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Olawaiye AB. 2023 FIGO staging for endometrial cancer, a look at both sides of the coin. Gynecol Oncol 2024; 184:243-244. [PMID: 38442469 DOI: 10.1016/j.ygyno.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. @upmc.edu
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Napoé GS, Parviainen KEL, Gosman GG, Olawaiye AB, Edwards RP. A Framework for Diversifying Obstetrics and Gynecology Training Programs. Obstet Gynecol 2024; 143:204-209. [PMID: 37989143 DOI: 10.1097/aog.0000000000005467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/21/2023] [Indexed: 11/23/2023]
Abstract
There is an urgent need to diversify the physician workforce in obstetrics and gynecology to serve a diverse patient population and mitigate disparities in care. There is a paucity of data on how to improve recruitment of individuals from underrepresented minoritized groups to the field of obstetrics and gynecology. This article outlines important steps for sharing the department's commitment to diversity, equity, and inclusion; addresses ways to attract a diverse applicant pool; and reviews the importance of and need to perform a holistic review of applicants. This commentary also shares some approaches to support faculty and trainees that may lead to sustained increases in diversity. Using this framework, the authors successfully increased the diversity of their obstetrics and gynecology residency program.
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Affiliation(s)
- Gnankang Sarah Napoé
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Felix AS, Sinnott JA, Cohn DE, Duggan MA, Havrilesky LJ, Olawaiye AB, Mariani A, Rodriquez M, Brett MA, Dinoi G, Meade CE, Hall B, Goldfeld E, Elishaev E, Sherman ME, Suarez AA. Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study. Gynecol Oncol 2023; 178:130-137. [PMID: 37862792 PMCID: PMC10842547 DOI: 10.1016/j.ygyno.2023.10.004] [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: 09/05/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. METHODS We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. RESULTS In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69-1.32) or OS (HR = 0.97, 95% CI = 0.72-1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06-5.05) and OS (HR = 2.16, 95% CI = 1.14-4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. CONCLUSION While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America.
| | - Jennifer A Sinnott
- Department of Statistics, The Ohio State University College of Arts and Sciences, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Máire A Duggan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Duke Cancer Institute, Durham, NC, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Andrea Mariani
- Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, United States of America
| | - Monica Rodriquez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Anne Brett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Giorgia Dinoi
- Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, United States of America
| | - Caitlin E Meade
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Bobbie Hall
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Esther Elishaev
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Mark E Sherman
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Adrian A Suarez
- Division of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Colombo N, Van Gorp T, Matulonis UA, Oaknin A, Grisham RN, Fleming GF, Olawaiye AB, Nguyen DD, Greenstein AE, Custodio JM, Pashova HI, Tudor IC, Lorusso D. Relacorilant + Nab-Paclitaxel in Patients With Recurrent, Platinum-Resistant Ovarian Cancer: A Three-Arm, Randomized, Controlled, Open-Label Phase II Study. J Clin Oncol 2023; 41:4779-4789. [PMID: 37364223 PMCID: PMC10602497 DOI: 10.1200/jco.22.02624] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE Despite therapeutic advances, outcomes for patients with platinum-resistant/refractory ovarian cancer remain poor. Selective glucocorticoid receptor modulation with relacorilant may restore chemosensitivity and enhance chemotherapy efficacy. METHODS This three-arm, randomized, controlled, open-label phase II study (ClinicalTrials.gov identifier: NCT03776812) enrolled women with recurrent, platinum-resistant/refractory, high-grade serous or endometrioid epithelial ovarian, primary peritoneal, or fallopian tube cancer, or ovarian carcinosarcoma treated with ≤4 prior chemotherapeutic regimens. Patients were randomly assigned 1:1:1 to (1) nab-paclitaxel (80 mg/m2) + intermittent relacorilant (150 mg the day before, of, and after nab-paclitaxel); (2) nab-paclitaxel (80 mg/m2) + continuous relacorilant (100 mg once daily); or (3) nab-paclitaxel monotherapy (100 mg/m2). Nab-paclitaxel was administered on days 1, 8, and 15 of each 28-day cycle. The primary end point was progression-free survival (PFS) by investigator assessment; objective response rate (ORR), duration of response (DOR), overall survival (OS), and safety were secondary end points. RESULTS A total of 178 women were randomly assigned. Intermittent relacorilant + nab-paclitaxel improved PFS (hazard ratio [HR], 0.66; log-rank test P = .038; median follow-up, 11.1 months) and DOR (HR, 0.36; P = .006) versus nab-paclitaxel monotherapy, while ORR was similar across arms. At the preplanned OS analysis (median follow-up, 22.5 months), the OS HR was 0.67 (P = .066) for the intermittent arm versus nab-paclitaxel monotherapy. Continuous relacorilant + nab-paclitaxel showed numerically improved median PFS but did not result in significant improvement over nab-paclitaxel monotherapy. Adverse events were comparable across study arms, with neutropenia, anemia, peripheral neuropathy, and fatigue/asthenia being the most common grade ≥3 adverse events. CONCLUSION Intermittent relacorilant + nab-paclitaxel improved PFS, DOR, and OS compared with nab-paclitaxel monotherapy. On the basis of protocol-prespecified Hochberg step-up multiplicity adjustment, the primary end point did not reach statistical significance (P < .025). A phase III evaluation of this regimen is underway (ClinicalTrials.gov identifier: NCT05257408).
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Affiliation(s)
- Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milan-Bicocca, Milan, Italy
| | - Toon Van Gorp
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | | | - Alexander B. Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | | | | | - Domenica Lorusso
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
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Orellana TJ, Garrett AA, Soong TR, Rives T, Courtney-Brooks M, Taylor SE, Lesnock J, Berger J, Boisen M, Coffman L, Buckanovich R, Mahdi H, Comerci JC, Beriwal S, Sukumvanich P, Edwards RP, Bhargava R, Olawaiye AB. The role of adjuvant treatment for early-stage uterine clear cell carcinomas. Gynecol Oncol 2023; 170:77-83. [PMID: 36641903 DOI: 10.1016/j.ygyno.2022.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/21/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Uterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma. METHODS Patients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival. RESULTS A total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01-0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01-0.8). CONCLUSIONS In this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings.
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Affiliation(s)
- T J Orellana
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America.
| | - A A Garrett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - T R Soong
- Department of Pathology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - T Rives
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - M Courtney-Brooks
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - S E Taylor
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J Lesnock
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J Berger
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - M Boisen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - L Coffman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R Buckanovich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - H Mahdi
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J C Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - S Beriwal
- Allegheny Health Network, Pittsburgh, PA, United States of America
| | - P Sukumvanich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R Bhargava
- Department of Pathology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - A B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
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6
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Leitao MM, Zhou QC, Brandt B, Iasonos A, Sioulas V, Lavigne Mager K, Shahin M, Bruce S, Black DR, Kay CG, Gandhi M, Qayyum M, Scalici J, Jones NL, Paladugu R, Brown J, Naumann RW, Levine MD, Mendivil A, Lim PC, Kang E, Cantrell LA, Sullivan MW, Martino MA, Kratz MK, Kolev V, Tomita S, Leath CA, Boitano TKL, Doo DW, Feltmate C, Sugrue R, Olawaiye AB, Goldfeld E, Ferguson SE, Suhner J, Abu-Rustum NR. The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol 2022; 166:417-424. [PMID: 35879128 PMCID: PMC9933771 DOI: 10.1016/j.ygyno.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. METHODS This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. RESULTS We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5). CONCLUSION This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America.
| | - Qin C Zhou
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Benny Brandt
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Vasileios Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Katherine Lavigne Mager
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Mark Shahin
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Shaina Bruce
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Destin R Black
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America; Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Carrie G Kay
- Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Meeli Gandhi
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Maira Qayyum
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Jennifer Scalici
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Nathaniel L Jones
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Rajesh Paladugu
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Monica D Levine
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Alberto Mendivil
- Gynecologic Oncology Associates, Hoag Cancer Center, Newport Beach, CA, United States of America
| | - Peter C Lim
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Elizabeth Kang
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Leigh A Cantrell
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Mackenzie W Sullivan
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Martin A Martino
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Melissa K Kratz
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Valentin Kolev
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Shannon Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Charles A Leath
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - David W Doo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Colleen Feltmate
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Ronan Sugrue
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jessa Suhner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai West/Mount Sinai Morningside, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America
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7
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Wilhite AM, Baca Y, Xiu J, Paladugu R, ElNaggar AC, Brown J, Winer IS, Morris R, Erickson BK, Olawaiye AB, Powell M, Korn WM, Rocconi RP, Khabele D, Jones NL. Molecular profiles of endometrial cancer tumors among Black patients. Gynecol Oncol 2022; 166:108-116. [PMID: 35490034 DOI: 10.1016/j.ygyno.2022.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Disparate outcomes exist between Black and White patients with endometrial cancer (EC). One contributing factor is the disproportionately low representation of Black patients in clinical trials and in tumor molecular profiling studies. Our objective was to investigate molecular profiles of ECs in a cohort with a high proportion of tumors from Black patients. METHODS A total of 248 EC samples and self-reported race data were collected from 6 institutions. Comprehensive tumor profiling and analyses were performed by Caris Life Sciences. RESULTS Tumors from 105 (42%) Black and 143 (58%) White patients were included. Serous histology (58% vs 36%) and carcinosarcoma (25% vs 16%), was more common among Black patients, and endometrioid was less common (17% vs 48%) (p < 0.01). Differences in gene mutations between cohorts corresponded to observed histologic differences between races. Specifically, TP53 mutations were predominant in serous tumors. In endometrioid tumors, mutations in ARID1A were the most common, and high rates of MSI-H, MMRd, and TMB-H were observed. In carcinosarcoma tumors, hormone receptor expression was high in tumors of Black patients (PR 23.4%, ER 30.8%). When stratified by histology, there were no significant differences between tumors from Black and White women. CONCLUSIONS This cohort had a high proportion of tumors from Black women. Distinct molecular profiles were driven primarily by more aggressive histologic subtypes among Black women. Continued effort is needed to include Black women and other populations under-represented in EC molecular profiling studies as targeted therapies and personalized medicine become mainstream.
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Affiliation(s)
- Annelise M Wilhite
- Mitchell Cancer Institute, University of South Alabama, Division of Gynecologic Oncology Mobile, AL, United States of America.
| | - Yasmine Baca
- Caris Life Sciences, Pheonix, AZ, United States of America
| | - Joanne Xiu
- Caris Life Sciences, Pheonix, AZ, United States of America
| | - Rajesh Paladugu
- Mitchell Cancer Institute, University of South Alabama, Division of Gynecologic Oncology Mobile, AL, United States of America
| | - Adam C ElNaggar
- West Cancer Center and Research Institute, Division of Gynecologic Oncology, Memphis, TN, United States of America
| | - Jubilee Brown
- Atrium Health, Division of Gynecologic Oncology, Charlotte, NC, United States of America
| | - Ira S Winer
- Wayne State University and Karmanos Cancer Institute, Division of Gynecologic Oncology, Detroit, MI, United States of America
| | - Robert Morris
- Wayne State University and Karmanos Cancer Institute, Division of Gynecologic Oncology, Detroit, MI, United States of America
| | - Britt K Erickson
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
| | - Alexander B Olawaiye
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, United States of America
| | - Matthew Powell
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - W Michael Korn
- Caris Life Sciences, Pheonix, AZ, United States of America
| | - Rodney P Rocconi
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Dineo Khabele
- Washington University, Division of Gynecologic Oncology, St. Louis, MO, United States of America
| | - Nathaniel L Jones
- Mitchell Cancer Institute, University of South Alabama, Division of Gynecologic Oncology Mobile, AL, United States of America
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8
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Orellana TJ, Kim H, Beriwal S, Bhargava R, Berger J, Buckanovich RJ, Coffman LG, Courtney-Brooks M, Mahdi H, Olawaiye AB, Sukumvanich P, Taylor SE, Smith KJ, Lesnock JL. Cost-effectiveness analysis of tumor molecular classification in high-risk early-stage endometrial cancer. Gynecol Oncol 2021; 164:129-135. [PMID: 34740462 DOI: 10.1016/j.ygyno.2021.10.071] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Tumor molecular analyses in endometrial cancer (EC) includes 4 distinct subtypes: (1) POLE-mutated, (2) mismatch repair protein (MMR) deficient, (3) p53 mutant, and (4) no specific molecular profile. Recently, a sub-analysis of PORTEC-3 demonstrated notable differences in treatment response between molecular classification (MC) groups. Cost of testing is one barrier to widespread adoption of MC. Therefore, we sought to determine the cost-effectiveness of MC in patients with stage I and II high-risk EC. METHODS A Markov decision model was developed to compare tumor molecular classification (TMC) vs. no testing (NT). A healthcare payor's perspective and 5-year time horizon were used. Base case data were abstracted from PORTEC-3 and the molecular sub-analysis. Cost and utility data were derived from public databases, peer-reviewed literature, and expert input. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Sensitivity analyses were performed to test model robustness. RESULTS When compared to NT, TMC was cost effective with an ICER of $25,578 per QALY gained; incremental cost was $1780 and incremental effectiveness was 0.070 QALYs. In one-way sensitivity analyses, results were most sensitive to the cost of POLE testing, but TMC remained cost-effective over all parameter ranges. CONCLUSIONS TMC in early-stage high-risk EC is cost-effective, and the model results were robust over a range of parameters. Given that MC can be used to guide adjuvant treatment decisions, these findings support adoption of TMC into routine practice.
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Affiliation(s)
- T J Orellana
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States.
| | - H Kim
- Department of Radiation Oncology, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, 5115 Centre Avenue, Pittsburgh, PA 15232, United States
| | - S Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, 5115 Centre Avenue, Pittsburgh, PA 15232, United States
| | - R Bhargava
- Department of Pathology, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213, United States
| | - J Berger
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - R J Buckanovich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States; Division of Hematology/Oncology, Department of Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, United States
| | - L G Coffman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States; Division of Hematology/Oncology, Department of Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, United States
| | - M Courtney-Brooks
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - H Mahdi
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - A B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - P Sukumvanich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - S E Taylor
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
| | - K J Smith
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave., Suite 200, Pittsburgh, PA 15213, United States
| | - J L Lesnock
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens' Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Suite 1750, Pittsburgh, PA 15213, United States
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9
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Abstract
Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors. A useful update for trainees and specialists regarding the diagnosis, staging, treatment, and some controversies in the management of vulvar neoplasms.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mauricio A Cuello
- Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Linda J Rogers
- Division of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC, Cape Town, South Africa
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10
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Olawaiye AB, Cotler J, Cuello MA, Bhatla N, Okamoto A, Wilailak S, Purandare CN, Lindeque G, Berek JS, Kehoe S. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet 2021; 155:43-47. [PMID: 34520062 PMCID: PMC9290586 DOI: 10.1002/ijgo.13880] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log‐rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan–Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan–Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross‐sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data‐derived, validated, and much simpler than earlier revisions. The FIGO Committee for Gynecologic Oncology's last revision of vulvar cancer staging was published over a decade ago. This 2021 revision is data‐derived, simplified, and user‐friendly.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph Cotler
- National Cancer Database, American College of Surgeons, Chicago, Illinois, USA
| | - Mauricio A Cuello
- Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | | | - Gerhard Lindeque
- Department of Obstetrics and Gynecology, University of Pretoria, Pretoria, South Africa
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Sean Kehoe
- Oxford Gynecological Cancer Center, Churchill Hospital, Oxford, UK.,St Peter's College, Oxford, UK
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11
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Olawaiye AB, Baker TP, Washington MK, Mutch DG. The new (Version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer. CA Cancer J Clin 2021; 71:287-298. [PMID: 33784415 DOI: 10.3322/caac.21663] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
The American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging for all cancer sites has been periodically updated as a published manual for many years. The last update, the eighth edition AJCC Cancer Staging Manual went into use on January 1, 2018. The AJCC has since restructured and updated its processes, and all AJCC staging-related data are now housed on its new application programming interface. Consequently, the next AJCC TNM staging update, AJCC version 9 TNM staging, will be published electronically and will be released chapter by chapter. The first chapter of version 9 AJCC TNM staging is the updated cervical cancer staging, which is now published. This article highlights the changes to the AJCC TNM cervical cancer staging; these changes align with the International Federation of Gynecology and Obstetrics staging. The most important of the changes are: 1) the incorporation of imaging and surgical findings, 2) the elimination of lateral spread from T1a, 3) the addition of a subcategory to T1b (T1b3), and 4) histopathology is updated to reflect human papillomavirus-associated and human papillomavirus-independent carcinomas.
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Affiliation(s)
- Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas P Baker
- The Joint Pathology Center, Defense Health Agency National Capital Regional Medical Directorate, Silver Spring, Maryland
| | - M Kay Washington
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
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12
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Heayn M, Skvarca LB, Zhu L, Edwards RP, Olawaiye AB, Modugno F, Elishaev E, Bhargava R. Impact of Ki-67 Labeling Index on Prognostic Significance of the Chemotherapy Response Score in Women With Tubo-ovarian Cancer Treated With Neoadjuvant Chemotherapy. Int J Gynecol Pathol 2021; 40:278-285. [PMID: 32897953 DOI: 10.1097/pgp.0000000000000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The chemotherapy response score (CRS) proposed by Bohm and colleagues in 2015 has been validated as a reproducible method for determining histopathologic response of tubo-ovarian carcinoma to neoadjuvant chemotherapy and stratifies tumor response into 3 groups: CRS1 is defined as minimal/no response, CRS2 as moderate response, and CRS3 as marked response. Although described as a 3-tiered system, it essentially works as a 2-tiered system (CRS1/CRS2 vs. CRS3) for assessing prognosis. Here, we analyzed the prognostic value of CRS in a large cohort of tubo-ovarian carcinomas at a tertiary care center and evaluated the potential for Ki-67 labeling index on post-neoadjuvant chemotherapy samples to provide additional prognostic information. We included 170 patients with tubo-ovarian carcinoma treated with neoadjuvant chemotherapy followed by interval debulking surgery. We determined CRS for each case by reviewing slides from the interval debulking surgery resection specimen and calculated progression-free survival and overall survival. For each case with residual disease (CRS1 and CRS2, n=123, 72%), we also performed Ki-67 antibody staining and determined both average and highest Ki-67 labeling index. Consistent with prior studies, patients in our cohort with CRS1 and CRS2 showed significantly shorter progression-free survival and overall survival compared with CRS3. Further, in the subset of cases with CRS1 and CRS2, Ki-67 labeling index was predictive of OS at multiple cutoff points. An average Ki-67 labeling index of 20% (log rank test P-value: 0.0004) or a highest Ki-67 labeling index of 50% (log rank test P-value: 0.0002) could provide a practically useful cutoff. Multivariable cox proportional hazard model showed worse overall survival with both, average Ki-67 >20% (hazard ratios: 2.02, P-value: 0.00422, confidence interval: 1.25-3.28) and highest Ki-67 >50% (hazard ratios: 1.88, P-value: 0.0205, confidence interval: 1.1-3.2). We propose adding Ki-67 labeling index to CRS to provide additional prognostic separation between patients with CRS1 and CRS2.
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13
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Lheureux S, Cristea MC, Bruce JP, Garg S, Cabanero M, Mantia-Smaldone G, Olawaiye AB, Ellard SL, Weberpals JI, Wahner Hendrickson AE, Fleming GF, Welch S, Dhani NC, Stockley T, Rath P, Karakasis K, Jones GN, Jenkins S, Rodriguez-Canales J, Tracy M, Tan Q, Bowering V, Udagani S, Wang L, Kunos CA, Chen E, Pugh TJ, Oza AM. Adavosertib plus gemcitabine for platinum-resistant or platinum-refractory recurrent ovarian cancer: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet 2021; 397:281-292. [PMID: 33485453 PMCID: PMC10792546 DOI: 10.1016/s0140-6736(20)32554-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [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: 09/14/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Wee1 (WEE1hu) inhibitor adavosertib and gemcitabine have shown preclinical synergy and promising activity in early phase clinical trials. We aimed to determine the efficacy of this combination in patients with ovarian cancer. METHODS In this double-blind, randomised, placebo-controlled, phase 2 trial, women with measurable recurrent platinum-resistant or platinum-refractory high-grade serous ovarian cancer were recruited from 11 academic centres in the USA and Canada. Women were eligible if they were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status of 0-2, a life expectancy of more than 3 months, and normal organ and marrow function. Women with ovarian cancer of non-high-grade serous histology were eligible for enrolment in a non-randomised exploratory cohort. Eligible participants with high-grade serous ovarian cancer were randomly assigned (2:1), using block randomisation (block size of three and six) and no stratification, to receive intravenous gemcitabine (1000 mg/m2 on days 1, 8, and 15) with either oral adavosertib (175 mg) or identical placebo once daily on days 1, 2, 8, 9, 15, and 16, in 28-day cycles until disease progression or unacceptable toxicity. Patients and the team caring for each patient were masked to treatment assignment. The primary endpoint was progression-free survival. The safety and efficacy analysis population comprised all patients who received at least one dose of treatment. The trial is registered with ClinicalTrials.gov, NCT02151292, and is closed to accrual. FINDINGS Between Sept 22, 2014, and May 30, 2018, 124 women were enrolled, of whom 99 had high-grade serous ovarian cancer and were randomly assigned to adavosertib plus gemcitabine (65 [66%]) or placebo plus gemcitabine (34 [34%]). 25 women with non-high-grade serous ovarian cancer were enrolled in the exploratory cohort. After randomisation, five patients with high-grade serous ovarian cancer were found to be ineligible (four in the experimental group and one in the control group) and did not receive treatment. Median age for all treated patients (n=119) was 62 years (IQR 54-67). Progression-free survival was longer with adavosertib plus gemcitabine (median 4·6 months [95% CI 3·6-6·4] with adavosertib plus gemcitabine vs 3·0 months [1·8-3·8] with placebo plus gemcitabine; hazard ratio 0·55 [95% CI 0·35-0·90]; log-rank p=0·015). The most frequent grade 3 or worse adverse events were haematological (neutropenia in 38 [62%] of 61 participants in the adavosertib plus gemcitabine group vs ten [30%] of 33 in the placebo plus gemcitabine group; thrombocytopenia in 19 [31%] of 61 in the adavosertib plus gemcitabine group vs two [6%] of 33 in the placebo plus gemcitabine group). There were no treatment-related deaths; two patients (one in each group in the high-grade serous ovarian cancer cohort) died while on study medication (from sepsis in the experimental group and from disease progression in the control group). INTERPRETATION The observed clinical efficacy of a Wee1 inhibitor combined with gemcitabine supports ongoing assessment of DNA damage response drugs in high-grade serous ovarian cancer, a TP53-mutated tumour type with high replication stress. This therapeutic approach might be applicable to other tumour types with high replication stress; larger confirmatory studies are required. FUNDING US National Cancer Institute Cancer Therapy Evaluation Program, Ontario Institute for Cancer Research, US Department of Defense, Princess Margaret Cancer Foundation, and AstraZeneca.
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Affiliation(s)
| | | | | | - Swati Garg
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | - Prisni Rath
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - Gemma N Jones
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Suzanne Jenkins
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, UK
| | | | - Michael Tracy
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Qian Tan
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Lisa Wang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Eric Chen
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada.
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14
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Keller A, Rodríguez-López JL, Patel AK, Vargo JA, Kim H, Houser CJ, Sukumvanich P, Berger JL, Boisen MM, Edwards RP, Taylor SE, Courtney-Brooks MB, Orr BC, Olawaiye AB, Beriwal S. Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience. Brachytherapy 2020; 20:104-111. [PMID: 32952053 DOI: 10.1016/j.brachy.2020.08.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The Vienna and Venezia (Elekta) are hybrid intracavitary/interstitial brachytherapy (BT) applicators for cervical cancers unsuitable for intracavitary BT alone to improve target coverage or reduce critical organ dose. There is limited outcome data with the use of these applicators outside published experience of the EMBRACE group. We report feasibility and early outcomes with the use of these hybrid applicators at our institution. METHODS AND MATERIALS Hybrid applicators were used to treat 61 patients with cervical cancer from November 2011 to December 2019. Indications for hybrid applicator use were involvement of the vagina in 10 patients (16%), residual central or parametrial disease in 46 patients (75%), and a narrow introitus in 5 patients (9%). Toxicities were graded using the CTCAE v4.0. Outcomes were assessed with the Kaplan-Meier method. RESULTS Median follow-up was 16 months (IQR 9-32 mos). Median HRCTV volume was 31.6 cm3 (IQR 25-48 cm3). Median HRCTV D90 was 86.1 Gy (IQR 84.3-88.0 Gy). In 54 patients with follow-up PET/CT at 3 months, complete initial imaging response locally was seen in 46 patients.Estimated 12-month Kaplan-Meier overall survival, locoregional control, distant control, and recurrence-free survival estimates were 86.9%, 80.6%, 73.8%, and 65.9%, respectively. The 12-month incidence of Grade 3+ GI/GU chronic toxicities was 5.7%, consisting of vesicovaginal fistula, rectovaginal fistula, and ureterovesical fistula. CONCLUSIONS Our single-institution data support the use of the hybrid applicators, as an alternative to traditional BT applicators when clinically warranted. Use of hybrid applicators is feasible with adequate coverage of disease in the vagina and parametrium.
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Affiliation(s)
- A Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - J L Rodríguez-López
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - A K Patel
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - J A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - H Kim
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - C J Houser
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - P Sukumvanich
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - J L Berger
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - M M Boisen
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - R P Edwards
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - S E Taylor
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - M B Courtney-Brooks
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - B C Orr
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - A B Olawaiye
- Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - S Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA.
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15
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Horne ZD, Teterichko SR, Glaser SM, Wegner RE, Hasan S, Crafton SM, Miller EM, Krivak TC, Viswanathan A, Olawaiye AB, Sukumvanich P, Beriwal S. Race-driven survival differential in women diagnosed with endometrial cancers in the USA. Int J Gynecol Cancer 2020; 30:1893-1901. [PMID: 32847996 DOI: 10.1136/ijgc-2020-001560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/07/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE African American women are increasingly being diagnosed with advanced and type II histology endometrial cancers. Outcomes have been observed to be worse in African American women, but whether or not race itself is a factor is unclear. We sought to evaluate the rates of diagnosis and outcomes on a stage-by-stage basis with respect to race using a large national cancer registry database. METHODS The National Cancer Data Base was searched for patients with surgically staged non-metastatic endometrial cancer between 2004 and 2015. Women were excluded if surgical stage/histology was unknown, there was no follow-up, or no information on subsequent treatment. Pairwise comparison was used to determine temporal trends and Cox hazards tests with Bonferroni correction were used to determine overall survival. RESULTS A total of 286 920 women were diagnosed with endometrial cancer and met the criteria for analysis. Median follow-up was 51 months (IQR 25.7-85.3). In multivariable models, in women with stage I disease, African American women had a higher risk of death than Caucasian women (HR 1.262, 95% CI 1.191 to 1.338, p<0.001) and Asian/Pacific Islander women had a lower risk of death than Caucasian women (HR 0.742, 95% CI 0.689 to 0.801, p<0.001). This held for African American women with stage II type I and type II disease (HR 1.26, 95% CI 1.109 to 1.444, p<0.001 and HR 1.235, 95% CI 1.098 to 1.388, p<0.001) but not for Asian/Pacific Islander women. African American women with stage IIIA-B disease also had a higher risk of death for type I and type II disease versus Caucasian women (HR 1.221, 95% CI 1.045 to 1.422, p=0.010 and HR 1.295, 95% CI 1.155 to 1.452, p<0.001). Asian/Pacific Islander women had a lower risk of death than Caucasian women with type I disease (HR 0.783, 95% CI 0.638 to 0.960, p=0.019) and type II disease (HR 0.790, 95% CI 0.624 to 0.999, p=0.05). African American women with stage IIIC1-2 had a higher risk of death with type I disease (HR 1.343, 95% CI 1.207 to 1.494, p<0.001) and type II disease (HR 1.141, 95% CI 1.055 to 1.233, p=0.001) whereas there was no significant difference between Caucasian women and Asian/Pacific Islander women. CONCLUSION Race appears to play an independent role in survival from endometrial cancer in the USA, with African American women having worse survival on a stage-for-stage basis compared with Caucasian women.
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Affiliation(s)
- Zachary D Horne
- Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Solomiya R Teterichko
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott M Glaser
- Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Rodney E Wegner
- Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Shaakir Hasan
- Radiation Oncology, New York Proton Center, New York City, New York, USA
| | - Sarah M Crafton
- Gynecologic Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Eirwen M Miller
- Gynecologic Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Thomas C Krivak
- Gynecologic Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Akila Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Paniti Sukumvanich
- Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Sushil Beriwal
- Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
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Konstantinopoulos PA, Cheng SC, Wahner Hendrickson AE, Penson RT, Schumer ST, Doyle LA, Lee EK, Kohn EC, Duska LR, Crispens MA, Olawaiye AB, Winer IS, Barroilhet LM, Fu S, McHale MT, Schilder RJ, Färkkilä A, Chowdhury D, Curtis J, Quinn RS, Bowes B, D'Andrea AD, Shapiro GI, Matulonis UA. Berzosertib plus gemcitabine versus gemcitabine alone in platinum-resistant high-grade serous ovarian cancer: a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2020; 21:957-968. [PMID: 32553118 PMCID: PMC8023719 DOI: 10.1016/s1470-2045(20)30180-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [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: 01/02/2020] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND High-grade serous ovarian cancers show increased replication stress, rendering cells vulnerable to ATR inhibition because of near universal loss of the G1/S checkpoint (through deleterious TP53 mutations), premature S phase entry (due to CCNE1 amplification, RB1 loss, or CDKN2A mRNA downregulation), alterations of homologous recombination repair genes, and expression of oncogenic drivers (through MYC amplification and other mechanisms). We hypothesised that the combination of the selective ATR inhibitor, berzosertib, and gemcitabine could show acceptable toxicity and superior efficacy to gemcitabine alone in high-grade serous ovarian cancer. METHODS In this multicentre, open-label, randomised, phase 2 study, 11 different centres in the US Experimental Therapeutics Clinical Trials Network enrolled women (aged ≥18 years) with recurrent, platinum-resistant high-grade serous ovarian cancer (determined histologically) and Eastern Cooperative Oncology Group performance status of 0 or 1, who had unlimited previous lines of cytotoxic therapy in the platinum-sensitive setting but no more than one line of cytotoxic therapy in the platinum-resistant setting. Eligible patients were randomly assigned (1:1) to receive intravenous gemcitabine (1000 mg/m2) on day 1 and day 8, or gemcitabine plus intravenous berzosertib (210 mg/m2) on day 2 and day 9 of a 21-day cycle until disease progression or intolerable toxicity. Randomisation was done centrally using the Theradex Interactive Web Response System, stratified by platinum-free interval, and with a permuted block size of six. Following central randomisation, patients and investigators were not masked to treatment assignment. The primary endpoint was investigator-assessed progression-free survival, and analyses included all patients who received at least one dose of the study drugs. The study is registered with ClinicalTrials.gov, NCT02595892, and is active but closed to enrolment. FINDINGS Between Feb 14, 2017, and Sept 7, 2018, 88 patients were assessed for eligibility, of whom 70 were randomly assigned to treatment with gemcitabine alone (36 patients) or gemcitabine plus berzosertib (34 patients). At the data cutoff date (Feb 21, 2020), the median follow-up was 53·2 weeks (25·6-81·8) in the gemcitabine plus berzosertib group and 43·0 weeks (IQR 23·2-69·1) in the gemcitabine alone group. Median progression-free survival was 22·9 weeks (17·9-72·0) for gemcitabine plus berzosertib and 14·7 weeks (90% CI 9·7-36·7) for gemcitabine alone (hazard ratio 0·57, 90% CI 0·33-0·98; one-sided log-rank test p=0·044). The most common treatment-related grade 3 or 4 adverse events were decreased neutrophil count (14 [39%] of 36 patients in the gemcitabine alone group vs 16 [47%] of 34 patients in the gemcitabine plus berzosertib group) and decreased platelet count (two [6%] vs eight [24%]). Serious adverse events were observed in ten (28%) patients in the gemcitabine alone group and nine (26%) patients in the gemcitabine plus berzosertib group. There was one treatment-related death in the gemcitabine alone group due to sepsis and one treatment-related death in the gemcitabine plus berzosertib group due to pneumonitis. INTERPRETATION To our knowledge, this is the first randomised study of an ATR inhibitor in any tumour type. This study shows a benefit of adding berzosertib to gemcitabine in platinum-resistant high-grade serous ovarian cancer. This combination warrants further investigation in this setting. FUNDING US National Cancer Institute.
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Affiliation(s)
| | - Su-Chun Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Richard T Penson
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Susan T Schumer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - L Austin Doyle
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elise C Kohn
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Linda R Duska
- Department of Obstetrics and Gynecology, Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Marta A Crispens
- Department of Obstetrics and Gynecology, Ingram Cancer Center, Vanderbilt University Nashville, TN, USA
| | - Alexander B Olawaiye
- Department of Obstetrics and Gynecology, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ira S Winer
- Department of Obstetrics and Gynecology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Lisa M Barroilhet
- Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T McHale
- Department of Obstetrics and Gynecology, Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Russell J Schilder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anniina Färkkilä
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dipanjan Chowdhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Curtis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roxanne S Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brittany Bowes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alan D D'Andrea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Buckanovich RJ, Rustin G, Uppal S, Olawaiye AB, Kelley JL, Berger JL, Landen CN. No Role for Maintenance Bevacizumab for Up-Front Stage IIIc (R0) Ovarian Cancer. J Clin Oncol 2019; 37:2707-2708. [PMID: 31449471 DOI: 10.1200/jco.19.01650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ronald J Buckanovich
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Gordon Rustin
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Shitanshu Uppal
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Alexander B Olawaiye
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Joseph L Kelley
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Jessica L Berger
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
| | - Charles N Landen
- Ronald J. Buckanovich, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Gordon Rustin, MD, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Shitanshu Uppal, MBBS, University of Michigan, Ann Arbor, MI; Alexander B. Olawaiye, MD; Joseph L. Kelley, MD; and Jessica L. Berger, MD, University of Pittsburgh, Pittsburgh, PA; and Charles N. Landen, MD, MS, University of Virginia, Charlottesville, VA
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18
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Mai PL, Miller A, Gail MH, Skates S, Lu K, Sherman ME, Ioffe OB, Rodriguez G, Cohn DE, Boggess J, Rutherford T, Kauff ND, Rader JS, Phillips KA, DiSilvestro PA, Olawaiye AB, Ridgway MR, Greene MH, Piedmonte M, Walker JL. Risk-Reducing Salpingo-Oophorectomy and Breast Cancer Risk Reduction in the Gynecologic Oncology Group Protocol-0199 (GOG-0199). JNCI Cancer Spectr 2019; 4:pkz075. [PMID: 32337492 DOI: 10.1093/jncics/pkz075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/18/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Risk-reducing salpingo-oophorectomy (RRSO) has been associated with approximately 50% breast cancer risk reduction among women with a pathogenic variant in BRCA1 or BRCA2 (BRCA1/2), a finding that has recently been questioned. Methods We estimated incidence rates of breast cancer and all cancers combined during 5 years of follow-up among participants selecting RRSO or ovarian cancer screening (OCS) among women with a BRCA1/2 pathogenic variant or strong breast and/or ovarian cancer family history. Ovarian or fallopian tube or peritoneal cancer incidence rates were estimated for the OCS group. Breast cancer hazard ratios (HRs) for time-dependent RRSO were estimated using Cox regression with age time-scale (4943 and 4990 women-years in RRSO and OCS cohorts, respectively). All statistical tests were two-sided. Results The RRSO cohort included 925 participants, and 1453 participants were in the OCS cohort (381 underwent RRSO during follow-up), with 88 incident breast cancers diagnosed. Among BRCA1/2 pathogenic variant carriers, a non-statistically significant lower breast cancer incidence was observed in the RRSO compared with the OCS cohort (HR = 0.86, 95% confidence interval = 0.45 to 1.67; P = .67). No difference was observed in the overall population or among subgroups stratified by prior breast cancer history or menopausal status. Seven fallopian tube and four ovarian cancers were prospectively diagnosed in the OCS cohort, and one primary peritoneal carcinoma occurred in the RRSO cohort. Conclusions These data suggest that RRSO might be associated with reduced breast cancer incidence among women with a BRCA1/2 pathogenic variant, although the effect, if present, is small. This evolving evidence warrants a thorough discussion regarding the impact of RRSO on breast cancer risk with women considering this intervention.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, National Cancer Institute, Rockville, MD
| | - Austin Miller
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Mitchell H Gail
- Biostatistics Branch, National Cancer Institute, Rockville, MD
| | - Steven Skates
- Department of Biostatistics Unit, Massachusetts General Hospital, Boston, MA
| | - Karen Lu
- Department of GYN Oncology, MD Anderson Cancer Center, Houston, TX
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, and Environmental Epidemiology Branch, National Cancer Institute, Rockville, MD
| | - Olga B Ioffe
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, NorthShore University Health System, Evanston, IL.,Department of Obstetrics and Gynecology, University of Chicago, Evanston, IL
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH
| | - John Boggess
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Raleigh, NC
| | | | - Noah D Kauff
- Gynecology and Clinical Genetics Services, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Janet S Rader
- Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kelly-Anne Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Paul A DiSilvestro
- Department of Obstetrics & Gynecology, Women & Infants Hospital, Providence, RI
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | - Mark H Greene
- Clinical Genetics Branch, National Cancer Institute, Rockville, MD
| | - Marion Piedmonte
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Joan L Walker
- Department of OB/GYN, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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19
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Olawaiye AB, Leath CA. Contemporary management of uterine clear cell carcinoma: A Society of Gynecologic Oncology (SGO) review and recommendation. Gynecol Oncol 2019; 155:365-373. [PMID: 31500893 DOI: 10.1016/j.ygyno.2019.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/17/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023]
Abstract
Uterine clear cell cancer (UCCC) is a rare but aggressive disease. Due to its rarity, large, prospective studies focused on UCCC are exceedingly difficult therefore available data are generally from small, retrospective studies. There is also pertinent information from subsection analysis of larger studies that include UCCC and other histotypes. In 2009, the clinical practice committee of the Society of Gynecologic Oncology (SGO) published a review on UCCC aimed at guiding management. Since that publication, there have been developments which are relevant to UCCC, these include availability of data from landmark trials regarding adjuvant therapy, increasing utilization of sentinel lymph node approach and availability of immunotherapy as a treatment option. This SGO review is updated with all relevant, published information since 2009 considered clinically important for management of UCCC. In addition, it follows the new SGO's style for this type of publication which includes utilization of the question and answer format.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sc., University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Iheagwara UK, Vargo JA, Chen KS, Burton DR, Taylor SE, Berger JL, Boisen MM, Comerci JT, Orr BC, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Courtney-Brooks MB, Beriwal S. Neoadjuvant Chemoradiation Therapy Followed by Extrafascial Hysterectomy in Locally Advanced Type II Endometrial Cancer Clinically Extending to Cervix. Pract Radiat Oncol 2019; 9:248-256. [DOI: 10.1016/j.prro.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
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21
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Horne ZD, Karukonda P, Kalash R, Edwards RP, Kelley JL, Comerci JT, Olawaiye AB, Courtney-Brooks M, Bochmeier MM, Berger JL, Taylor SE, Sukumvanich P, Beriwal S. Single-Institution Experience in 3D MRI-Based Brachytherapy for Cervical Cancer for 239 Women: Can Dose Overcome Poor Response? Int J Radiat Oncol Biol Phys 2019; 104:157-164. [DOI: 10.1016/j.ijrobp.2018.12.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 11/15/2022]
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22
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Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145:129-135. [PMID: 30656645 DOI: 10.1002/ijgo.12749] [Citation(s) in RCA: 495] [Impact Index Per Article: 99.0] [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: 07/24/2018] [Revised: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent. METHODS Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations. RESULTS In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care. CONCLUSION The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.
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Affiliation(s)
- Neerja Bhatla
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mauricio Cuello Fredes
- Division Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lynette A Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Seija Grenman
- University of Turku and Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Kanishka Karunaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sean T Kehoe
- University of Birmingham and St. Peters College, Oxford, UK
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
- RTI International India, New Delhi, India
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Brooks RA, Tritchler DS, Darcy KM, Lankes HA, Salani R, Sperduto P, Guntupalli S, DiSilvestro P, Kesterson J, Olawaiye AB, Moxley K, Waggoner S, Santin A, Rader JS, Kizer NT, Thaker PH, Powell MA, Mutch DG, Birrer MJ, Goodfellow PJ. GOG 8020/210: Risk stratification of lymph node metastasis, disease progression and survival using single nucleotide polymorphisms in endometrial cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2019; 153:335-342. [PMID: 30827726 DOI: 10.1016/j.ygyno.2019.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/28/2019] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The ability to stratify a patient's risk of metastasis and survival permits more refined care. A proof of principle study was undertaken to investigate the relationship between single nucleotide polymorphisms (SNPs) in literature based candidate cancer genes and the risk of nodal metastasis and clinical outcome in endometrioid endometrial cancer (EEC) patients. METHODS Surgically-staged EEC patients from the Gynecologic Oncology Group or Washington University School of Medicine with germline DNA available were eligible. Fifty-four genes represented by 384 SNPs, were evaluated by Illumina Custom GoldenGate array. Association with lymph node metastases was the primary outcome. Progression-free survival (PFS) and overall survival (OS) was also evaluated. RESULTS 361 SNPs with high quality genotype data were evaluated in 337 patients with outcome data. Five SNPs in CXCR2 had an odds ratio (OR) between 0.68 and 0.70 (p-value ≤ 0.025). The A allele rs946486 in ABL had an OR of 1.5 (p-value = 0.01) for metastasis. The G allele in rs7795743 in EGFR had an OR for metastasis of 0.68 (p-value = 0.02) and hazard ratio (HR) for progression of 0.66 (p-value = 0.004). Importantly, no SNP met genome wide significance after adjusting for multiple test correcting and clinical covariates. The A allele in rs2159359 SNP in NME1 and the G allele in rs13222385 in EGFR were associated with worse OS. Both exhibited genome wide significance; rs13222385 remained significant after adjusting for prognostic clinical variables. CONCLUSION SNPs in cancer genes including rs2159359 SNP in NME1 and rs13222385 in EGFR may stratify risk in EEC and are prioritized for further investigation.
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Affiliation(s)
- Rebecca A Brooks
- Division of Gynecologic Oncology, University of California at Dabvis, Sacramento, CA, United States of America.
| | | | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Inova Medical Campus, Falls Church, VA, United States of America
| | - Heather A Lankes
- Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Paul Sperduto
- Division of Radiation Oncology, Ridgeview Medical Center, Waconia, MN, United States of America
| | - Saketh Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Paul DiSilvestro
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Joshua Kesterson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Penn State College of Medicine, Milton S. Hershey Medical Center, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA, United States of America
| | - Katherine Moxley
- Department of OB/GYN, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Steven Waggoner
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Alessandro Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States of America
| | - Janet S Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nora T Kizer
- Department of Obstetrics and Gynecology, Springfield Clinic, Springfield, IL, United States of America
| | - Premal H Thaker
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - Matthew A Powell
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - David G Mutch
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - Michael J Birrer
- Division of Hematology Oncology, The University of Alabama, Birmingham, AL, United States of America
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
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Dohopolski MJ, Horne ZD, Pradhan D, Bhargava R, Edwards RP, Kelley JL, Comerci JT, Olawaiye AB, Courtney-Brooks M, Berger JL, Sukumvanich P, Beriwal S. The Prognostic Significance of p16 Status in Patients With Vulvar Cancer Treated With Vulvectomy and Adjuvant Radiation. Int J Radiat Oncol Biol Phys 2019; 103:152-160. [DOI: 10.1016/j.ijrobp.2018.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/28/2018] [Accepted: 08/04/2018] [Indexed: 01/25/2023]
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Abstract
Uterine sarcomas account for approximately 3%-7% of all uterine cancers. Since carcinosarcomas are currently classified as metaplastic carcinomas, leiomyosarcomas remain the most common subtype. Exclusion of several histologic variants of leiomyoma, as well as atypical smooth muscle tumors (so-called "smooth muscle tumors of uncertain malignant potential"), has highlighted that the vast majority of leiomyosarcomas are high-grade tumors associated with poor prognosis even when apparently confined to the uterus. Low-grade endometrial stromal sarcomas are indolent tumors associated with long-term survival. High-grade endometrial stromal sarcomas and undifferentiated endometrial sarcomas behave more aggressively than tumors showing nuclear uniformity. Adenosarcomas have a favorable prognosis except for tumors showing myometrial invasion or sarcomatous overgrowth. The prognosis for carcinosarcomas (which are considered here in a postscript fashion) is usually worse than that for grade 3 endometrial carcinomas. Tumor stage is the single most important prognostic factor for uterine sarcomas.
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Affiliation(s)
- Nomonde Mbatani
- Department of Obstetrics and Gynecology, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa.,South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC), Cape Town, South Africa
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Olawaiye AB, Java JJ, Krivak TC, Friedlander M, Mutch DG, Glaser G, Geller M, O'Malley DM, Wenham RM, Lee RB, Bodurka DC, Herzog TJ, Bookman MA. Corrigendum to "Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study" [Gynecol. Oncol. 151 (2018) 18-23]. Gynecol Oncol 2018; 152:220. [PMID: 30360899 DOI: 10.1016/j.ygyno.2018.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - James J Java
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States of America
| | - Thomas C Krivak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Western Pennsylvania Hospital, Pittsburgh, PA, United States of America
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW, Department of Medical Oncology, The Prince of Wales Hospital, Sydney, Australia
| | - David G Mutch
- Dept. of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO 63110, United States of America
| | - Gretchen Glaser
- Gynecologic Oncology, Carilion Clinic Gynecological Oncology, Roanoke, VA 24016, United States of America
| | - Melissa Geller
- Dept. of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical Center-Fairview, Minneapolis, MN 55455, United States of America
| | - David M O'Malley
- Dept. of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States of America
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States of America
| | - Roger B Lee
- Tacoma General Hospital, Tacoma,WA, United States of America
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
| | - Thomas J Herzog
- Dept. of Obstetrics & Gynecology, University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati, OH 45267, United States of America
| | - Michael A Bookman
- The Permanente Medical Group, Inc., 2350 Geary Blvd, Room 115, San Francisco, CA 94115, United States of America
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Arend RC, Toboni MD, Montgomery AM, Burger RA, Olawaiye AB, Monk BJ, Herzog TJ. Systemic Treatment of Metastatic/Recurrent Uterine Leiomyosarcoma: A Changing Paradigm. Oncologist 2018; 23:1533-1545. [PMID: 30139839 DOI: 10.1634/theoncologist.2018-0095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/18/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
The treatment of metastatic and recurrent uterine leoimyosarcoma (uLMS) has evolved rapidly in the past several years. Leoimyosarcoma is extremely aggressive and responds poorly to traditional chemotherapeutics. Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these new compounds. Additionally, the potential role of immunotherapy is being assessed in current uLMS clinical trials. Given the increasing number of agents available both in the U.S. and globally, a treatment template that addresses optimal sequencing based upon expert consensus would be useful. Current guidelines, although listing various options, lack granularity by line of therapy. Most patients with leiomyosarcoma, even in early stage, are treated with surgery followed by adjuvant chemotherapy despite uLMS being relatively chemoresistant. Adjuvant chemotherapy often includes the combination of gemcitabine and docetaxel with or without doxorubicin in first-line systemic therapy, but these cytotoxic agents only provide patients with advanced disease a 5-year survival <30%. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uLMS. Critical ongoing studies investigating novel approaches including immunotherapeutics and genetic alterations also will be discussed. IMPLICATIONS FOR PRACTICE: Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these compounds. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uterine leoimyosarcoma.
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Affiliation(s)
- Rebecca C Arend
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Michael D Toboni
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Allison M Montgomery
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Robert A Burger
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona and Creighton University, Phoenix, Arizona, USA
| | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Institute and College of Medicine, Cincinnati, Ohio, USA
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Olawaiye AB, Java JJ, Krivak TC, Friedlander M, Mutch DG, Glaser G, Geller M, O'Malley DM, Wenham RM, Lee RB, Bodurka DC, Herzog TJ, Bookman MA. Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2018; 151:18-23. [PMID: 30135020 DOI: 10.1016/j.ygyno.2018.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/20/2018] [Revised: 07/24/2018] [Accepted: 07/29/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the relationship between chemotherapy dose modification (dose adjustment or treatment delay), overall survival (OS) and progression-free survival (PFS) for women with advanced-stage epithelial ovarian carcinoma (EOC) and primary peritoneal carcinoma (PPC) who receive carboplatin and paclitaxel. METHODS Women with stages III and IV EOC and PPC treated on the Gynecologic Oncology Group phase III trial, protocol 182, who completed eight cycles of carboplatin with paclitaxel were evaluated in this study. The patients were grouped per dose modification and use of granulocyte colony stimulating factor (G-CSF). The primary end point was OS; Hazard ratios (HR) for PFS and OS were calculated for patients who completed eight cycles of chemotherapy. Patients without dose modification were the referent group. All statistical analyses were performed using the R programming language and environment. RESULTS A total of 738 patients were included in this study; 229 (31%) required dose modification, 509 did not. The two groups were well-balanced for demographic and prognostic factors. The adjusted hazard ratios (HR) for disease progression and death among dose-modified patients were: 1.43 (95% CI, 1.19-1.72, P < 0.001) and 1.26 (95% CI, 1.04-1.54, P = 0.021), respectively. Use of G-CSF was more frequent in dose-modified patients with an odds ratio (OR) of 3.63 (95% CI: 2.51-5.26, P < 0.001) compared to dose-unmodified patients. CONCLUSION Dose-modified patients were at a higher risk of disease progression and death. The need for chemotherapy dose modification may identify patients at greater risk for adverse outcomes in advanced stage EOC and PPC.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - James J Java
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States of America
| | - Thomas C Krivak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Western Pennsylvania Hospital, Pittsburgh, PA, United States of America.
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW, Department of Medical Oncology, The Prince of Wales Hospital, Sydney, Australia.
| | - David G Mutch
- Dept. of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Gretchen Glaser
- Gynecologic Oncology, Carilion Clinic Gynecological Oncology, Roanoke, VA 24016, United States of America.
| | - Melissa Geller
- Dept. of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical Center-Fairview, Minneapolis, MN 55455, United States of America.
| | - David M O'Malley
- Dept. of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States of America.
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States of America.
| | - Roger B Lee
- Tacoma General Hospital, Tacoma, WA, United States of America
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
| | - Thomas J Herzog
- Dept. of Obstetrics & Gynecology, University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati, OH 45267, United States of America.
| | - Michael A Bookman
- The Permanente Medical Group, Inc. 2350 Geary Blvd, Room 115 San Francisco, CA 94115, United States of America.
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Gebhardt BJ, Vargo JA, Kim H, Houser CJ, Glaser SM, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Courtney-Brooks M, Beriwal S. Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina. Gynecol Oncol 2018; 150:293-299. [PMID: 29929925 DOI: 10.1016/j.ygyno.2018.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Brachytherapy is integral to vaginal cancer treatment and is typically delivered using an intracavitary single-channel vaginal cylinder (SCVC) or an interstitial brachytherapy (ISBT) applicator. Multi-channel vaginal cylinder (MCVC) applicators allow for improved organ-at-risk (OAR) sparing compared to SCVC while maintaining target coverage. We present clinical outcomes of patients treated with image-based high dose-rate (HDR) brachytherapy using a MCVC. METHODS AND MATERIALS Sixty patients with vaginal cancer (27% primary vaginal and 73% recurrence from other primaries) were treated with combination external beam radiotherapy (EBRT) and image-based HDR brachytherapy utilizing a MCVC if residual disease thickness was 7 mm or less after EBRT. All pts received 3D image-based BT to a total equivalent dose of 70-80 Gy. RESULTS The median high-risk clinical target volume was 24.4 cm3 (interquartile range [IQR], 14.1), with a median dose to 90% of 77.2 Gy (IQR, 2.8). After a median follow-up of 45 months (range, 11-78), the 4-year local-regional control, distant control, DFS, and OS rates were 92.6%, 76.1%, 64.0%, and 67.2%, respectively. The 4-year LRC rates were similar between the primary vaginal (92%) and recurrent (93%) groups (p = 0.290). Pts with lymph node positive disease had a lower rate of distant control at 4 years (22.7% vs. 89.0%, p < 0.001). There were no Grade 3 or higher acute complications. The 4-year rate of late Grade 3 or higher toxicity was 2.7%. CONCLUSIONS Clinical outcomes of pts with primary and recurrent vaginal cancer treated definitively in a systematic manner with combination EBRT with image-guided HDR BT utilizing a MCVC applicator demonstrate high rates of local control and low rates of severe morbidity. The MCVC technique allows interstitial implantation to be avoided in select pts with ≤7 mm residual disease thickness following EBRT while maintaining excellent clinical outcomes with extended 4-year follow-up in this rare malignancy.
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Affiliation(s)
- Brian J Gebhardt
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Hayeon Kim
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher J Houser
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Scott M Glaser
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Paniti Sukumvanich
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Alexander B Olawaiye
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Joseph L Kelley
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert P Edwards
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - John T Comerci
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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31
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Dohopolski MJ, Horne ZD, Gebhardt BJ, Glaser SM, Edwards RP, Kelley JL, Comerci JT, Olawaiye AB, Courtney-Brooks M, Berger JL, Sukumvanich P, Beriwal S. Single-institutional outcomes of adjuvant brachytherapy for Stage I endometrial cancer-Are outcomes consistent with randomized studies? Brachytherapy 2018; 17:564-570. [PMID: 29426745 DOI: 10.1016/j.brachy.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/26/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Vaginal brachytherapy (VBT) alone has been shown to be a viable adjuvant treatment strategy for most patients with Stage I endometrioid endometrial cancer. We sought to examine our institutional data following practice pattern changes resulting from the publications of GOG-99 and PORTEC-2. METHODS AND MATERIALS We retrospectively analyzed women who underwent adjuvant VBT after surgical staging for Stage 1 endometrioid endometrial cancer at our institution from 2007 to 2014. RESULTS We identified 297 women. Median time to last followup or death was 52.3 months (interquartile range: 32.3-72.3 months). By International Federation of Gynecology and Obstetrics 2009 staging, 162 patients (54.5%) had Stage IA and 128 (43.1%) had Stage IB disease. Ninety-nine (33.3%) patients had Grade 1, 153 (51.5%) had Grade 2, and 45 (15.2%) had Grade 3 disease. According to GOG-249 and PORTEC-2 criteria, 167 (56.2%) and 127 (42.7%) patients were with high-intermediate-risk disease. Two women had Stage IB Grade 3 disease. The most common high-dose-rate-VBT regimen was 2100 cGy/three fractions to a depth of 5 mm. Four (two acute and two late) (1.3%) Grade 3 genitourinary toxicities were reported: three episodes of vaginal dehiscence (after second course of VBT, 2 months after completion of VBT, and 1 year after completion of VBT) and one episode of radiation necrosis. Twenty-one (7%) women recurred: three recurred in the vagina, two recurred in the pelvic lymph nodes, and 16 recurred distantly. CONCLUSIONS Outcomes appear consistent with published randomized data in women with high-intermediate-risk endometrial cancer who are treated with brachytherapy alone. Recurrence and complication rates were minimal.
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Affiliation(s)
- Michael J Dohopolski
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Zachary D Horne
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Brian J Gebhardt
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Scott M Glaser
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Robert P Edwards
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Joseph L Kelley
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - John T Comerci
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Alexander B Olawaiye
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | | | - Jessica L Berger
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Paniti Sukumvanich
- Department of Gynecologic Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA.
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Olawaiye AB. Chemo First, Then Radiation, and Perhaps Surgery. Int J Radiat Oncol Biol Phys 2018; 100:290-291. [PMID: 29353646 DOI: 10.1016/j.ijrobp.2017.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Iheagwara UK, Burton D, Vargo JA, Boisen MM, Comerci JT, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Courtney-Brooks M, Berger JL, Taylor SE, Beriwal S. Is There a Role of Neoadjuvant Radiotherapy Including High Dose Rate Image-Based Brachytherapy in Locally Advanced Type II Endometrial Cancer Clinically Extending to Cervix ± Parametria? Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.04.008] [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: 10/19/2022]
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Mai PL, Piedmonte M, Han PK, Moser RP, Walker JL, Rodriguez G, Boggess J, Rutherford TJ, Zivanovic O, Cohn DE, Thigpen JT, Wenham RM, Friedlander ML, Hamilton CA, Bakkum-Gamez J, Olawaiye AB, Hensley ML, Greene MH, Huang HQ, Wenzel L. Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 145:122-129. [PMID: 28190649 DOI: 10.1016/j.ygyno.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. METHODS Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. RESULTS Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates. CONCLUSIONS Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Marion Piedmonte
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME 04101, United States.
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States.
| | - Joan L Walker
- Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL 60201, United States.
| | - John Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC 27514, United States.
| | - Thomas J Rutherford
- Gynecologic Oncology, Yale University School of Medicine, New Haven, CT 06520, United States.
| | - Oliver Zivanovic
- Innovative Surgical Technology, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Robert M Wenham
- Department of Gynecologic Oncology, Program of Chemical Biology and Molecular Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
| | | | - Chad A Hamilton
- Gynecologic Cancer Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States.
| | - Jamie Bakkum-Gamez
- Department of GYN Surgery, Mayo Clinic, Rochester, MN 55905, United States.
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15143, United States.
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, United States.
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Helen Q Huang
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Lari Wenzel
- Center for Health Policy Research, University of California, Irvine, Irvine, CA 92697, United States.
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Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, Dizon DS, Kash JJ, Meyer LA, Moore KN, Olawaiye AB, Oldham J, Salani R, Sparacio D, Tew WP, Vergote I, Edelson MI. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3460-73. [PMID: 27502591 DOI: 10.1200/jco.2016.68.6907] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [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 To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. RECOMMENDATIONS All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alexi A Wright
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kari Bohlke
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Deborah K Armstrong
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Michael A Bookman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William A Cliby
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Robert L Coleman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Don S Dizon
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Joseph J Kash
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Larissa A Meyer
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kathleen N Moore
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Alexander B Olawaiye
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Jessica Oldham
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ritu Salani
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Dee Sparacio
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William P Tew
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ignace Vergote
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Mitchell I Edelson
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium.
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Lin JF, Muñiz K, Sukumvanich P, Gehrig P, Beriwal S, Kelley JL, Edwards RP, Olawaiye AB. Survival advantage associated with multimodal therapy in women with node-positive (stage-IIIC) uterine papillary serous carcinoma: a National Cancer Database study. BJOG 2015; 123:1846-52. [DOI: 10.1111/1471-0528.13726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- JF Lin
- Magee-Womens Hospital of UPMC; Pittsburgh PA USA
| | - K Muñiz
- Albert Einstein College of Medicine of Yeshiva University; Bronx NY USA
| | | | - P Gehrig
- University of North Carolina School of Medicine; Chapel Hill NC USA
| | - S Beriwal
- Magee-Womens Hospital of UPMC; Pittsburgh PA USA
| | - JL Kelley
- Magee-Womens Hospital of UPMC; Pittsburgh PA USA
| | - RP Edwards
- Magee-Womens Hospital of UPMC; Pittsburgh PA USA
| | - AB Olawaiye
- Magee-Womens Hospital of UPMC; Pittsburgh PA USA
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Yu MC, Austin RM, Lin J, Beck T, Beriwal S, Comerci JT, Edwards RP, Sukumvanich P, Kelley J, Olawaiye AB. The Role of High-Risk Human Papilloma Virus Testing in the Surveillance of Cervical Cancer After Treatment. Arch Pathol Lab Med 2015; 139:1437-40. [DOI: 10.5858/arpa.2014-0534-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Cervical cancer affects 12 000 women in the United States annually. However, despite its prevalence, there remains no good methodology to detect its recurrence.
Objective
To identify the role of cervicovaginal high-risk human papilloma virus (hr-HPV) testing in predicting cervical cancer recurrence.
Design
This is a retrospective study of patients who underwent hr-HPV testing as part of their routine surveillance for cervical cancer. Standard statistical analyses, including χ2 test and multivariable logistic regression, were performed with IBM SPSS 19.0.
Results
A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P = .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P = .02, 95% confidence interval: 1.5–99.6). Using 2 × 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.
Conclusions
Persistence of hr-HPV is a risk factor for disease recurrence. High-risk–HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alexander B. Olawaiye
- From the Departments of Gynecology Oncology (Drs Yu, Lin, Comerci, Edwards, Sukumvanich, Kelley, and Olawaiye), Pathology (Dr Austin), and Radiation Oncology (Dr Beriwal), Magee-Women's Hospital, Pittsburgh, Pennsylvania; and the Department of Gynecology Oncology, University of Washington, Seattle (Dr Beck)
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Abstract
Background Primary ovarian and cervical melanomas are extremely rare tumors with a poor prognosis. Diagnosis requires a high index of suspicion as presentation can mimic benign conditions clinically and other neoplasms histologically. Cases A 41 year-old with an adnexal mass underwent surgical staging for a stage IA ovarian melanoma. Imaging revealed a brain metastasis treated with radiation. Subsequent nodal recurrence was treated with immune and targeted therapies. She is alive with disease at 61 months follow-up. A 54 year-old presented after endocervical melanoma was diagnosed with polypectomy. She underwent radical hysterectomy, lymphadenectomy, and adjuvant brachytherapy. Immediate post-treatment imaging revealed widespread liver and pulmonary metastasis, currently being treated with ipilimumab. Conclusion Immunohistochemistry can facilitate the diagnosis of gynecologic melanoma, and multidisciplinary treatment is recommended. Ovarian and cervical melanomas are rare tumors that present diagnostic challenges. Survival is poor, and multidisciplinary treatment is recommended. Immunotherapy should be considered in the treatment of gynecologic melanoma.
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Affiliation(s)
- Jessica L Berger
- Division of Gynecologic Oncology at Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Daman Samrao
- Department of Pathology at Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Marilyn Huang
- Division of Gynecologic Oncology at Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Alexander B Olawaiye
- Division of Gynecologic Oncology at Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Vargo JA, Boisen MM, Comerci JT, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JC, Edwards RP, Huang M, Courtney-Brooks M, Beriwal S. Neoadjuvant High-Dose-Rate Brachytherapy Followed By Extrafascial Hysterectomy for Locally Advanced Endometrial Cancer Clinically Extending to Cervix or Parametria. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.211] [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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Vargo JA, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Huang M, Courtney-Brooks M, Beriwal S. Image-Based Multichannel Vaginal Cylinder Brachytherapy for Vaginal Cancers. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.294] [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: 11/25/2022]
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Gill BS, Kim H, Houser CJ, Kelley JL, Sukumvanich P, Edwards RP, Comerci JT, Olawaiye AB, Huang M, Courtney-Brooks M, Beriwal S. MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience. Int J Radiat Oncol Biol Phys 2015; 91:540-7. [DOI: 10.1016/j.ijrobp.2014.10.053] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
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Linkov F, Edwards RP, Althouse A, Rauh-Hain JA, Del Carmen MG, Freese KE, Kelley JL, Olawaiye AB. Obesity, lymphadenectomy and survival outcomes in intermediate to high-risk, early-stage endometrial cancer patients. Future Oncol 2015; 11:607-15. [PMID: 25686116 DOI: 10.2217/fon.14.247] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Lymphadenectomy or lymph node dissection is a topic of controversy in endometrial cancer (EC) treatment. MATERIALS & METHODS Associations between lymph node dissections and clinical factors were retrospectively examined in obese, endometrioid endometrial cancer patients with early-stage disease between 1995 and 2005. Overall, EC-specific and recurrence-free survival were also evaluated. RESULTS Out of 192 patients, 61 (32%) did not have a lymph node examination, 55 (29%) had less than ten lymph nodes removed and 76 (39%) had ≥10 removed. Lymph node dissection count was not significantly associated with overall, EC-specific or recurrence-free survival. CONCLUSION Analysis revealed no significant associations between ≥10 dissected lymph nodes and survival outcomes among obese, EC patients, which supports the need for additional investigation of the merit of lymphadenectomy among these patients.
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Affiliation(s)
- Faina Linkov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15260, USA
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Vargo JA, Kim H, Choi S, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Beriwal S. Extended Field Intensity Modulated Radiation Therapy With Concomitant Boost for Lymph Node–Positive Cervical Cancer: Analysis of Regional Control and Recurrence Patterns in the Positron Emission Tomography/Computed Tomography Era. Int J Radiat Oncol Biol Phys 2014; 90:1091-8. [DOI: 10.1016/j.ijrobp.2014.08.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/25/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, Brewer M, Boruta D, Villella J, Herzog T, Shahin FA. Corrigendum to “Endometrial cancer: A review and current management strategies: Part I” [Gynecol Oncol 134 (2014) 385–392]. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.08.035] [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: 10/24/2022]
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Vargo JA, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Huang M, Courtney-Brooks M, Beriwal S. Image-based multichannel vaginal cylinder brachytherapy for vaginal cancer. Brachytherapy 2014; 14:9-15. [PMID: 25456026 DOI: 10.1016/j.brachy.2014.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 08/29/2014] [Revised: 10/01/2014] [Accepted: 10/08/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. METHODS AND MATERIALS A total of 41 patients with vaginal cancer (24% primary vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. RESULTS The median high-risk clinical target volume was 24.2 cc (interquartile range [IQR], 12.6), with a median dose to 90% (D90) of 77.1 Gy (IQR, 3.4). The median dose to 2 cc (D(2 cc)) for the bladder, rectum, and sigmoid were 59.4 Gy (IQR, 5.6), 58.2 Gy (IQR, 4.1), and 52.3 Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for vaginal, bladder, urethral, and gastrointestinal, respectively. CONCLUSIONS Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Hayeon Kim
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Christopher J Houser
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Paniti Sukumvanich
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Alexander B Olawaiye
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Joseph L Kelley
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Robert P Edwards
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - John T Comerci
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Marilyn Huang
- Department of Gynecology Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
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Vargo JA, Boisen MM, Comerci JT, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Huang M, Courtney-Brooks M, Beriwal S. Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria. Gynecol Oncol 2014; 135:190-5. [DOI: 10.1016/j.ygyno.2014.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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Gill BS, Kim H, Houser C, Olsen A, Kelley J, Edwards RP, Comerci J, Sukumvanich P, Olawaiye AB, Huang M, Courtney-Brooks M, Beriwal S. Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma. Brachytherapy 2014; 13:542-7. [DOI: 10.1016/j.brachy.2014.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
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Berger JL, Smith A, Zorn KK, Sukumvanich P, Olawaiye AB, Kelley J, Krivak TC. Outcomes analysis of an alternative formulation of PEGylated liposomal doxorubicin in recurrent epithelial ovarian carcinoma during the drug shortage era. Onco Targets Ther 2014; 7:1409-13. [PMID: 25143745 PMCID: PMC4133030 DOI: 10.2147/ott.s62881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background In response to the critical shortage of Doxil®, the US Food and Drug Administration (FDA) allowed temporary importation of non-FDA-approved second-generation liposomal doxorubicin, Lipo-Dox®. Lipo-Dox utilizes a different liposomal particle than Doxil and demonstrates different pharmacokinetic properties. Its use has never been evaluated in a North American population. The objective of this study was to evaluate the efficacy and tolerability of Lipo-Dox at Magee-Womens Hospital, University of Pittsburgh Medical Center, for patients with recurrent epithelial ovarian cancer who were treated during the Doxil shortage. Methods Patients treated with Lipo-Dox from January 2012 to December 2012 were identified retrospectively. Disease response was defined radiographically by RECIST (Response Evaluation Criteria in Solid Tumors) or biochemically by CA-125 level if measurable disease was not present. Survival was defined from the start date of Lipo-Dox until the date of progression or death. Toxicity was assessed by the Gynecologic Oncology Group common toxicity criteria. Results Eighteen patients with recurrent epithelial ovarian cancer who received Lipo-Dox were identified. These patients had a median of three prior treatment regimens. The median number of Lipo-Dox cycles given was 3.5 (range 1–8). No patients had a complete or partial response. Two patients had stable disease over a mean follow-up of 144.5 days. Fourteen patients had progressive disease, with a median time to progression of 82 days. Progression was based on CA-125 in four patients and RECIST in the remainder. Nine patients died from the disease. Conclusion Although this represents a small, pretreated population, there were no clinical responses to Lipo-Dox, raising the question as to whether it is an equivalent substitute for Doxil. Further evaluation is needed, but if confirmed, these findings raise concerns regarding the use of current stocks of Lipo-Dox, as well as the prudence of managing future drug shortages with pharmacologically similar, but clinically untested drugs.
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Affiliation(s)
- Jessica L Berger
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Ashlee Smith
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Kristin K Zorn
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Paniti Sukumvanich
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Alexander B Olawaiye
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Joseph Kelley
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
| | - Thomas C Krivak
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Division of Gynecologic Oncology, Pittsburgh, PA, USA
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Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, Brewer M, Boruta D, Villella J, Herzog T, Abu Shahin F. Endometrial cancer: A review and current management strategies: Part I. Gynecol Oncol 2014; 134:385-92. [DOI: 10.1016/j.ygyno.2014.05.018] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/21/2022]
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Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, Brewer M, Boruta D, Herzog TJ, Shahin FA. Endometrial cancer: A review and current management strategies: Part II. Gynecol Oncol 2014; 134:393-402. [DOI: 10.1016/j.ygyno.2014.06.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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