-β2 levels (rs11118119; AAF = 0.11; P-value < 1.4e-14). This finding was validated in a cohort of 538 prostate cancer patients from CALGB 90401 (AAF = 0.10, P-value < 3.3e-25). The analysis also validated a cis-pQTL we had previously reported for VEGF-A in advanced pancreatic cancer, and additionally identified trans-pQTLs for VEGF-R3, and cis-pQTLs for CD73. Conclusions This study has provided evidence of a novel cis germline genetic variant that regulates circulating TGF-β2 levels in plasma of patients with advanced mCRC and prostate cancer. Moreover, the validation of previously identified pQTLs for VEGF-A, CD73, and VEGF-R3, potentiates the validity of these associations.
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Affiliation(s)
- Julia C.F. Quintanilha
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexander B. Sibley
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Yingmiao Liu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Donna Niedzwiecki
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Alliance Statistics and Data Management Center, Duke University, Durham, NC, USA
| | - Susan Halabi
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Alliance Statistics and Data Management Center, Duke University, Durham, NC, USA
| | - Layne Rogers
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Bert O’Neil
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Hedy Kindler
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - William Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan Venook
- Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Howard L. McLeod
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; and Utah Tech University, St George, UT, USA (current); and Intermountain Healthcare, St George, UT, USA (current)
| | - Mark J. Ratain
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Andrew B. Nixon
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Federico Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kouros Owzar
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Alliance Statistics and Data Management Center, Duke University, Durham, NC, USA
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Piawah S, Kyaw TS, Trepka K, Stewart AL, Mora RV, Stanfield D, Levine K, Van Blarigan EL, Venook A, Turnbaugh PJ, Nguyen T, Atreya CE. Associations between the Gut Microbiota, Race, and Ethnicity of Patients with Colorectal Cancer: A Pilot and Feasibility Study. Cancers (Basel) 2023; 15:4546. [PMID: 37760515 PMCID: PMC10526839 DOI: 10.3390/cancers15184546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is more prevalent among some racial and ethnic minority and low socioeconomic status populations. Although the gut microbiota is a risk factor for CRC and varies with race and ethnicity, its role in CRC disparities remains poorly understood. METHODS We examined the feasibility of recruiting sociodemographically diverse CRC patients for a microbiome study involving a home stool collection. We also explored whether race and ethnicity were associated with gut microbiome composition. We recruited Black/African American, Hispanic/Latino, and non-Hispanic White patients who were receiving care for active CRC to complete a comprehensive dietary and lifestyle survey, self-collect a stool sample, and complete an exit interview. Gut microbial diversity and composition were analyzed using 16S rRNA gene sequencing. RESULTS 30 individuals consented (of 35 who were eligible and contacted) with 5 (17%) Black/African American, 11 (37%) Hispanic/Latino, and 14 (46%) non-Hispanic White. A total of 22 (73%) completed the dietary and lifestyle survey; 18 (63%) returned a stool sample. Even after controlling for socioeconomic, dietary, or treatment-related covariates, microbiome composition was associated with race and ethnicity. Fusobacteriota (a phylum associated with the development and progression of CRC) was significantly higher in the Black/African American group compared to others, and microbial diversity was higher in samples from non-Hispanic White individuals compared to Hispanic/Latino individuals. CONCLUSION Our study shows that it is feasible to recruit and collect stool samples from diverse individuals with CRC and found significant associations in gut microbial structure with race and ethnicity.
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Affiliation(s)
- Sorbarikor Piawah
- Department of Medicine, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
- UCSF Center for Aging in Diverse Communities, San Francisco, CA 94143, USA
| | - Than S. Kyaw
- Department of Microbiology and Immunology, University of California, San Francisco, CA 92521, USA
- School of Medicine, University of California, San Francisco, CA 92521, USA
| | - Kai Trepka
- Department of Microbiology and Immunology, University of California, San Francisco, CA 92521, USA
| | - Anita L. Stewart
- UCSF Center for Aging in Diverse Communities, San Francisco, CA 94143, USA
- Institute for Health & Aging, University of California, San Francisco, CA 92521, USA
- School of Nursing, University of California, San Francisco, CA 92521, USA
| | - Rosa V. Mora
- School of Medicine, University of California, San Francisco, CA 92521, USA
| | - Dalila Stanfield
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
| | - Kendall Levine
- Department of Medicine, University of California, San Francisco, CA 94143, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Erin L. Van Blarigan
- Department of Urology, University of California, San Francisco, CA 92521, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 92521, USA
| | - Alan Venook
- Department of Medicine, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
| | - Peter J. Turnbaugh
- Department of Microbiology and Immunology, University of California, San Francisco, CA 92521, USA
- Chan Zuckerberg Biohub-San Francisco, San Francisco, CA 40385, USA
| | - Tung Nguyen
- Department of Medicine, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
- UCSF Center for Aging in Diverse Communities, San Francisco, CA 94143, USA
| | - Chloe E. Atreya
- Department of Medicine, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
- Osher Center for Integrative Medicine, San Francisco, CA 94115, USA
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Kyaw TS, Upadhyay V, Tolstykh I, Van Loon K, Laffan A, Stanfield D, Gempis D, Kenfield SA, Chan JM, Piawah S, Atreya CE, Ng K, Venook A, Kidder W, Turnbaugh PJ, Van Blarigan EL. Variety of Fruit and Vegetables and Alcohol Intake are Associated with Gut Microbial Species and Gene Abundance in Colorectal Cancer Survivors. Am J Clin Nutr 2023; 118:518-529. [PMID: 37474105 PMCID: PMC10550847 DOI: 10.1016/j.ajcnut.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Adherence to the American Cancer Society (ACS) guidelines of avoiding obesity, maintaining physical activity, and consuming a diet rich in fruits, vegetables, and whole grains is associated with longer survival in colorectal cancer (CRC) survivors. Dietary components of the ACS guidelines may act in part by changing the microbiome, which is implicated in CRC outcomes. OBJECTIVES We conducted a pilot cross-sectional study to explore associations between ACS guidelines and the gut microbiome. METHODS Stool samples and questionnaires were collected from 28 CRC survivors at the University of California, San Francisco from 2019 to 2020. ACS scores were calculated based on validated questionnaires. Gut microbial community structure from 16S amplicons and gene/pathway abundances from metagenomics were tested for associations with the ACS score and its components using ANOVA and general linear models. RESULTS The overall ACS score was not significantly associated with variations in the fecal microbiota. However, fruit and vegetable intake and alcohol intake accounted for 19% (P = 0.005) and 13% (P = 0.01) of variation in the microbiota, respectively. Fruit/vegetable consumption was associated with increased microbial diversity, increased Firmicutes, decreased Bacteroidota, and changes to multiple genes and metabolic pathways, including enriched pathways for amino acid and short-chain fatty acid biosynthesis and plant-associated sugar degradation. In contrast, alcohol consumption was positively associated with overall microbial diversity, negatively associated with Bacteroidota abundance, and associated with changes to multiple genes and metabolic pathways. The other components of the ACS score were not statistically significantly associated with the fecal microbiota in our sample. CONCLUSIONS These results guide future studies examining the impact of changes in the intake of fruits, vegetables, and alcoholic drinks on the gut microbiome of CRC survivors.
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Affiliation(s)
- Than S Kyaw
- Department of Microbiology and Immunology, University of California, San Francisco, CA, United States
| | - Vaibhav Upadhyay
- Department of Microbiology and Immunology, University of California, San Francisco, CA, United States; Department of Medicine, University of California, San Francisco, CA, United States
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Katherine Van Loon
- Department of Medicine, University of California, San Francisco, CA, United States; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Angela Laffan
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Dalila Stanfield
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Daryll Gempis
- Department of Microbiology and Immunology, University of California, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Department of Urology, University of California, San Francisco, United States
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Department of Urology, University of California, San Francisco, United States
| | - Sorbarikor Piawah
- Department of Medicine, University of California, San Francisco, CA, United States; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Chloe E Atreya
- Department of Medicine, University of California, San Francisco, CA, United States; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Kimmie Ng
- Dana Farber Cancer Institute, Boston, MA, United States
| | - Alan Venook
- Department of Medicine, University of California, San Francisco, CA, United States; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Wesley Kidder
- Department of Medicine, University of California, San Francisco, CA, United States; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
| | - Peter J Turnbaugh
- Department of Microbiology and Immunology, University of California, San Francisco, CA, United States; Chan Zuckerberg Biohub - San Francisco, San Francisco, CA, United States.
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Department of Urology, University of California, San Francisco, United States.
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Basch E, Dueck AC, Mitchell SA, Mamon H, Weiser M, Saltz L, Gollub M, Rogak L, Ginos B, Mazza GL, Colgrove B, Chang G, Minasian L, Denicoff A, Thanarajasingam G, Musher B, George T, Venook A, Farma J, O'Reilly E, Meyerhardt JA, Shi Q, Schrag D. Patient-Reported Outcomes During and After Treatment for Locally Advanced Rectal Cancer in the PROSPECT Trial (Alliance N1048). J Clin Oncol 2023; 41:3724-3734. [PMID: 37270691 PMCID: PMC10351948 DOI: 10.1200/jco.23.00903] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/05/2023] Open
Abstract
PURPOSE The standard of care for locally advanced rectal cancer in North America is neoadjuvant pelvic chemoradiation with fluorouracil (5FUCRT). Neoadjuvant chemotherapy with fluorouracil and oxaliplatin (FOLFOX) is an alternative that may spare patients the morbidity of radiation. Understanding the relative patient experiences with these options is necessary to inform treatment decisions. METHODS PROSPECT was a multicenter, unblinded, noninferiority, randomized trial of neoadjuvant FOLFOX versus 5FUCRT, which enrolled adults with rectal cancer clinically staged as T2N+, cT3N-, or cT3N+ who were candidates for sphincter-sparing surgery. Neoadjuvant FOLFOX was given in six cycles over 12 weeks, followed by surgery. Neoadjuvant 5FUCRT was delivered in 28 fractions over 5.5 weeks, followed by surgery. Adjuvant chemotherapy was suggested but not mandated in both groups. Enrolled patients were asked to provide patient-reported outcomes (PROs) at baseline, during neoadjuvant treatment, and at 12 months after surgery. PROs included 14 symptoms from the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Additional PRO instruments measured bowel, bladder, sexual function, and health-related quality of life (HRQL). RESULTS From June 2012 to December 2018, 1,194 patients were randomly assigned, 1,128 initiated treatment, and 940 contributed PRO-CTCAE data (493 FOLFOX; 447 5FUCRT). During neoadjuvant treatment, patients reported significantly lower rates of diarrhea and better overall bowel function with FOLFOX while anxiety, appetite loss, constipation, depression, dysphagia, dyspnea, edema, fatigue, mucositis, nausea, neuropathy, and vomiting were lower with 5FUCRT (all multiplicity adjusted P < .05). At 12 months after surgery, patients randomly assigned to FOLFOX reported significantly lower rates of fatigue and neuropathy and better sexual function versus 5FUCRT (all multiplicity adjusted P < .05). Neither bladder function nor HRQL differed between groups at any time point. CONCLUSION For patients with locally advanced rectal cancer choosing between neoadjuvant FOLFOX and 5FUCRT, the distinctive PRO profiles inform treatment selection and shared decision making.
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Affiliation(s)
- Ethan Basch
- Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - Amylou C. Dueck
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | | | - Harvey Mamon
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA
| | - Martin Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Rogak
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brenda Ginos
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | - Gina L. Mazza
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | - Brian Colgrove
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - George Chang
- Department of Colon and Rectal Surgery, MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Benjamin Musher
- The Southwest Oncology Group (SWOG), Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Thomas George
- NRG Oncology, University of Florida Health Cancer Center, Gainesville, FL
| | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Eileen O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Wang QL, Ma C, Yuan C, Shi Q, Wolpin BM, Zhang Y, Fuchs CS, Meyer J, Zemla T, Cheng E, Kumthekar P, Guthrie KA, Couture F, Kuebler P, Kumar P, Tan B, Krishnamurthi S, Goldberg RM, Venook A, Blanke C, Shields AF, O’Reilly EM, Meyerhardt JA, Ng K. Plasma 25-Hydroxyvitamin D Levels and Survival in Stage III Colon Cancer: Findings from CALGB/SWOG 80702 (Alliance). Clin Cancer Res 2023; 29:2621-2630. [PMID: 37289007 PMCID: PMC10524689 DOI: 10.1158/1078-0432.ccr-23-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess whether higher plasma 25-hydroxyvitamin D [25(OH)D] is associated with improved outcomes in colon cancer and whether circulating inflammatory cytokines mediate such association. EXPERIMENTAL DESIGN Plasma samples were collected from 1,437 patients with stage III colon cancer enrolled in a phase III randomized clinical trial (CALGB/SWOG 80702) from 2010 to 2015, who were followed until 2020. Cox regressions were used to examine associations between plasma 25(OH)D and disease-free survival (DFS), overall survival (OS), and time to recurrence (TTR). Mediation analysis was performed for circulating inflammatory biomarkers of C-reactive protein (CRP), IL6, and soluble TNF receptor 2 (sTNF-R2). RESULTS Vitamin D deficiency [25(OH)D <12 ng/mL] was present in 13% of total patients at baseline and in 32% of Black patients. Compared with deficiency, nondeficient vitamin D status (≥12 ng/mL) was significantly associated with improved DFS, OS, and TTR (all Plog-rank<0.05), with multivariable-adjusted HRs of 0.68 (95% confidence interval, 0.51-0.92) for DFS, 0.57 (0.40-0.80) for OS, and 0.71 (0.52-0.98) for TTR. A U-shaped dose-response pattern was observed for DFS and OS (both Pnonlinearity<0.05). The proportion of the association with survival that was mediated by sTNF-R2 was 10.6% (Pmediation = 0.04) for DFS and 11.8% (Pmediation = 0.05) for OS, whereas CRP and IL6 were not shown to be mediators. Plasma 25(OH)D was not associated with the occurrence of ≥ grade 2 adverse events. CONCLUSIONS Nondeficient vitamin D is associated with improved outcomes in patients with stage III colon cancer, largely independent of circulation inflammations. A randomized trial is warranted to elucidate whether adjuvant vitamin D supplementation improves patient outcomes.
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Affiliation(s)
- Qiao-Li Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Brian M. Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Yin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Charles S. Fuchs
- Genentech and Roche, South San Francisco, CA, USA
- Yale Cancer Center, Yale School of Medicine, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jeffrey Meyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Tyler Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - En Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Priya Kumthekar
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Lou & Jean Malnati Brain Tumor Institute at the Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Katherine A. Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH, USA
| | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Smitha Krishnamurthi
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | - Alan Venook
- University of California, San Francisco, CA, USA
| | - Charles Blanke
- SWOG Cancer Research Network Group Chair’s Office, Oregon Health and Science University Knight Cancer Institute, Portland, OR, USA
| | - Anthony F. Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical Center, New York, NY, USA
| | - Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Liu VN, Zuniga KB, Paciorek A, Zhang L, Chan JM, Carroll PR, Van Loon K, Laffan A, Venook A, Van Blarigan EL, Kenfield SA. Barriers and confidence among colorectal and prostate cancer survivors participating in two behavioral intervention studies. Support Care Cancer 2023; 31:453. [PMID: 37428241 DOI: 10.1007/s00520-023-07901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Exercise and healthy diet are key components of cancer survivorship. We sought to explore perceived barriers to engaging in healthy diet and exercise, and whether these barriers change throughout remote-based behavioral interventions. METHODS Smart Pace (SP) and Prostate 8 (P8) were two 12-week pilot randomized controlled trials (RCTs) among 42 colorectal cancer (CRC) survivors and 76 prostate cancer (PC) survivors, respectively, that encouraged participants to implement exercise (both) and healthy diet (P8 only) through text messaging and wearable fitness monitors; P8 also included web materials. Participants completed surveys on perceived barriers and confidence in their ability to implement healthy behaviors at enrollment and 12 weeks; P8 also included a 52-week assessment. RESULTS At enrollment, CRC survivors commonly reported a lack of discipline/willpower (36%), time (33%), and energy (31%); PC survivors often reported a lack of knowledge about healthy dietary behaviors (26%). Not having anyone with whom to exercise with was a common barrier among both groups (21% in CRC, 20% in PC). Among the intervention groups in both studies, various enrollment barriers (overall, functional/psychological disability, aversiveness, excuses, and inconveniences) were associated with change in behavior over time. CONCLUSIONS Among CRC and PC survivors, there are multiple potential barriers related to motivation, time, social support, and lack of knowledge, that can be addressed and overcome to improve healthy behaviors. Tailoring lifestyle interventions to participants' individual barriers and confidence is needed to promote and sustain behavior change long-term.
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Affiliation(s)
- Vivian N Liu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.
| | - Kyle B Zuniga
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
- David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Alan Paciorek
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
- Department of Urology, University of California, San Francisco, United States
| | - Peter R Carroll
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Angela Laffan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Alan Venook
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
- Department of Urology, University of California, San Francisco, United States
| | - Stacey A Kenfield
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
- Department of Urology, University of California, San Francisco, United States
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9
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Savoie MB, Paciorek A, Van Loon K, Anwar M, Atreya CE, Johnson PC, Kenfield SA, Laffan A, Levin AO, Smith JF, Stanfield D, Venook A, Zhang L, Van Blarigan EL, Rowen T. Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma. J Sex Med 2023; 20:439-446. [PMID: 36805959 PMCID: PMC10078939 DOI: 10.1093/jsxmed/qdac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 02/20/2023]
Abstract
BACKGROUND Women diagnosed with colorectal cancer (CRC) or anal squamous cell carcinoma (ASCC) are at high risk of sexual dysfunction after treatment, yet little is known about recovery and risk factors for chronic dysfunction. AIM We aimed to describe sexual function and sexual activity among women who underwent definitive treatment for CRC or ASCC, examine relationships between time since treatment completion and sexual function, and explore factors associated with desire and changes in sexual desire over time. METHODS As part of a prospective cohort study of patients with gastrointestinal cancer at the University of California San Francisco, female-identifying participants who finished definitive treatment for CRC or ASCC completed the Female Sexual Function Index (FSFI) at 6- to 12-month intervals. We used multivariable linear mixed models to explore factors associated with the FSFI desire subscale. OUTCOMES Outcomes were rates of sexual activity, proportion at risk for sexual dysfunction (FSFI score <26.55), total FSFI score, and FSFI desire subscale. RESULTS Among the 97 cancer survivors who completed at least 1 FSFI, the median age was 59 years, the median time since treatment end was 14 months, and 87% were menopausal. Fifty-five women (57%) had a history of colon cancer; 21 (22%), rectal cancer; and 21 (22%), ASCC. An additional 13 (13%) had a current ostomy. Approximately half the women were sexually active (n = 48, 49%). Among these 48 sexually active women, 34 (71%) had FSFI scores indicating risk for sexual dysfunction. Among the 10 sexually active women who completed a FSFI ≥2 years since end of treatment, the median total score was 22.6 (IQR, 15.6-27.3). None of the evaluated characteristics were associated with desire (age, tumor site, treatment, menopause status, or ostomy status). CLINICAL IMPLICATIONS Consistent with prior studies, we found low desire scores after treatment for CRC or ASCC, with little recovery over time, suggesting that patients should not expect an eventual rebound of sexual function. STRENGTHS AND LIMITATIONS Strengths of our study include longitudinal data and use of the validated FSFI. Women with ASCC composed 22% of our cohort, allowing for insight into this rare disease group. Limitations of this study include the small sample size, particularly for longitudinal analyses, and the enrollment of patients at variable times since treatment end. CONCLUSION We observed a high prevalence of sexual health concerns, including low desire, after the treatment of CRC and ASCC that persisted for years after treatment was completed.
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Affiliation(s)
- Marissa B Savoie
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Alan Paciorek
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Mekhail Anwar
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, CA 94720, United States
| | - Chloe E Atreya
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - P Connor Johnson
- Harvard Medical School, Boston, MA 02115, United States
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, United States
| | - Stacey A Kenfield
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Angela Laffan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
| | - Anna O Levin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Psycho-Oncology, University of California San Francisco, San Francisco, CA 94143, United States
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Dalila Stanfield
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
| | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Li Zhang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Tami Rowen
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, United States
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10
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Fidelman N, Atreya C, Griffith M, Milloy A, Carnevale J, Venook A, Van Loon K. Abstract No. 266 Phase I Prospective Trial of TAS-102 (Trifluridine and Tipiracil) and Radioembolization with 90Y Resin Microspheres for Chemo-Refractory Colorectal Liver Metastases. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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11
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Lee S, Ma C, Shi Q, Kumar P, Couture F, Kuebler P, Krishnamurthi S, Lewis D, Tan B, Goldberg RM, Venook A, Blanke C, O'Reilly EM, Shields AF, Meyerhardt JA. Potential Mediators of Oxaliplatin-Induced Peripheral Neuropathy From Adjuvant Therapy in Stage III Colon Cancer: Findings From CALGB (Alliance)/SWOG 80702. J Clin Oncol 2023; 41:1079-1091. [PMID: 36367997 PMCID: PMC9928634 DOI: 10.1200/jco.22.01637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We sought to evaluate the independent and interactive associations of planned treatment duration, celecoxib use, physical activity, body mass index (BMI), diabetes mellitus, and vitamin B6 with oxaliplatin-induced peripheral neuropathy (OIPN) among patients with stage III colon cancer enrolled in a clinical trial. METHODS We conducted a prospective, observational study of 2,450 patients with stage III colon cancer enrolled in the CALGB/SWOG 80702 trial, randomly assigned to 6 versus 12 cycles of adjuvant fluorouracil, leucovorin, and oxaliplatin chemotherapy with or without 3 years of celecoxib. OIPN was reported using the Common Terminology Criteria for Adverse Events (CTCAE) during and following completion of chemotherapy and the FACT/GOG-NTX-13 15-17 months after random assignment. Multivariate analyses were adjusted for baseline sociodemographic and clinical factors. RESULTS Patients assigned to 12 treatment cycles, relative to 6, were significantly more likely to experience higher-grade CTCAE- and FACT/GOG-NTX-13-reported neuropathy and longer times to resolution, while neither celecoxib nor vitamin B6 intake attenuated OIPN. Exercising ≥ 9 MET-hours per week after treatment relative to < 9 was associated with improvements in FACT/GOG-NTX-13-reported OIPN (adjusted difference in means, 1.47; 95% CI, 0.49 to 2.45; P = .003). Compared with patients with baseline BMIs < 25, those with BMIs ≥ 25 were at significantly greater risk of developing higher-grade CTCAE-reported OIPN during (adjusted odds ratio, 1.18; 95% CI, 1.00 to 1.40; P = .05) and following completion (adjusted odds ratio, 1.23; 95% CI, 1.01 to 1.50; P = .04) of oxaliplatin treatment. Patients with diabetes were significantly more likely to experience worse FACT/GOG-NTX-13-reported neuropathy relative to those without (adjusted difference in means, -2.0; 95% CI, -3.3 to -0.73; P = .002). There were no significant interactions between oxaliplatin treatment duration and any of these potentially modifiable exposures. CONCLUSION Lower physical activity, higher BMI, diabetes, and longer planned treatment duration, but not celecoxib use or vitamin B6 intake, may be associated with significantly increased OIPN severity.
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Affiliation(s)
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Kumar
- Heartland Cancer Research NCORP, Illinois CancerCare PC, Peoria, IL
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH
| | | | - DeQuincy Lewis
- Southeast Clinical Oncology Research Consortium NCORP, Cone Health Medical Group, Asheboro, NC
| | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
| | | | - Alan Venook
- University of California San Francisco, San Francisco, CA
| | - Charles Blanke
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
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12
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Spanogiannopoulos P, Kyaw TS, Guthrie BGH, Bradley PH, Lee JV, Melamed J, Malig YNA, Lam KN, Gempis D, Sandy M, Kidder W, Van Blarigan EL, Atreya CE, Venook A, Gerona RR, Goga A, Pollard KS, Turnbaugh PJ. Host and gut bacteria share metabolic pathways for anti-cancer drug metabolism. Nat Microbiol 2022; 7:1605-1620. [PMID: 36138165 PMCID: PMC9530025 DOI: 10.1038/s41564-022-01226-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
Pharmaceuticals have extensive reciprocal interactions with the microbiome, but whether bacterial drug sensitivity and metabolism is driven by pathways conserved in host cells remains unclear. Here we show that anti-cancer fluoropyrimidine drugs inhibit the growth of gut bacterial strains from 6 phyla. In both Escherichia coli and mammalian cells, fluoropyrimidines disrupt pyrimidine metabolism. Proteobacteria and Firmicutes metabolized 5-fluorouracil to its inactive metabolite dihydrofluorouracil, mimicking the major host mechanism for drug clearance. The preTA operon was necessary and sufficient for 5-fluorouracil inactivation by E. coli, exhibited high catalytic efficiency for the reductive reaction, decreased the bioavailability and efficacy of oral fluoropyrimidine treatment in mice and was prevalent in the gut microbiomes of colorectal cancer patients. The conservation of both the targets and enzymes for metabolism of therapeutics across domains highlights the need to distinguish the relative contributions of human and microbial cells to drug efficacy and side-effect profiles.
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Affiliation(s)
- Peter Spanogiannopoulos
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Than S Kyaw
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Ben G H Guthrie
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Patrick H Bradley
- Gladstone Institutes, San Francisco, CA, USA
- Department of Microbiology, The Ohio State University, Columbus, OH, USA
| | - Joyce V Lee
- Department of Cell and Tissue Biology, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan Melamed
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, CA, USA
| | - Ysabella Noelle Amora Malig
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, CA, USA
| | - Kathy N Lam
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Daryll Gempis
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA
| | - Moriah Sandy
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wesley Kidder
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Erin L Van Blarigan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Chloe E Atreya
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Alan Venook
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Roy R Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, CA, USA
| | - Andrei Goga
- Department of Cell and Tissue Biology, University of California San Francisco, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Katherine S Pollard
- Gladstone Institutes, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Peter J Turnbaugh
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
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13
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Katz MHG, Shi Q, Meyers J, Herman JM, Chuong M, Wolpin BM, Ahmad S, Marsh R, Schwartz L, Behr S, Frankel WL, Collisson E, Leenstra J, Williams TM, Vaccaro G, Venook A, Meyerhardt JA, O’Reilly EM. Efficacy of Preoperative mFOLFIRINOX vs mFOLFIRINOX Plus Hypofractionated Radiotherapy for Borderline Resectable Adenocarcinoma of the Pancreas: The A021501 Phase 2 Randomized Clinical Trial. JAMA Oncol 2022; 8:1263-1270. [PMID: 35834226 PMCID: PMC9284408 DOI: 10.1001/jamaoncol.2022.2319] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023]
Abstract
Importance National guidelines endorse treatment with neoadjuvant therapy for borderline resectable pancreatic ductal adenocarcinoma (PDAC), but the optimal strategy remains unclear. Objective To compare treatment with neoadjuvant modified FOLFIRINOX (mFOLFIRINOX) with or without hypofractionated radiation therapy with historical data and establish standards for therapy in borderline resectable PDAC. Design, Setting, and Participants This prospective, multicenter, randomized phase 2 clinical trial conducted from February 2017 to January 2019 among member institutions of National Clinical Trials Network cooperative groups used standardized quality control measures and included 126 patients, of whom 70 (55.6%) were registered to arm 1 (systemic therapy; 54 randomized, 16 following closure of arm 2 at interim analysis) and 56 (44.4%) to arm 2 (systemic therapy and sequential hypofractionated radiotherapy; all randomized before closure). Data were analyzed by the Alliance Statistics and Data Management Center during September 2021. Interventions Arm 1: 8 treatment cycles of mFOLFIRINOX (oxaliplatin, 85 mg/m2; irinotecan, 180 mg/m2; leucovorin, 400 mg/m2; and infusional fluorouracil, 2400 mg/m2) over 46 hours, administered every 2 weeks. Arm 2: 7 treatment cycles of mFOLFIRINOX followed by stereotactic body radiotherapy (33-40 Gy in 5 fractions) or hypofractionated image-guided radiotherapy (25 Gy in 5 fractions). Patients without disease progression underwent pancreatectomy, which was followed by 4 cycles of treatment with postoperative FOLFOX6 (oxaliplatin, 85 mg/m2; leucovorin, 400 mg/m2; bolus fluorouracil, 400 mg/m2; and infusional fluorouracil, 2400 mg/m2 over 46 hours). Main Outcomes and Measures Each treatment arm's 18-month overall survival (OS) rate was compared with a historical control rate of 50%. A planned interim analysis mandated closure of either arm for which 11 or fewer of the first 30 accrued patients underwent margin-negative (R0) resection. Results Of 126 patients, 62 (49%) were women, and the median (range) age was 64 (37-83) years. Among the first 30 evaluable patients enrolled to each arm, 17 patients in arm 1 (57%) and 10 patients in arm 2 (33%) had undergone R0 resection, leading to closure of arm 2 but continuation to full enrollment in arm 1. The 18-month OS rate of evaluable patients was 66.7% (95% CI, 56.1%-79.4%) in arm 1 and 47.3% (95% CI 35.8%-62.5%) in arm 2. The median OS of evaluable patients in arm 1 and arm 2 was 29.8 (95% CI, 21.1-36.6) months and 17.1 (95% CI, 12.8-24.4) months, respectively. Conclusions and Relevance This randomized clinical trial found that treatment with neoadjuvant mFOLFIRINOX alone was associated with favorable OS in patients with borderline resectable PDAC compared with mFOLFIRINOX treatment plus hypofractionated radiotherapy; thus, mFOLFIRINOX represents a reference regimen in this setting. Trial Registration ClinicalTrials.gov Identifier: NCT02839343.
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Affiliation(s)
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Jeff Meyers
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Joseph M. Herman
- Northwell Cancer Institute, National Cancer Institute Community Oncology Research Program, Manhasset, New York
| | | | | | - Syed Ahmad
- University of Cincinnati, Cincinnati, Ohio
| | - Robert Marsh
- NorthShore University Health System, Evanston, Illinois
| | | | | | - Wendy L. Frankel
- The Ohio State University Arthur G James Cancer Hospital, Columbus
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14
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Kulke MH, Ou FS, Niedzwiecki D, Huebner L, Kunz P, Kennecke HF, Wolin EM, Chan JA, O’Reilly EM, Meyerhardt JA, Venook A. Everolimus with or without bevacizumab in advanced pNET: CALGB 80701 (Alliance). Endocr Relat Cancer 2022; 29:335-344. [PMID: 35324465 PMCID: PMC9257687 DOI: 10.1530/erc-21-0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/23/2022]
Abstract
Treatment with the MTOR inhibitor everolimus improves progression-free survival (PFS) in pancreatic neuroendocrine tumors (pNETs), but it is not known if the addition of a VEGF pathway inhibitor to an MTOR inhibitor enhances antitumor activity. We performed a randomized phase II study evaluating everolimus with or without bevacizumab in patients with advanced pNETs. One hundred and fifty patients were randomized to receive everolimus 10 mg daily with or without bevacizumab 10 mg/kg i.v. every 2 weeks. Patients also received standard dose of octreotide in both arms. The primary endpoint was PFS, based on local investigator review. Treatment with the combination of everolimus and bevacizumab resulted in improved progression-free survival compared to everolimus (16.7 months compared to 14.0 months; one-sided stratified log-rank P = 0.1028; hazard ratio (HR) 0.80 (95% CI 0.56-1.13)), meeting the predefined primary endpoint. Confirmed tumor responses were observed in 31% (95% CI 20%, 41%) of patients receiving combination therapy, as compared to only 12% (95% CI 5%, 19%) of patients receiving treatment with everolimus (P = 0.0053). Median overall survival duration was similar in the everolimus and combination arm (42.5 and 42.1 months, respectively). Treatment-related toxicities were more common in the combination arm. In summary, treatment with everolimus and bevacizumab led to superior PFS and higher response rates compared to everolimus in patients with advanced pNETs. Although the higher rate of treatment-related adverse events may limit the use of this combination, our results support the continued evaluation of VEGF pathway inhibitors in pNETs.
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Affiliation(s)
- Matthew H. Kulke
- Section of Hematology and Medical Oncology, Boston University and Boston Medical Center, 820 Harrison Ave, Boston, MA, 02118
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center and Mayo Clinic Cancer Center, 200 First Street SW Rochester, MN 55905
| | - Donna Niedzwiecki
- Department of Biostatistics, Duke Cancer Center, 200 Duke Medicine Circle Durham, NC 22710
| | - Lucas Huebner
- Alliance Statistics and Data Management Center Mayo Clinic Cancer Center, 200 First Street SW Rochester, MN 55905
| | - Pamela Kunz
- Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510
| | | | - Edward M. Wolin
- Tisch Cancer Institute. 1470 Madison Ave, New York, NY, 10029
| | - Jennifer A Chan
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | | | - Alan Venook
- UCSF Helen Diller Family Comprehensive Cancer Center, Box 1705 UCSF San Francisco, CA, 94143
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15
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Quintanilha JC, Wang J, Sibley AB, Xu W, Espin-Garcia O, Jiang C, Etheridge AS, Ratain MJ, Lenz HJ, Bertagnolli M, Kindler HL, Dickler MN, Venook A, Liu G, Owzar K, Lin D, Innocenti F. Genome-wide association studies of survival in 1520 cancer patients treated with bevacizumab-containing regimens. Int J Cancer 2022; 150:279-289. [PMID: 34528705 PMCID: PMC8627468 DOI: 10.1002/ijc.33810] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
Germline variants might predict cancer progression. Bevacizumab improves overall survival (OS) in patients with advanced cancers. No biomarkers are available to identify patients that benefit from bevacizumab. A meta-analysis of genome-wide association studies (GWAS) was conducted in 1,520 patients from Phase III trials (CALGB 80303, 40503, 80405 and ICON7), where bevacizumab was randomized to treatment without bevacizumab. We aimed to identify genes and single nucleotide polymorphisms (SNPs) associated with survival independently of bevacizumab treatment or through interaction with bevacizumab. A cause-specific Cox model was used to test the SNP-OS association in both arms combined (prognostic), and the effect of SNPs-bevacizumab interaction on OS (predictive) in each study. The SNP effects across studies were combined using inverse variance. Findings were tested for replication in advanced colorectal and ovarian cancer patients from The Cancer Genome Atlas (TGCA). In the GWAS meta-analysis, patients with rs680949 in PRUNE2 experienced shorter OS compared to patients without it (P = 1.02 × 10-7 , hazard ratio [HR] = 1.57, 95% confidence interval [CI] 1.33-1.86), as well as in TCGA (P = .0219, HR = 1.58, 95% CI 1.07-2.35). In the GWAS meta-analysis, patients with rs16852804 in BARD1 experienced shorter OS compared to patients without it (P = 1.40 × 10-5 , HR = 1.51, 95% CI 1.25-1.82) as well as in TCGA (P = 1.39 × 10-4 , HR = 3.09, 95% CI 1.73-5.51). Patients with rs3795897 in AGAP1 experienced shorter OS in the bevacizumab arm compared to the nonbevacizumab arm (P = 1.43 × 10-5 ). The largest GWAS meta-analysis of bevacizumab treated patients identified PRUNE2 and BARD1 (tumor suppressor genes) as prognostic genes of colorectal and ovarian cancer, respectively, and AGAP1 as a potentially predictive gene that interacts with bevacizumab with respect to patient survival.
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Affiliation(s)
- Julia C.F. Quintanilha
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jin Wang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexander B. Sibley
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network and Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network and Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Chen Jiang
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Amy S. Etheridge
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark J. Ratain
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Hedy L. Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
| | | | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, USA
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Kouros Owzar
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Danyu Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Federico Innocenti
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Correspondence: Federico Innocenti, MD, PhD. University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Genetic Medicine Bldg. 120 Mason Farm Rd, Campus Box 7361, Chapel Hill, NC 27599-7361, Tel 919-966-9422 Fax 919-966-5863,
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16
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Yin J, Cohen R, Jin Z, Liu H, Pederson L, Adams R, Grothey A, Maughan TS, Venook A, Van Cutsem E, Punt C, Koopman M, Falcone A, Tebbutt NC, Seymour MT, Bokemeyer C, Rubio ED, Kaplan R, Heinemann V, Chibaudel B, Yoshino T, Zalcberg J, Andre T, De Gramont A, Shi Q, Lenz HJ. Prognostic and Predictive Impact of Primary Tumor Sidedness for Previously Untreated Advanced Colorectal Cancer. J Natl Cancer Inst 2021; 113:1705-1713. [PMID: 34061178 DOI: 10.1093/jnci/djab112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Unplanned subgroup analyses from several studies have suggested primary tumor sidedness (PTS) as a potential prognostic and predictive parameter in metastatic colorectal cancer (mCRC). We aimed to investigate the impact of PTS on outcomes of mCRC patients. METHODS PTS data of 9277 mCRC patients from 12 first-line randomized trials in the ARCAD database were pooled. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox models adjusting for age, sex, performance status, prior radiation/chemotherapy, and stratified by treatment arm. Predictive value was tested by interaction term between PTS and treatment (cetuximab plus chemotherapy vs chemotherapy alone). All statistical tests were 2-sided. RESULTS Compared with right-sided metastatic colorectal cancer patients (n = 2421, 26.1%), left-sided metastatic colorectal cancer patients (n = 6856, 73.9%) had better OS (median = 21.6 vs 15.9 months; adjusted hazard ratio [HRadj] = 0.71, 95% confidence interval [CI] = 0.67 to 0.76; P < .001) and PFS (median = 8.6 vs 7.5 months; HRadj = 0.80, 95% CI = 0.75 to 0.84; P < .001). Interaction between PTS and KRAS mutation was statistically significant (Pinteraction < .001); left-sidedness was associated with better prognosis among KRAS wild-type (WT) (OS HRadj = 0.59, 95% CI = 0.53 to 0.66; PFS HRadj =0.68, 95% CI = 0.61 to 0.75) but not among KRAS mutated tumors. Among KRAS-WT tumors, survival benefit from anti-EGFR was confirmed for left-sidedness (OS HRadj = 0.85, 95% CI = 0.75 to 0.97; P = .01; PFS HRadj = 0.77, 95% CI = 0.67 to 0.88; P < .001) but not for right-sidedness. CONCLUSIONS The prognostic value of PTS is restricted to the KRAS-WT population. PTS is predictive of anti-EGFR efficacy, with a statistically significant improvement of survival for left-sidedness mCRC patients. These results suggest treatment choice in mCRC should be based on both PTS and KRAS status.
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Affiliation(s)
- Jun Yin
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Paris, France
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heshan Liu
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Levi Pederson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | - Timothy S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
- St James's Hospital, University of Leeds, Leeds, UK
| | - Alan Venook
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven, University of Leuven, Leuven, Belgium
| | - Cornelis Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Niall C Tebbutt
- Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - Matthew T Seymour
- NIHR Clinical Research Network, St James's Hospital, University of Leeds, Leeds, UK
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eduardo Diaz Rubio
- Universidad Complutense Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, Madrid, Spain
| | - Richard Kaplan
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Volker Heinemann
- University Hospital Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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17
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Cohen R, Liu H, Fiskum J, Adams R, Chibaudel B, Maughan TS, Van Cutsem E, Venook A, Douillard JY, Heinemann V, Ja Punt C, Falcone A, Bokemeyer C, Kaplan R, Lenz HJ, Koopman M, Yoshino T, Zalcberg J, Grothey A, de Gramont A, Shi Q, André T. BRAF V600E Mutation in First-Line Metastatic Colorectal Cancer: An Analysis of Individual Patient Data From the ARCAD Database. J Natl Cancer Inst 2021; 113:1386-1395. [PMID: 33734401 DOI: 10.1093/jnci/djab042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/06/2021] [Accepted: 03/15/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND First-line therapeutic strategies for patients with BRAFV600E-mutated (BRAFmt) metastatic colorectal cancer (mCRC) mainly rely on subgroup analyses from randomized controlled trials (RCTs). We aimed to assess the prognostic and predictive impact of BRAFmt on the efficacy of targeted therapies with first-line chemotherapy. METHODS Individual patient data from first-line RCTs with BRAF and KRAS status data in the ARCAD database were pooled. Progression-free survival and overall survival (OS) were assessed using Kaplan-Meier and Cox models. Outcomes were compared between treatment groups that were concurrently randomly assigned whenever possible. RESULTS A total of 6391 patients from 10 RCTs were included: 573 BRAFmt (9.0%), 2059 KRASmt (32.2%), and 3759 double wild type (58.8%). BRAFmt mCRC patients experienced statistically significantly poorer OS than those with KRASmt (adjusted hazard ratio [HRadj] = 1.46, 95% confidence interval [CI] = 1.30 to 1.64) and patients with double wild-type tumors (HRadj = 2.14, 95% CI = 1.94 to 2.36). Anti-EGFR agents did not improve progression-free survival or OS of BRAFmt mCRC patients, based on 4 RCTs testing chemotherapy with or without anti-epidermal growth factor receptor (anti-EGFR) (HRadj = 0.96, 95% CI = 0.71 to 1.30; and HRadj = 0.85, 95% CI = 0.66 to 1.14, respectively). CONCLUSIONS Our data suggest that the addition of anti-EGFR agents to chemotherapy is ineffective as first-line treatment for BRAFmt mCRC patients.
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Affiliation(s)
- Romain Cohen
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Heshan Liu
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Timothy S Maughan
- Cancer Research UK and the Medical Research Council Oxford Institute for Radiation Oncology, Oxford, UK
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Belgium
| | - Alan Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA, USA
| | | | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany
| | - Cornelis Ja Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thierry André
- Department of Medical Oncology, Sorbonne University, Saint-Antoine Hospital, Paris, France
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18
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Yin J, Dawood S, Cohen R, Meyers J, Zalcberg J, Yoshino T, Seymour M, Maughan T, Saltz L, Van Cutsem E, Venook A, Schmoll HJ, Goldberg R, Hoff P, Hecht JR, Hurwitz H, Punt C, Diaz Rubio E, Koopman M, Cremolini C, Heinemann V, Tournigard C, Bokemeyer C, Fuchs C, Tebbutt N, Souglakos J, Doulliard JY, Kabbinavar F, Chibaudel B, de Gramont A, Shi Q, Grothey A, Adams R. Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis. Ther Adv Med Oncol 2021; 13:17588359211020547. [PMID: 34262614 PMCID: PMC8252342 DOI: 10.1177/17588359211020547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs). DESIGN Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions. RESULTS Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3-4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001). CONCLUSIONS Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.
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Affiliation(s)
- Jun Yin
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
| | - Shaheenah Dawood
- Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE
| | - Romain Cohen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeff Meyers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Leonard Saltz
- Memory Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Alan Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA, USA
| | | | - Richard Goldberg
- Department of Oncology, West Virginia University, Morgantown, WV, USA
| | - Paulo Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil
| | - J. Randolph Hecht
- Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA
| | | | - Cornelis Punt
- Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Niall Tebbutt
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Center, Cardiff, UK
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19
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Lee S, Zhang S, Ma C, Ou FS, Wolfe EG, Ogino S, Niedzwiecki D, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Gross CP, Irwin ML, Meyerhardt JA, Fuchs CS. Race, Income, and Survival in Stage III Colon Cancer: CALGB 89803 (Alliance). JNCI Cancer Spectr 2021; 5:pkab034. [PMID: 34104867 PMCID: PMC8178799 DOI: 10.1093/jncics/pkab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/10/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background Disparities in colon cancer outcomes have been reported across race and socioeconomic status, which may reflect, in part, access to care. We sought to assess the influences of race and median household income (MHI) on outcomes among colon cancer patients with similar access to care. Methods We conducted a prospective, observational study of 1206 stage III colon cancer patients enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial. Race was self-reported by 1116 White and 90 Black patients at study enrollment; MHI was determined by matching 973 patients’ home zip codes with publicly available US Census 2000 data. Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary, and lifestyle factors. All statistical tests were 2-sided. Results Over a median follow-up of 7.7 years, the adjusted hazard ratios for Blacks (compared with Whites) were 0.94 (95% confidence interval [CI] = 0.66 to 1.35, P = .75) for disease-free survival, 0.91 (95% CI = 0.62 to 1.35, P = .65) for recurrence-free survival, and 1.07 (95% CI = 0.73 to 1.57, P = .73) for overall survival. Relative to patients in the highest MHI quartile, the adjusted hazard ratios for patients in the lowest quartile were 0.90 (95% CI = 0.67 to 1.19, Ptrend = .18) for disease-free survival, 0.89 (95% CI = 0.66 to 1.22, Ptrend = .14) for recurrence-free survival, and 0.87 (95% CI = 0.63 to 1.19, Ptrend = .23) for overall survival. Conclusions In this study of patients with similar health-care access, no statistically significant differences in outcomes were found by race or MHI. The substantial gaps in outcomes previously observed by race and MHI may not be rooted in differences in tumor biology but rather in access to quality care.
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Affiliation(s)
| | - Sui Zhang
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Eric G Wolfe
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Shuji Ogino
- Department of Oncologic Pathology, Dana-Farber/Partners CancerCare and Harvard Medical School, Boston, MA, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH, USA
| | | | - Alexander Hantel
- Loyola University Stritch School of Medicine, Naperville, IL, USA
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | | | - Michael Messino
- Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC, USA
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Cary P Gross
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Charles S Fuchs
- Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Smilow Cancer Hospital and Yale School of Medicine, New Haven, CT, USA.,Genentech, South San Francisco, CA, USA
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20
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Meyerhardt JA, Shi Q, Fuchs CS, Meyer J, Niedzwiecki D, Zemla T, Kumthekar P, Guthrie KA, Couture F, Kuebler P, Bendell JC, Kumar P, Lewis D, Tan B, Bertagnolli M, Grothey A, Hochster HS, Goldberg RM, Venook A, Blanke C, O’Reilly EM, Shields AF. Effect of Celecoxib vs Placebo Added to Standard Adjuvant Therapy on Disease-Free Survival Among Patients With Stage III Colon Cancer: The CALGB/SWOG 80702 (Alliance) Randomized Clinical Trial. JAMA 2021; 325:1277-1286. [PMID: 33821899 PMCID: PMC8025124 DOI: 10.1001/jama.2021.2454] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
Importance Aspirin and cyclooxygenase 2 (COX-2) inhibitors have been associated with a reduced risk of colorectal polyps and cancer in observational and randomized studies. The effect of celecoxib, a COX-2 inhibitor, as treatment for nonmetastatic colon cancer is unknown. Objective To determine if the addition of celecoxib to adjuvant chemotherapy with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) improves disease-free survival in patients with stage III colon cancer. Design, Setting, and Participants Cancer and Leukemia Group B (Alliance)/Southwest Oncology Group 80702 was a 2 × 2 factorial design, phase 3 trial conducted at 654 community and academic centers throughout the United States and Canada. A total of 2526 patients with stage III colon cancer were enrolled between June 2010 and November 2015 and were followed up through August 10, 2020. Interventions Patients were randomized to receive adjuvant FOLFOX (every 2 weeks) for 3 vs 6 months with or without 3 years of celecoxib (400 mg orally daily; n = 1263) vs placebo (n = 1261). This report focuses on the results of the celecoxib randomization. Main Outcomes and Measures The primary end point was disease-free survival, measured from the time of randomization until documented recurrence or death from any cause. Secondary end points included overall survival, adverse events, and cardiovascular-specific events. Results Of the 2526 patients who were randomized (mean [SD] age, 61.0 years [11 years]; 1134 women [44.9%]), 2524 were included in the primary analysis. Adherence with protocol treatment, defined as receiving celecoxib or placebo for more than 2.75 years or continuing treatment until recurrence, death, or unacceptable adverse events, was 70.8% for patients treated with celecoxib and 69.9% for patients treated with placebo. A total of 337 patients randomized to celecoxib and 363 to placebo experienced disease recurrence or died, and with 6 years' median follow-up, the 3-year disease-free survival was 76.3% for celecoxib-treated patients vs 73.4% for placebo-treated patients (hazard ratio [HR] for disease recurrence or death, 0.89; 95% CI, 0.76-1.03; P = .12). The effect of celecoxib treatment on disease-free survival did not vary significantly according to assigned duration of adjuvant chemotherapy (P for interaction = .61). Five-year overall survival was 84.3% for celecoxib vs 81.6% for placebo (HR for death, 0.86; 95% CI, 0.72-1.04; P = .13). Hypertension (any grade) occurred while treated with FOLFOX in 14.6% of patients in the celecoxib group vs 10.9% of patients in the placebo group, and a grade 2 or higher increase in creatinine levels occurred after completion of FOLFOX in 1.7% vs 0.5% of patients, respectively. Conclusions and Relevance Among patients with stage III colon cancer, the addition of celecoxib for 3 years, compared with placebo, to standard adjuvant chemotherapy did not significantly improve disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT01150045.
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Affiliation(s)
- Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, Massachusetts
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Charles S. Fuchs
- Yale Cancer Center, Yale School of Medicine, Smilow Cancer Hospital, New Haven, Connecticut
| | - Jeffrey Meyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Tyler Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Priya Kumthekar
- Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Katherine A. Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, Ohio
| | | | | | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Monica Bertagnolli
- Office of the Alliance Group Chair, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Axel Grothey
- West Cancer Center & Research Institute, Germantown, Tennessee
| | | | | | | | - Charles Blanke
- SWOG Cancer Research Network Group Chair’s Office, Oregon Health and Science University Knight Cancer Institute
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York
| | - Anthony F. Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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21
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Dasari A, Morris VK, Allegra CJ, Atreya C, Benson AB, Boland P, Chung K, Copur MS, Corcoran RB, Deming DA, Dwyer A, Diehn M, Eng C, George TJ, Gollub MJ, Goodwin RA, Hamilton SR, Hechtman JF, Hochster H, Hong TS, Innocenti F, Iqbal A, Jacobs SA, Kennecke HF, Lee JJ, Lieu CH, Lenz HJ, Lindwasser OW, Montagut C, Odisio B, Ou FS, Porter L, Raghav K, Schrag D, Scott AJ, Shi Q, Strickler JH, Venook A, Yaeger R, Yothers G, You YN, Zell JA, Kopetz S. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper. Nat Rev Clin Oncol 2020; 17:757-770. [PMID: 32632268 PMCID: PMC7790747 DOI: 10.1038/s41571-020-0392-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chloe Atreya
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Ki Chung
- Division of Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet S Copur
- CHI Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan B Corcoran
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dustin A Deming
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J George
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stanley R Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MD, USA
| | - Federico Innocenti
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Division of Surgery, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburgh, PA, USA
| | - Hagen F Kennecke
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clara Montagut
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fang-Shu Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Porter
- Patient Advocate, NCI Colon Task Force, Boston, MA, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah Schrag
- Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Zell
- Department of Epidemiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Karapetis C, Liu H, Sorich M, Fiskum J, Grothey A, Adams R, Venook A, Heinemann V, Lenz H, Yoshino T, Zalcberg J, Chibaudel B, Buyse M, De Gramont A, Shi Q. 434P Impact of molecular markers status on treatment effects comparing EGFR and VEGF monoclonal antibodies (mAbs) in untreated metastatic colorectal cancer (mCRC): Pooled individual patient data (IPD) analysis of randomized trials from the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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Papamichael D, Lopes G, Olswold C, Chibaudel B, Zalcberg J, Van Cutsem E, Venook A, Maughan T, Heinemann V, Kaplan R, Bokemeyer C, Lenz H, Yoshino T, Adams R, Grothey A, De Gramont A, Shi Q. 432P Toxicity and efficacy of 1st line cetuximab (cetux)-based therapy in RAS wildtype (WT) older patients (pts) with metastatic colorectal cancer (mCRC): A pooled analysis from 1,274 pts in the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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24
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Johnson RM, Qu X, Thomas J, Kschonsak Y, Huw LY, Ou FS, Sokol E, Ihuegbu N, Zill O, Kabbarah O, Daemen A, Bourgon R, Venook A, Innocenti F, Lenz HJ, de Sousa e Melo F, Bais C. Abstract LB-063: ARID1A mutations induce an EGFR-like gene expression signature and confer intrinsic and acquired resistance to cetuximab treatment in first line metastatic CRC. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-lb-063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Extensive biological and clinical evidence supports the notion many CRC tumors are addicted to EGFR/KRAS/MAPK signaling. For example, mutations in KRAS, BRAF and other MAPK pathway components confer intrinsic or acquired resistance to anti-EGFR therapy. However, a significant proportion of acquired resistance cases have remained unexplained. ARID1A mutations are found in approximately 11% of CRC tumors, but a connection between ARID1A mutations and EGFR/MAPK signaling activation in CRC has not been previously suspected. By leveraging the genomic biomarker data collected from 333 patients at baseline and at progression who participated in the CALGB/SWOG 80405 trial, we found that mutations in ARID1A, a key component of SWI/SNF complex, were enriched in the cell free DNA of 6/16 of the patients whose tumors had become resistant to anti-EGFR therapy with ARID1A mutations detected at either timepoint (adj. p = 0.03, OR = 0.09, two-tailed fisher's exact test). In contrast, there was no evidence of enriched ARID1A mutations in patients treated with bevacizumab. To investigate the potential role of a broader ARID1A deficiency phenotype in resistance to cetuximab therapy, we developed an ARID1A mutant-like signature from TCGA that captures the transcriptional profile characteristic of ARID1A mutants. Using this signature to stratify CALGB patients based on gene expression data collected on tissue at diagnosis, we also found patients with an ARID1A mutant-like gene expression profile had worst outcome in patients treated with cetuximab than bevacizumab with adjustment for established clinical variables for both OS [p = 0.0002, hazard ratio (HR) 6.2, 95% confidence interval (CI) 2.4-16], and PFS [p = 0.0008, HR 4.7 (1.9 -12)], suggesting that ARID1A mutations may be also a mechanism of intrinsic resistance to anti-EGFR therapies. Gene expression analysis demonstrated that ARID1A deficiency leads to re-activation of an EGFR-like signature, suggesting reactivation of this pathway as a possible mechanism of resistance. Furthermore, CRISPR knockout of ARID1A in the cetuximab-sensitive CRC cell line NCI-H508 conferred elevated MAPK signaling relative to parental line and resistance to cetuximab in culture. Consistent with these findings, we also observed strong mutual exclusivity between ARID1A mutations and mutations in the EGFR/MAPK signaling pathway in more than 40,000 lung and colorectal cancer patients profiled in the FoundationCore® database. Strikingly, in lung cancers where EGFR mutations structural variants (SV) are more prevalent, EGFR SV was the top mutually exclusive alteration with ARID1A mutations in lung cancers. Of 5980 lung cancer patients with ARID1A and/or EGFR SVs, only 100 patients (1.7%) had both SVs. Taken together, our data suggest that ARID1A loss-of-function mutations may promote resistance to cetuximab by driving an EGFR-like transcription program in the absence of ligand-dependent activation of EGFR. Our results suggest that ARID1A defects could be potentially used as an exclusion biomarker for cetuximab treatment decisions, and they provide a rationale for exploring therapeutic MAPK inhibition in ARID1A mutant CRC patients.
Citation Format: Radia Marie Johnson, Xueping Qu, Joshua Thomas, Yvonne Kschonsak, Ling-Yuh Huw, Fang-Shu Ou, Ethan Sokol, Nnamdi Ihuegbu, Oliver Zill, Omar Kabbarah, Anneleen Daemen, Richard Bourgon, Alan Venook, Federico Innocenti, Heinz-Josef Lenz, Felipe de Sousa e Melo, Carlos Bais. ARID1A mutations induce an EGFR-like gene expression signature and confer intrinsic and acquired resistance to cetuximab treatment in first line metastatic CRC [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-063.
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Affiliation(s)
| | - Xueping Qu
- 1Genentech, Inc., South San Francisco, CA
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25
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Savoie M, Paciorek A, Van Blarigan E, Smith J, Laffan A, Zhang L, Levin A, Kenfield S, Anwar M, Atreya C, Venook A, Van Loon K, Rowen T. 006 Sexual Function in Women after Treatment for Colorectal Cancer and Anal Cancer. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Morales-Oyarvide V, Yuan C, Babic A, Zhang S, Niedzwiecki D, Brand-Miller JC, Sampson-Kent L, Ye X, Li Y, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Wu K, Willett WC, Giovannucci EL, Wolpin BM, Meyerhardt JA, Fuchs CS, Ng K. Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance). J Natl Cancer Inst 2020; 111:170-179. [PMID: 30726946 DOI: 10.1093/jnci/djy098] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/08/2018] [Accepted: 04/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.
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Affiliation(s)
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ana Babic
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sui Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jennie C Brand-Miller
- Institute of Obesity, Nutrition, and Exercise, University of Sydney, Sydney, Australia
| | - Laura Sampson-Kent
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Xing Ye
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | - Yanping Li
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH
| | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Michael Messino
- Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Department of Pathology, Harvard Medical School, Boston, MA
| | - Kana Wu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Charles S Fuchs
- Yale Cancer Center, Smilow Cancer Hospital and Yale School of Medicine, New Haven, CT
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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27
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Ursem C, Zhou M, Paciorek A, Atreya CE, Ko AH, Venook A, Zhang L, Van Loon K. Clinicopathologic Characteristics and Impact of Oophorectomy for Ovarian Metastases from Colorectal Cancer. Oncologist 2020; 25:564-571. [PMID: 32031306 DOI: 10.1634/theoncologist.2019-0282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As survival with metastatic colorectal cancer (CRC) and imaging modalities improve, detection of ovarian metastases may be increasing. The ovary may serve as a sanctuary site for malignant cells; however, there is a paucity of data regarding the role for oophorectomy. METHODS This is a single-institution retrospective study of patients with CRC with ovarian metastases from 2009 to 2017. We evaluated patient, disease, and treatment related factors associated with overall survival (OS) from initial diagnosis of metastatic CRC. RESULTS Of 108 patients assessed, the median age was 50, 19% had localized disease at initial presentation, 64% had ovarian metastases at initial CRC diagnosis, and 77% underwent oophorectomy. Median OS was 29.6 months across all patients, and it was 36.7 months in patients who underwent oophorectomy versus 25.0 months in patients who did not (hazard ratio [HR] 0.54). In multivariate analysis, the effect of oophorectomy on OS suggested protection but was not statistically significant (HR 0.57). Resection of primary tumor was performed in 71% of patients, which was independently associated with improved OS (HR 0.21). Twelve patients (11%) remained alive at 5 years after diagnosis of metastatic disease. CONCLUSION Although it has been previously reported that patients with CRC with ovarian metastases have poor prognosis, the median OS for this cohort was comparable to existing OS data for patients with metastatic CRC. In patients treated with chemotherapy, we did not find the ovarian metastasis to frequently serve as a sanctuary site of disease. However, we found that in carefully selected patients, oophorectomy may confer a survival benefit. IMPLICATIONS FOR PRACTICE In colorectal cancer (CRC) ovarian metastasis is not necessarily associated with worse prognosis than metastasis to other sites. In carefully selected patients with ovarian metastases from CRC, oophorectomy may confer a survival benefit. Specifically, development of ovarian metastasis early in the disease course, resection of the primary tumor, and limited extraovarian metastatic disease are clinical features that are potentially associated with benefit from oophorectomy. A subset of patients with ovarian metastasis from CRC have potential to become long-term survivors (>5 years).
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Affiliation(s)
- Carling Ursem
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Margaret Zhou
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Alan Paciorek
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Chloe E Atreya
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew H Ko
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Alan Venook
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Li Zhang
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Katherine Van Loon
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, California, USA
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28
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Innocenti F, Rashid N, Wancen M, Ou FS, Qu X, Denning S, Bertagnolli M, Blanke C, Venook A, Kabbarah O, Lenz H. Next-generation sequencing (NGS) in metastatic colorectal cancer (mCRC): Novel mutated genes and their effect on response to therapy (Alliance). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Van Blarigan EL, Fuchs CS, Niedzwiecki D, Zhang S, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Giovannucci EL, Ng K, Meyerhardt JA. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol 2019; 4:783-790. [PMID: 29710284 DOI: 10.1001/jamaoncol.2018.0126] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival. Objective To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer. Design, Setting, and Participants This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017. Exposures We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy. Main Outcomes and Measures Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival. Results Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42% lower risk of death during the study period (HR, 0.58; 95% CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95% CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95% CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95% CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95% CI, 0.44-0.94; P = .05 for trend). Conclusions and Relevance Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival. Trial Registration clinicaltrials.gov Identifier: NCT00003835.
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Affiliation(s)
- Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,Department of Urology, University of California, San Francisco
| | - Charles S Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Donna Niedzwiecki
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Sui Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, Ohio
| | - Renaud Whittom
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Alexander Hantel
- Loyola University, Stritch School of Medicine, Naperville, Illinois
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | - Michael Messino
- Southeast Clinical Oncology Research Consortium, Mission Hospitals Inc, Asheville, North Carolina
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Program in Molecular Pathology Epidemiology (MPE), Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Das R, Ou F, Washburn C, Innocenti F, Nixon A, Lenz H, Blanke C, Niedzwiecki D, Khalil I, Harms B, Venook A. Bayesian machine learning on CALGB/SWOG 80405 (Alliance) and PEAK data identify a heterogeneous landscape of clinical predictors of overall survival (OS) in different populations of metastatic colorectal cancer (mCRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Schrag D, Weiser M, Saltz L, Mamon H, Gollub M, Basch E, Venook A, Shi Q. Challenges and solutions in the design and execution of the PROSPECT Phase II/III neoadjuvant rectal cancer trial (NCCTG N1048/Alliance). Clin Trials 2019; 16:165-175. [PMID: 30688523 PMCID: PMC6440868 DOI: 10.1177/1740774518824539] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND More than half of the 40,000 incident rectal cancer patients in the United States each year are diagnosed at clinical stage II and III (locally advanced stage). For this group, high rates of cure can be achieved with the combination of pelvic radiation and sensitizing 5-fluorouracil (chemoradiation), surgery and chemotherapy, but treatment is long, arduous and toxicities are substantial. The PROSPECT trial (N1048, NCT01515787) was designed to determine whether neoadjuvant chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX) could be used as an alternative to neoadjuvant chemoradiation without compromising treatment outcomes and to spare these patients excess toxicity. The statistical design balanced the twin co-primary goals of achieving low local and distant recurrence rates. Study design features contended with the need for stringent safeguards given limited phase II data, the need for straightforward criteria to facilitate both accrual and protocol fidelity and the importance of patients' perspectives on symptom burden and treatment toxicity. METHODS PROSPECT is an ongoing multi-site two-group seamless phase II/III randomized trial comparing standard neoadjuvant chemoradiation versus neoadjuvant chemotherapy with selective use of chemoradiation for patients with locally advanced rectal cancer. Challenges addressed in the design and conduct of PROSPECT have included the following: (1) setting safety thresholds given limited single-center phase II data, (2) establishing workable eligibility criteria, (3) balancing competing time to local and distant recurrence as co-primary endpoints and (4) obtaining reliable and complete data for patients' symptom burden. The design and implementation challenges, choices, modifications and their implications for the design of future national cooperative group clinical trials are presented. RESULTS PROSPECT incorporated stringent thresholds for both complete surgical resection (R0) and the time to local recurrence as early stopping rules. When predetermined stopping criteria were not met after evaluation of the first 366 participants in the randomized phase II, the study transitioned seamlessly to phase III with cumulative accrual of over 1000 participants. Eligibility criteria stipulating rectal tumor location based on distance from the anal verge were unworkable, and the protocol was amended to a more pragmatic approach that assigned surgeons with primary responsibility for determining eligibility. Central radiology review was feasible and in some cases prompted discontinuation of protocol treatment. Participation in toxicity reporting using the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events was uniformly high and was well accepted by participants from over 200 sites in the United States, Canada and Switzerland. CONCLUSION The strategies used to overcome these obstacles may inform the design of other studies that involve multi-modality treatment interventions, particularly trials where implementation of consistent criteria for eligibility and outcomes across hundreds of practice settings is necessary.
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Affiliation(s)
- Deborah Schrag
- Dana-Farber Cancer Institute, Division of Populations Sciences and Harvard Medical School, Boston, MA, USA
| | - Martin Weiser
- Memorial Sloan Kettering Cancer Center, Department of Surgery and Weill Medical College of Cornell University, New York, NY, USA
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, Department of Medical Oncology and Weill Medical College of Cornell University, New York, NY, USA
| | - Harvey Mamon
- Brigham and Women’s Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Marc Gollub
- Memorial Sloan Kettering Cancer Center, Department of Radiology and Weill Medical College of Cornell University, New York, NY, USA
| | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Division of Medical Oncology and University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alan Venook
- University of California San Francisco Cancer Center, Division of Medical Oncology and University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo Clinic Cancer Center, Rochester, MN, USA
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Van Blarigan EL, Ou FS, Niedzwiecki D, Zhang S, Fuchs CS, Saltz L, Mayer RJ, Venook A, Ogino S, Song M, Benson A, Hantel A, Atkins JN, Giovannucci EL, Meyerhardt JA. Dietary Fat Intake after Colon Cancer Diagnosis in Relation to Cancer Recurrence and Survival: CALGB 89803 (Alliance). Cancer Epidemiol Biomarkers Prev 2018; 27:1227-1230. [PMID: 30038051 PMCID: PMC6170705 DOI: 10.1158/1055-9965.epi-18-0487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/11/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Higher intake of long-chain ω-3 polyunsaturated fatty acids and nuts, rich plant sources of unsaturated fats, after colon cancer diagnosis are associated with improved survival. It is not known whether the amount or the distribution of other types of fat is associated with survival after colon cancer.Methods: We prospectively examined postdiagnostic total, animal, and vegetable fats, as well as the saturated, monounsaturated, polyunsaturated, and trans fat in relation to disease-free survival among 1,011 patients with stage III colon cancer. Patients were enrolled between 1999 and 2001 at the onset of adjuvant chemotherapy and followed for recurrence or death through 2009.Results: During median follow-up of 7 years, we observed 305 deaths and 81 recurrences (total events: 386). Neither total nor any specific type of dietary fat examined was statistically significantly associated with risk of cancer recurrence or death from any cause (disease-free survival) after stage III colon cancer.Conclusions: The amount and type (animal, vegetable, saturated, monounsaturated, polyunsaturated, and trans) of dietary fat consumed after colon cancer does not appear to be substantially associated with risk of recurrence or survival.Impact: Neither total nor major types (animal, vegetable, saturated, monounsaturated, polyunsaturated, and trans) of dietary fat consumed after colon cancer was associated with cancer recurrence or survival. Cancer Epidemiol Biomarkers Prev; 27(10); 1227-30. ©2018 AACR.
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Affiliation(s)
- Erin L. Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA,Department of Urology, University of California, San Francisco, CA
| | - Fang-Shu Ou
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, MA
| | | | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Shuji Ogino
- Dana-Farber/Partners CancerCare, Boston, MA,Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Broad Institute of MIT and Harvard, Cambridge, MA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - James N Atkins
- Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, NC
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Das R, Furchtgott L, Ou FS, Swanson D, Hayete B, Harms B, Cunha D, Latourelle J, Wuest D, Khalil I, Washburn C, Rich K, Blanke C, Meyerhardt J, Niedzwiecki D, Nixon A, O’Reilly E, Innocenti F, Lenz HJ, Venook A. Causal modeling of CALGB/SWOG 80405 (Alliance) identifies primary (1°) side-related angiogenic drivers of metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guercio BJ, Zhang S, Niedzwiecki D, Li Y, Babic A, Morales-Oyarvide V, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Zoltick ES, Stampfer M, Ng K, Wu K, Willett WC, Giovannucci EL, Meyerhardt JA, Fuchs CS. Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance). PLoS One 2018; 13:e0199244. [PMID: 30024889 PMCID: PMC6053135 DOI: 10.1371/journal.pone.0199244] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/01/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose Observational studies have demonstrated increased colon cancer recurrence and mortality in states of excess energy balance, as denoted by factors including sedentary lifestyle, diabetes, increased dietary glycemic load, and increased intake of sugar-sweetened beverages. Nonetheless, the relation between artificially sweetened beverages, a popular alternative for sugar-sweetened beverages, and colon cancer recurrence and survival is unknown. Methods We analyzed data from 1,018 patients with stage III colon cancer who prospectively reported dietary intake during and after chemotherapy while enrolled in a National Cancer Institute-sponsored trial of adjuvant chemotherapy. Using Cox proportional hazards regressions, we assessed associations of artificially sweetened beverage intake with cancer recurrence and mortality. Results Patients consuming one or more 12-ounce servings of artificially sweetened beverages per day experienced an adjusted hazard ratio for cancer recurrence or mortality of 0.54 (95% confidence interval, 0.36 to 0.80) when compared to those who largely abstained (Ptrend = .004). Similarly, increasing artificially sweetened beverage intake was also associated with a significant improvement in both recurrence-free survival (Ptrend = .005) and overall survival (Ptrend = .02). Substitution models demonstrated that replacing a 12-ounce serving of a sugar-sweetened beverage with an isovolumetric serving of an artificially sweetened beverage per day was associated with a 23% lower risk of cancer recurrence and mortality (relative risk, 0.77; 95% confidence interval, 0.63 to 0.95; P = .02). Conclusion Higher artificially sweetened beverage consumption may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer. This association may be mediated by substitution for sugar-sweetened alternatives. Further studies are needed to confirm these findings.
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Affiliation(s)
- Brendan J. Guercio
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Donna Niedzwiecki
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina, United States of America
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ana Babic
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | | | - Leonard B. Saltz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Robert J. Mayer
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Rex B. Mowat
- Toledo Community Hospital Oncology Program, Toledo, Ohio, United States of America
| | | | - Alexander Hantel
- Edward-Elmhurst Healthcare, Naperville, Illinois, United States of America
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
| | - Daniel Atienza
- Virginia Oncology Associates, Norfolk, Virginia, United States of America
| | - Michael Messino
- Southeast Clinical Oncology Research (SCOR) Consortium, Mission Hospitals, Incorporated, Asheville, North Carolina, United States of America
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Shuji Ogino
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Molecular Pathological Epidemiology (MPE), Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emilie S. Zoltick
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Meir Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kimmie Ng
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Edward L. Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Charles S. Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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Bekaii-Saab T, Marcello K, Fisher G, Kopetz S, Strickler J, Venook A, Obholz K. Variability of current global practice patterns in the management of metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brown JC, Zhang S, Niedzwiecki D, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Li Y, Zhang X, Ng K, Willett WC, Giovannucci EL, Fuchs CS, Meyerhardt JA. Grain Intake and Clinical Outcome in Stage III Colon Cancer: Results From CALGB 89803 (Alliance). JNCI Cancer Spectr 2018; 2:pky017. [PMID: 29877501 PMCID: PMC5977856 DOI: 10.1093/jncics/pky017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/16/2018] [Accepted: 03/29/2018] [Indexed: 12/15/2022] Open
Abstract
Background Energy balance–related risk factors for colon cancer recurrence and mortality—type II diabetes, hyperinsulinemia, inflammation, and visceral obesity—are positively correlated with consumption of refined grains and negatively correlated with consumption of whole grains. We examined the relationship between the consumption of refined and whole grains with cancer recurrence and mortality in a cohort of patients with colon cancer. Methods We conducted a prospective observational study of 1024 patients with stage III colon cancer who participated in a randomized trial of postoperative chemotherapy. Patients reported consumption of refined and whole grains using a food frequency questionnaire during and six months after chemotherapy. The primary outcome was disease-free survival (DFS). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. All P values are two-sided. Results During a median follow-up of 7.3 years, 394 patients experienced a DFS event. The hazard ratio for DFS was 1.56 (95% CI = 1.09 to 2.24) for patients consuming three or more servings per day of refined grains compared with patients consuming less than one serving per day (Ptrend = .005). The hazard ratio for DFS was 0.89 (95% CI = 0.66 to 1.20) for patients consuming three or more servings per day of whole grains compared with patients consuming less than one serving per day (Ptrend = .54). The hazard ratio for DFS of substituting one serving per day of refined grain with one serving per day of whole grain was 0.87 (95% CI = 0.79 to 0.96, P = .007). Conclusions The choice of grain consumed may be associated with cancer recurrence and mortality. Future studies are necessary to confirm our findings and to inform the design of randomized trials.
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Affiliation(s)
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, MA
| | | | | | | | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH
| | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Michael Messino
- Southeast Clinical Oncology Research (SCOR) Consortium, Mission Hospitals, Inc., Asheville, NC
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer, Chicago, IL
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Shuji Ogino
- Dana-Farber/Partners CancerCare, Boston, MA.,Harvard T.H. Chan School of Public Health, Boston, MA.,Brigham and Women's Hospital, Boston, MA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Kimmie Ng
- Dana-Farber/Partners CancerCare, Boston, MA
| | | | - Edward L Giovannucci
- Harvard T.H. Chan School of Public Health, Boston, MA.,Brigham and Women's Hospital, Boston, MA
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Snyder RA, Hu CY, Cuddy A, Francescatti AB, Schumacher JR, Van Loon K, You YN, Kozower BD, Greenberg CC, Schrag D, Venook A, McKellar D, Winchester DP, Chang GJ. Association Between Intensity of Posttreatment Surveillance Testing and Detection of Recurrence in Patients With Colorectal Cancer. JAMA 2018; 319:2104-2115. [PMID: 29800181 PMCID: PMC6151863 DOI: 10.1001/jama.2018.5816] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Surveillance testing is performed after primary treatment for colorectal cancer (CRC), but it is unclear if the intensity of testing decreases time to detection of recurrence or affects patient survival. Objective To determine if intensity of posttreatment surveillance is associated with time to detection of CRC recurrence, rate of recurrence, resection for recurrence, or overall survival. Design, Setting, and Participants A retrospective cohort study of patient data abstracted from the medical record as part of a Commission on Cancer Special Study merged with records from the National Cancer Database. A random sample of patients (n=8529) diagnosed with stage I, II, or III CRC treated at a Commission on Cancer-accredited facilities (2006-2007) with follow-up through December 31, 2014. Exposures Intensity of imaging and carcinoembryonic antigen (CEA) surveillance testing derived empirically at the facility level using the observed to expected ratio for surveillance testing during a 3-year observation period. Main Outcomes and Measures The primary outcome was time to detection of CRC recurrence; secondary outcomes included rates of resection for recurrent disease and overall survival. Results A total of 8529 patients (49% men; median age, 67 years) at 1175 facilities underwent surveillance imaging and CEA testing within 3 years after their initial CRC treatment. The cohort was distributed by stage as follows: stage I, 25.0%; stage II, 35.2%; and stage III, 39.8%. Patients treated at high-intensity facilities-4188 patients (49.1%) for imaging and 4136 (48.5%) for CEA testing-underwent a mean of 2.9 (95% CI, 2.8-2.9) imaging scans and a mean of 4.3 (95% CI, 4.2-4.4) CEA tests. Patients treated at low-intensity facilities-4341 patients (50.8%) for imaging and 4393 (51.5%) for CEA testing-underwent a mean of 1.6 (95% CI, 1.6-1.7) imaging scans and a mean of 1.6 (95% CI, 1.6-1.7) CEA tests. Imaging and CEA surveillance intensity were not associated with a significant difference in time to detection of cancer recurrence. The median time to detection of recurrence was 15.1 months (IQR, 8.2-26.3) for patients treated at facilities with high-intensity imaging surveillance and 16.0 months (IQR, 7.9-27.2) with low-intensity imaging surveillance (difference, -0.95 months; 95% CI, -2.59 to 0.68; HR, 0.99; 95% CI, 0.90-1.09) and was 15.9 months (IQR, 8.5-27.5) for patients treated at facilities with high-intensity CEA testing and 15.3 months (IQR, 7.9-25.7) with low-intensity CEA testing (difference, 0.59 months; 95% CI, -1.33 to 2.51; HR, 1.00; 95% CI, 0.90-1.11). No significant difference existed in rates of resection for cancer recurrence (HR for imaging, 1.22; 95% CI, 0.99-1.51 and HR for CEA testing, 1.12; 95% CI, 0.91-1.39) or overall survival (HR for imaging, 1.01; 95% CI, 0.94-1.08 and HR for CEA testing, 0.96; 95% CI, 0.89-1.03) among patients treated at facilities with high- vs low-intensity imaging or CEA testing surveillance. Conclusions and Relevance Among patients treated for stage I, II, or III CRC, there was no significant association between surveillance intensity and detection of recurrence. Trial Registration clinicaltrials.gov Identifier: NCT02217865.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
- Department of Surgery, University of South Carolina School of Medicine, Greenville
| | - Chung-Yuan Hu
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Amanda Cuddy
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Y Nancy You
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Deborah Schrag
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Daniel McKellar
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery, Wright State University, Dayton, Ohio
| | - David P Winchester
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - George J Chang
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2018; 28:1713-1729. [PMID: 28407110 DOI: 10.1093/annonc/mdx175] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. Methods This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. Results Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. Conclusion This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Van Blarigan EL, Fuchs CS, Niedzwiecki D, Ye X, Zhang S, Song M, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Giovannucci EL, Meyerhardt JA. Marine ω-3 Polyunsaturated Fatty Acid and Fish Intake after Colon Cancer Diagnosis and Survival: CALGB 89803 (Alliance). Cancer Epidemiol Biomarkers Prev 2018; 27:438-445. [PMID: 29358223 PMCID: PMC5939380 DOI: 10.1158/1055-9965.epi-17-0689] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/06/2017] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Marine ω-3 polyunsaturated fatty acids (PUFAs), primarily found in dark fish, may prevent colorectal cancer progression, in part through inhibition of prostaglandin-endoperoxide synthase 2 (PTGS2). However, data in humans are limited.Methods: We examined marine ω-3 PUFAs and fish intake and survival among 1,011 colon cancer patients enrolled in Cancer and Leukemia Group B 89803 between 1999 and 2001 and followed through 2009. Diet was assessed during and 6 months after chemotherapy. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free (DFS), recurrence-free (RFS), and overall survival (OS).Results: We observed 343 recurrences and 305 deaths (median follow-up: 7 years). Patients in the highest vs. lowest quartile of marine ω-3 PUFA intake had an HR for DFS of 0.72 (95% CI, 0.54-0.97; Ptrend = 0.03). Individuals who consumed dark fish ≥1/week versus never had longer DFS (HR 0.65; 95% CI, 0.48-0.87; P-value = 0.007), RFS (HR 0.61; 95% CI, 0.46-0.86; Ptrend = 0.007), and OS (HR 0.68; 95% CI, 0.48-0.96; Ptrend = 0.04). In a subset of 510 patients, the association between marine ω-3 PUFA intake and DFS appeared stronger in patients with high PTGS2 expression (HR 0.32; 95% CI, 0.11-0.95; Ptrend = 0.01) compared with patients with absent/low PTGS2 expression (HR 0.78; 95% CI, 0.48-1.27; Ptrend = 0.35; Pinteraction = 0.19).Conclusions: Patients with high intake of marine ω-3 PUFAs and dark fish after colon cancer diagnosis may have longer DFS.Impact: Randomized controlled trials examining dark fish and/or marine ω-3 PUFA supplements and colon cancer recurrence/survival are needed. Cancer Epidemiol Biomarkers Prev; 27(4); 438-45. ©2018 AACR.
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Affiliation(s)
- Erin L. Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California,Department of Urology, University of California, San Francisco, California
| | - Charles S. Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Donna Niedzwiecki
- Alliance Statistics and Data Center, Duke University Medical Center, Durham, North Carolina
| | - Xing Ye
- Alliance Statistics and Data Center, Duke University Medical Center, Durham, North Carolina
| | - Sui Zhang
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Robert J. Mayer
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Rex B. Mowat
- Toledo Community Hospital Oncology Program, Toledo, Ohio
| | - Renaud Whittom
- Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Alexander Hantel
- Loyola University Stritch School of Medicine, Naperville, Illinois
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | - Michael Messino
- Southeast Clinical Oncology Research (SCOR) Consortium, Mission Hospitals-Memorial Campus, Asheville, North Carolina
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Alan Venook
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Shuji Ogino
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward L. Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Fadelu T, Zhang S, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson AB, Atienza DM, Messino M, Kindler HL, Venook A, Ogino S, Ng K, Wu K, Willett W, Giovannucci E, Meyerhardt J, Bao Y, Fuchs CS. Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance). J Clin Oncol 2018; 36:1112-1120. [PMID: 29489429 PMCID: PMC5891130 DOI: 10.1200/jco.2017.75.5413] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known. Patients and Methods We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality. Results After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; Ptrend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; Ptrend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; Ptrend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; Ptrend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality. Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.
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Affiliation(s)
- Temidayo Fadelu
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Sui Zhang
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Donna Niedzwiecki
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Xing Ye
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Leonard B Saltz
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Robert J Mayer
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Rex B Mowat
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Renaud Whittom
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Alexander Hantel
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Al B Benson
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Daniel M Atienza
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Michael Messino
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Hedy L Kindler
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Alan Venook
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Shuji Ogino
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Kimmie Ng
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Kana Wu
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Walter Willett
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Edward Giovannucci
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Jeffrey Meyerhardt
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Ying Bao
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Charles S Fuchs
- Temidayo Fadelu, Sui Zhang, Robert J. Mayer, Shuji Ogino, Kimmie Ng, Jeffrey Meyerhardt, and Charles S. Fuchs, Dana-Farber/Partners CancerCare; Shuji Ogino, Kana Wu, Walter Willett, and Edward Giovannucci, Harvard TH Chan School of Public Health; Shuji Ogino, Edward Giovannucci, and Ying Bao, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Donna Niedzwiecki and Xing Ye, Alliance Statistics and Data Center, Duke University, Durham; Michael Messino, Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al B. Benson, Robert H Lurie Comprehensive Cancer Center, Northwestern University; Hedy L. Kindler, University of Chicago Comprehensive Cancer, Chicago, IL; Daniel M. Atienza, Virginia Oncology Associates, Norfolk, VA; Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA; and Charles S. Fuchs, Yale Cancer Center, Yale School of Medicine, New Haven, CT
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Fuchs MA, Yuan C, Sato K, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Innocenti F, Warren RS, Bertagnolli MM, Ogino S, Giovannucci EL, Horvath E, Meyerhardt JA, Ng K. Predicted vitamin D status and colon cancer recurrence and mortality in CALGB 89803 (Alliance). Ann Oncol 2018; 28:1359-1367. [PMID: 28327908 DOI: 10.1093/annonc/mdx109] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Observational studies suggest that higher levels of 25-hydroxyvitamin D3 (25(OH)D) are associated with a reduced risk of colorectal cancer and improved survival of colorectal cancer patients. However, the influence of vitamin D status on cancer recurrence and survival of patients with stage III colon cancer is unknown. Patients and methods We prospectively examined the influence of post-diagnosis predicted plasma 25(OH)D on outcome among 1016 patients with stage III colon cancer who were enrolled in a National Cancer Institute-sponsored adjuvant therapy trial (CALGB 89803). Predicted 25(OH)D scores were computed using validated regression models. We examined the influence of predicted 25(OH)D scores on cancer recurrence and mortality (disease-free survival; DFS) using Cox proportional hazards. Results Patients in the highest quintile of predicted 25(OH)D score had an adjusted hazard ratio (HR) for colon cancer recurrence or mortality (DFS) of 0.62 (95% confidence interval [CI], 0.44-0.86), compared with those in the lowest quintile (Ptrend = 0.005). Higher predicted 25(OH)D score was also associated with a significant improvement in recurrence-free survival and overall survival (Ptrend = 0.01 and 0.0004, respectively). The benefit associated with higher predicted 25(OH)D score appeared consistent across predictors of cancer outcome and strata of molecular tumor characteristics, including microsatellite instability and KRAS, BRAF, PIK3CA, and TP53 mutation status. Conclusion Higher predicted 25(OH)D levels after a diagnosis of stage III colon cancer may be associated with decreased recurrence and improved survival. Clinical trials assessing the benefit of vitamin D supplementation in the adjuvant setting are warranted. ClinicalTrials.gov Identifier NCT00003835.
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Affiliation(s)
- M A Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - C Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - K Sato
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - D Niedzwiecki
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - X Ye
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - L B Saltz
- Memorial Sloan-Kettering Cancer Center, New York
| | - R J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - R B Mowat
- Toledo Community Hospital Oncology Program, Toledo, USA
| | - R Whittom
- Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - A Hantel
- Edward Cancer Center, Naperville
| | - A Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - D Atienza
- Virginia Oncology Associates, Norfolk
| | - M Messino
- Southeast Cancer Control Consortium, Mission Hospitals-Memorial Campus, Asheville
| | | | - A Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - F Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill, Chapel Hill
| | - R S Warren
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - M M Bertagnolli
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - S Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E Horvath
- Alliance Protocol Operations Office, Chicago, USA
| | - J A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - K Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
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42
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McCleary NJ, Hubbard J, Mahoney MR, Meyerhardt JA, Sargent D, Venook A, Grothey A. Challenges of conducting a prospective clinical trial for older patients: Lessons learned from NCCTG N0949 (alliance). J Geriatr Oncol 2018; 9:24-31. [PMID: 28917648 PMCID: PMC5757827 DOI: 10.1016/j.jgo.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/14/2017] [Accepted: 08/14/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES While the risk of developing colorectal cancer increases with age, there are limited prospective data regarding best treatment in the older adult population. We launched a phase III trial to evaluate difference in treatment outcome for older adults (aged ≥70years) with advanced colorectal cancer. Here we review the challenges faced and reasons for poor accrual to N0949. MATERIALS AND METHODS We describe the conceptualization, development and limited results of N0949, a randomized phase III study of fluoropyrimidine/bevacizumab with or without oxaliplatin (mFOLFOX7 or XELOX) as first line chemotherapy for metastatic colorectal cancer. Fluoropyrimidine was physician choice (e.g., 5-FU/LV or capecitabine). RESULTS Of the projected 380 patients, only 32 patients were enrolled between the study activation in January 2011 until its closure in September 2012. Reasons for poor accrual included eligibility criteria that were too stringent, discomfort with randomizing older patients to regimens of varying intensity without considering their physical fitness, and discomfort with the use of bevacizumab in the older patient population. Several efforts were mounted to design a rationale and age-appropriate study, consider toxicities and varying study practices, and be responsive to stakeholder feedback. CONCLUSIONS Challenges were experienced in conducting the first prospective phase III study evaluating progression-free survival of older adults with advanced colorectal cancer receiving palliative chemotherapy with fluoropyrimidine/bevacizumab with or without oxaliplatin in the USA. Future efforts to evaluate treatment outcomes in the older adult population should reflect on lessons learned in this large national effort.
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Affiliation(s)
- Nadine J McCleary
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA, United States.
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Michelle R Mahoney
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA, United States
| | - Daniel Sargent
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States
| | - Alan Venook
- Department of Medical Oncology, University of San Francisco, CA, United States
| | - Axel Grothey
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2017. [PMID: 28407110 DOI: 10.1093/annonc/mdx175.pmid:28407110;pmcid:pmc6246616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. METHODS This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. RESULTS Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. CONCLUSION This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Tantoy IY, Dhruva A, Cataldo J, Venook A, Cooper BA, Paul SM, Levine JD, Conley YP, Cartwright F, Lee K, Wright F, Miaskowski C. Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy. J Gastrointest Oncol 2017; 8:109-126. [PMID: 28280616 DOI: 10.21037/jgo.2017.01.09] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients who received chemotherapy (CTX) alone (n=304) or CTX with TT (n=93). METHODS Patients completed self-report questionnaires, approximately one week after they received CTX. A modified version of the Memorial Symptom Assessment Scale (MSAS) was used to obtain data on symptom occurrence, severity, and distress. Binary logistic regression analyses were used to test for differences in symptom occurrence rates between the two treatment groups. Ordinal logistic regression analyses were used to test for differences in severity and distress ratings between the two treatment groups. RESULTS Patients who received CTX with TT were significantly younger (P=0.009); were diagnosed with cancer longer (P=0.004); had a higher number of prior treatments (P=0.024); had metastatic disease, specifically to the liver (P<0.001); had a diagnosis of anal, colon, rectum, or colorectal cancer (CRC) (P<0.001); and were positive for detection of B-Raf proto-oncogene, serine/threonine kinase (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (both P<0.001). In addition, CTX treatment regimens were significantly different between the two groups (P<0.001). After controlling for significant covariates, patients who received TT reported lower occurrence rates for lack of energy, cough, feeling drowsy, and difficulty sleeping (all, P<0.05). Patients who received TT reported lower severity scores for dry mouth (P=0.034) and change in the way food tastes (P=0.035). However, they reported higher severity scores for "I don't look like myself" (P=0.026). No differences in symptom distress scores were found between the two treatment groups. CONCLUSIONS This study is the first to evaluate for differences in the symptom experience of GI cancer patients who received CTX alone or CTX with TT using a multidimensional symptom assessment scale. While between group differences in patients' symptom experiences were identified, both treatment groups warrant ongoing assessments to optimally manage their symptoms.
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Affiliation(s)
- Ilufredo Y Tantoy
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Janine Cataldo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Alan Venook
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kathryn Lee
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Fay Wright
- Department of Nursing and Acute Care/Health Systems, School of Nursing, Yale University, New Haven, CT, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
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Abou-Alfa GK, Andersen JB, Chapman W, Choti M, Forbes SJ, Gores GJ, Hong TS, Harding JJ, Vander Heiden MG, Javle M, Kelley RK, Kwong LN, Lowery M, Merrell A, Miyabe K, Rhim A, Saha S, Sia D, Tanasanvimon S, Venook A, Valle JW, Walesky C, Whetstine J, Willenbring H, Zhu AX, Mayer D, Stanger BZ. Advances in cholangiocarcinoma research: report from the third Cholangiocarcinoma Foundation Annual Conference. J Gastrointest Oncol 2016; 7:819-827. [PMID: 28078106 PMCID: PMC5177567 DOI: 10.21037/jgo.2016.11.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Jesper B. Andersen
- Department of Health and Medical Sciences, Biotech Research and Innovation Centre, University of Copenhagen, Denmark
| | | | | | | | | | | | - James J. Harding
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Lawrence N. Kwong
- Koch Institute at the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Maeve Lowery
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Supriya Saha
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | - Donna Mayer
- Cholangiocarcinoma Foundation, Salt Lake City, UT, USA
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Enzinger PC, Burtness BA, Niedzwiecki D, Ye X, Douglas K, Ilson DH, Villaflor VM, Cohen SJ, Mayer RJ, Venook A, Benson AB, Goldberg RM. CALGB 80403 (Alliance)/E1206: A Randomized Phase II Study of Three Chemotherapy Regimens Plus Cetuximab in Metastatic Esophageal and Gastroesophageal Junction Cancers. J Clin Oncol 2016; 34:2736-42. [PMID: 27382098 DOI: 10.1200/jco.2015.65.5092] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To determine the optimal chemotherapy backbone for testing in future US cooperative group studies for metastatic esophageal and gastroesophageal junction cancers. Cetuximab was added to each treatment arm based on promising preclinical data. PATIENTS AND METHODS Patients with previously untreated metastatic esophageal or gastroesophageal junction cancer were randomly assigned at a one-to-one-to-one ratio to epirubicin, cisplatin, and continuous-infusion fluorouracil (ECF), irinotecan plus cisplatin (IC), or FOLFOX (oxaliplatin, leucovorin, and bolus and infusional fluorouracil). All treatment programs included cetuximab once per week. The primary end point was response rate. Secondary outcomes included overall survival, progression-free survival, time to treatment failure, and safety. As prespecified, primary and secondary analyses were conducted only among patients with adenocarcinoma. RESULTS This study randomly assigned 245 patients, including 222 with adenocarcinoma. Among patients with adenocarcinoma, response rate was 60.9% (95% CI, 47.9 to 72.8) for ECF plus cetuximab, 45.0% (95% CI, 33.0 to 57.0) for IC plus cetuximab, and 54.3% (95% CI, 42.0 to 66.2) for FOLFOX plus cetuximab. Median overall survival was 11.6, 8.6, and 11.8 months; median progression-free survival was 7.1, 4.9, and 6.8 months; and median time to treatment failure was 5.6, 4.3, and 6.7 months for each of these arms, respectively. FOLFOX plus cetuximab required fewer treatment modifications compared with ECF plus cetuximab and IC plus cetuximab (P = .013), and fewer patients were removed from treatment because of an adverse event or experienced treatment-related death. CONCLUSION In combination with cetuximab, ECF and FOLFOX had similar efficacy, but FOLFOX was better tolerated. Although differences were nonsignificant, IC plus cetuximab seemed to be the least effective and most toxic of the three regimens tested.
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Affiliation(s)
- Peter C Enzinger
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH.
| | - Barbara Ann Burtness
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Donna Niedzwiecki
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Xing Ye
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Kathe Douglas
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - David H Ilson
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Victoria Meucci Villaflor
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Steven J Cohen
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Robert J Mayer
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Alan Venook
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Al Bowen Benson
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
| | - Richard M Goldberg
- Peter C. Enzinger and Robert J. Mayer, Dana-Farber Cancer Institute, Harvard Medical School, and Alliance for Clinical Trials in Oncology, Boston, MA; Barbara Ann Burtness and Steven J. Cohen, Fox Chase Cancer Center; Barbara Ann Burtness, Steven J. Cohen, and Al Bowen Benson III, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA; Donna Niedzwiecki, Xing Ye, and Kathe Douglas, Alliance Statistics and Data Center, Duke University, Durham, NC; David H. Ilson, Memorial Sloan Kettering Cancer Center and Alliance for Clinical Trials in Oncology, New York, NY; Victoria Meucci Villaflor, University of Chicago Medicine and Alliance for Clinical Trials in Oncology; Al Bowen Benson III, Northwestern University Feinberg School of Medicine, Chicago, IL; Alan Venook, University of California San Francisco Helen Diller Family Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, San Francisco, CA; and Richard M. Goldberg, Ohio State University James Comprehensive Cancer Center and Alliance for Clinical Trials in Oncology, Columbus, OH
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Strosberg JR, Cives M, Hwang J, Weber T, Nickerson M, Atreya CE, Venook A, Kelley RK, Valone T, Morse B, Coppola D, Bergsland EK. A phase II study of axitinib in advanced neuroendocrine tumors. Endocr Relat Cancer 2016; 23:411-8. [PMID: 27080472 PMCID: PMC4963225 DOI: 10.1530/erc-16-0008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/17/2022]
Abstract
Neuroendocrine tumors (NETs) are highly vascular neoplasms overexpressing vascular endothelial growth factor (VEGF) as well as VEGF receptors (VEGFR). Axitinib is a potent, selective inhibitor of VEGFR-1, -2 and -3, currently approved for the treatment of advanced renal cell carcinoma. We performed an open-label, two-stage design, phase II trial of axitinib 5mg twice daily in patients with progressive unresectable/metastatic low-to-intermediate grade carcinoid tumors. The primary end points were progression-free survival (PFS) and 12-month PFS rate. The secondary end points included time to treatment failure (TTF), overall survival (OS), overall radiographic response rate (ORR), biochemical response rate and safety. A total of 30 patients were enrolled and assessable for toxicity; 22 patients were assessable for response. After a median follow-up of 29months, we observed a median PFS of 26.7months (95% CI, 11.4-35.1), with a 12-month PFS rate of 74.5% (±10.2). The median OS was 45.3 months (95% CI, 24.4-45.3), and the median TTF was 9.6months (95% CI, 5.5-12). The best radiographic response was partial response (PR) in 1/30 (3%) and stable disease (SD) in 21/30 patients (70%); 8/30 patients (27%) were unevaluable due to early withdrawal due to toxicity. Hypertension was the most common toxicity that developed in 27 patients (90%). Grade 3/4 hypertension was recorded in 19 patients (63%), leading to treatment discontinuation in six patients (20%). Although axitinib appears to have an inhibitory effect on tumor growth in patients with advanced, progressive carcinoid tumors, the high rate of grade 3/4 hypertension may represent a potential impediment to its use in unselected patients.
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Affiliation(s)
- J R Strosberg
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M Cives
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - J Hwang
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - T Weber
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - M Nickerson
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - C E Atreya
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - A Venook
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - R K Kelley
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - T Valone
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - B Morse
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - D Coppola
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - E K Bergsland
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
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48
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Kober KM, Dunn L, Mastick J, Cooper B, Langford D, Melisko M, Venook A, Chen LM, Wright F, Hammer M, Schmidt BL, Levine J, Miaskowski C, Aouizerat BE. Gene Expression Profiling of Evening Fatigue in Women Undergoing Chemotherapy for Breast Cancer. Biol Res Nurs 2016; 18:370-85. [PMID: 26957308 DOI: 10.1177/1099800416629209] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Moderate-to-severe fatigue occurs in up to 94% of oncology patients undergoing active treatment. Current interventions for fatigue are not efficacious. A major impediment to the development of effective treatments is a lack of understanding of the fundamental mechanisms underlying fatigue. In the current study, differences in phenotypic characteristics and gene expression profiles were evaluated in a sample of breast cancer patients undergoing chemotherapy (CTX) who reported low (n = 19) and high (n = 25) levels of evening fatigue. Compared to the low group, patients in the high evening fatigue group reported lower functional status scores, higher comorbidity scores, and fewer prior cancer treatments. One gene was identified as upregulated and 11 as downregulated in the high evening fatigue group. Gene set analysis found 24 downregulated and 94 simultaneously up- and downregulated pathways between the two fatigue groups. Transcript origin analysis found that differential expression (DE) originated primarily from monocytes and dendritic cell types. Query of public data sources found 18 gene expression experiments with similar DE profiles. Our analyses revealed that inflammation, neurotransmitter regulation, and energy metabolism are likely mechanisms associated with evening fatigue severity; that CTX may contribute to fatigue seen in oncology patients; and that the patterns of gene expression may be shared with other models of fatigue (e.g., physical exercise and pathogen-induced sickness behavior). These results suggest that the mechanisms that underlie fatigue in oncology patients are multifactorial.
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Affiliation(s)
- Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Dale Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - Michelle Melisko
- School of Medicine, University of California, San Francisco, CA, USA
| | - Alan Venook
- School of Medicine, University of California, San Francisco, CA, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA, USA
| | - Fay Wright
- College of Nursing, New York University, New York, NY, USA
| | - Marilyn Hammer
- College of Nursing, New York University, New York, NY, USA
| | - Brian L Schmidt
- Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA Institute for Human Genetics, University of California, San Francisco, CA, USA
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49
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Guercio BJ, Sato K, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Hu FB, Ogino S, Wu K, Willett WC, Giovannucci EL, Meyerhardt JA, Fuchs CS. Coffee Intake, Recurrence, and Mortality in Stage III Colon Cancer: Results From CALGB 89803 (Alliance). J Clin Oncol 2015; 33:3598-607. [PMID: 26282659 DOI: 10.1200/jco.2015.61.5062] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Observational studies have demonstrated increased colon cancer recurrence in states of relative hyperinsulinemia, including sedentary lifestyle, obesity, and increased dietary glycemic load. Greater coffee consumption has been associated with decreased risk of type 2 diabetes and increased insulin sensitivity. The effect of coffee on colon cancer recurrence and survival is unknown. PATIENTS AND METHODS During and 6 months after adjuvant chemotherapy, 953 patients with stage III colon cancer prospectively reported dietary intake of caffeinated coffee, decaffeinated coffee, and nonherbal tea, as well as 128 other items. We examined the influence of coffee, nonherbal tea, and caffeine on cancer recurrence and mortality using Cox proportional hazards regression. RESULTS Patients consuming 4 cups/d or more of total coffee experienced an adjusted hazard ratio (HR) for colon cancer recurrence or mortality of 0.58 (95% CI, 0.34 to 0.99), compared with never drinkers (Ptrend = .002). Patients consuming 4 cups/d or more of caffeinated coffee experienced significantly reduced cancer recurrence or mortality risk compared with abstainers (HR, 0.48; 95% CI, 0.25 to 0.91; Ptrend = .002), and increasing caffeine intake also conferred a significant reduction in cancer recurrence or mortality (HR, 0.66 across extreme quintiles; 95% CI, 0.47 to 0.93; Ptrend = .006). Nonherbal tea and decaffeinated coffee were not associated with patient outcome. The association of total coffee intake with improved outcomes seemed consistent across other predictors of cancer recurrence and mortality. CONCLUSION Higher coffee intake may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer.
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Affiliation(s)
- Brendan J Guercio
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Kaori Sato
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Donna Niedzwiecki
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Xing Ye
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Leonard B Saltz
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Robert J Mayer
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Rex B Mowat
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Renaud Whittom
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Alexander Hantel
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Al Benson
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Daniel Atienza
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Michael Messino
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Hedy Kindler
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Alan Venook
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Frank B Hu
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Shuji Ogino
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Kana Wu
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Walter C Willett
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Edward L Giovannucci
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Jeffrey A Meyerhardt
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Charles S Fuchs
- Brendan J. Guercio, Shuji Ogino, and Edward L. Giovannucci, Harvard Medical School; Kaori Sato, Robert J. Mayer, Shuji Ogino, Jeffrey A. Meyerhardt, and Charles S. Fuchs, Dana-Farber Cancer Institute; Frank B. Hu, Shuji Ogino, Kana Wu, Walter C. Willett, and Edward L. Giovannucci, Harvard T.H. Chan School of Public Health; Shuji Ogino and Edward L. Giovannucci, Brigham and Women's Hospital, Boston, MA; Leonard B. Saltz, Memorial Sloan Kettering Cancer Center, New York, NY; Rex B. Mowat, Toledo Community Hospital Oncology Program, Toledo, OH; Renaud Whittom, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Alexander Hantel, Loyola University Stritch School of Medicine, Naperville; Al Benson, Northwestern University; Hedy Kindler, University of Chicago, Chicago, IL; Daniel Atienza, Virginia Oncology Associates, Norfolk, VA; Donna Niedzwiecki and Xing Ye, Duke University Medical Center, Durham; Michael Messino, Southeast Cancer Control Consortium, Mission Hospitals, Asheville, NC; and Alan Venook, University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA.
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Fidelman N, Kerlan R, Taylor A, Kolli K, Kohi M, Hawkins R, Pampaloni M, Atreya C, Bergsland E, Kelley R, Ko A, Korn W, Van Loon K, Luan J, McWhirter R, Johanson C, Venook A. Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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