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Holmes FA, Hellerstedt BA, Pippen JE, Vukelja SJ, Collea R, Kocs DM, Blum JL, McIntyre KJ, Barve MA, Brooks BD, Osborne CR, Wang Y, Asmar L, O'Shaughnessy J. Five-year results of a phase II trial of preoperative 5-fluorouracil, epirubicin, cyclophosphamide followed by docetaxel with capecitabine (wTX) (with trastuzumab in HER2-positive patients) for patients with stage II or III breast cancer. Cancer Med 2018; 7:2288-2298. [PMID: 29582557 PMCID: PMC6010779 DOI: 10.1002/cam4.1472] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 02/18/2018] [Accepted: 02/26/2018] [Indexed: 01/04/2023] Open
Abstract
We aimed to increase pathologic complete response (pCR) in patients with invasive breast cancer by adding preoperative capecitabine to docetaxel following 5-fluorouracil, epirubicin, cyclophosphamide (FEC) (with trastuzumab for patients with HER2-positive disease) and to evaluate 5-year disease-free survival (DFS) associated with this preoperative regimen. Chemotherapy included four cycles of FEC100 (5-fluorouracil 500 mg/m2 , epirubicin 100 mg/m2 , cyclophosphamide 500 mg/m2 IV on Day 1 every 21 days) followed by 4 21-day cycles of docetaxel (35 mg/m2 days 1 and 8) concurrently with capecitabine (825 mg/m2 orally twice daily for 14 days followed by 7 days off) (wTX). For HER2-positive patients, treatment was modified by decreasing epirubicin to 75 mg/m2 and adding trastuzumab (H) in standard doses (FEC75-H →wTX-H). The study objective was to achieve a pCR rate in the breast and axillary lymph nodes of 37% in patients with HER2-negative breast cancer and of 67% in patients with HER2-positive breast cancer treated with preoperative trastuzumab. A total of 186 patients were enrolled on study. In an intent-to-treat analysis, the pCR rate was 31% (37/118, 95% CI: 24-40%) in the HER2-negative patients, 24% (15/62, 95% CI: 14-37%) in ER-positive/HER2-negative patients, 39% (22/56, 95% CI: 27-53%) in the ER-negative/HER2-negative patients, and 46% (29/63, 95% CI: 34-48%) in the HER2-positive patients. The pCR rate in the 40 trastuzumab-treated patients was 53% (21/40, 95% CI: 38-67%). Grade 3 and 4 adverse events included neutropenia, leukopenia, diarrhea, and hand-foot skin reactions. One trastuzumab-treated patient developed grade 3 cardiotoxicity, and 4 others experienced grade 1-2 decrements in left ventricular function; all five patients' cardiac function returned to their baseline upon completion of trastuzumab. At 5 years, disease-free survival was 70% in the HER2-negative population (78% in ER-positive/HER2-negative and 62% in the ER-negative/HER2-negative patients) and 80% in the HER2-positive patients (87% in the trastuzumab-treated HER2-positive patients). At 5 years, overall survival was 80% in the HER2-negative population (88% in ER-positive/HER2-negative and 71% in the ER-negative/HER2-negative patients) and 86% in the HER2-positive patients (94.5% in the trastuzumab-treated HER2-positive patients). FEC100 (FEC75 with trastuzumab) followed by weekly docetaxel plus capecitabine, with or without trastuzumab is a safe, effective preoperative cytotoxic regimen. However, the addition of capecitabine to docetaxel following FEC, with or without trastuzumab, did not increase pCR rates nor 5-year DFS over the rates that have been reported with standard preoperative doxorubicin/cyclophosphamide (AC) followed by paclitaxel, with or without trastuzumab. Therefore, the use of capecitabine as part of preoperative chemotherapy is not recommended.
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Affiliation(s)
- Frankie Ann Holmes
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Houston Memorial CityHoustonTexas
| | - Beth A. Hellerstedt
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Austin CentralAustinTexas
| | - John E. Pippen
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Svetislava J. Vukelja
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyTylerTexas
| | - Rufus P. Collea
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- New York Oncology HematologyAlbanyNew York
| | - Darren M. Kocs
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyRound RockTexas
| | - Joanne L. Blum
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Kristi J. McIntyre
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyDallas Presbyterian HospitalDallasTexas
| | - Minal A. Barve
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyDallas Presbyterian HospitalDallasTexas
| | - Barry D. Brooks
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas OncologyMedical City DallasDallasTexas
| | - Cynthia R. Osborne
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
| | - Yunfei Wang
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
| | - Lina Asmar
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
| | - Joyce O'Shaughnessy
- US Oncology ResearchMcKesson Specialty HealthThe WoodlandsTexas
- Texas Oncology‐Baylor Sammons Cancer CenterDallasTexas
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Gawade PL, Berlin JA, Henry DH, Tomita D, Brooks BD, Franklin J, Bradbury BD, Critchlow CW. Changes in the use of erythropoiesis-stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes. Pharmacoepidemiol Drug Saf 2017; 26:1357-1366. [DOI: 10.1002/pds.4293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 06/13/2017] [Accepted: 07/23/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Prasad L. Gawade
- Center for Observational Research; Amgen Inc.; Thousand Oaks CA USA
| | | | - David H. Henry
- Department of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Dianne Tomita
- Global Biostatistical Science; Amgen Inc.; Thousand Oaks CA USA
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Daller JR, Wong J, Brooks BD, McKee JS. An inexpensive system for evaluating the tussive and anti-tussive properties of chemicals in conscious, unrestrained guinea pigs. J Pharmacol Toxicol Methods 2012; 66:232-7. [PMID: 22796572 DOI: 10.1016/j.vascn.2012.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/14/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Commercial whole-body plethysmography systems used to evaluate the anti-tussive potential of drugs employ sophisticated technology, but these systems may be cost prohibitive for some laboratories. The present study describes an alternative, inexpensive system for evaluating the tussive and anti-tussive potential of drugs in conscious, unrestrained guinea pigs. METHODS The system is composed of a transparent small animal anesthesia induction box fitted with a microphone, a camera and a pneumotachometer to simultaneously capture audio, video, air flow and air pressure in real time. Data acquisition and analysis was performed using free software for audio and video, and a research pneumotach system for flow and pressure. System suitability testing was performed by exposing conscious, unrestrained guinea pigs to nebulized aqueous solutions of a selective agonist for TRPV1 (citric acid) or a selective agonist for TRPA1 (AITC), with or without pre-treatment with a selective antagonist for TRPV1 (BCTC) or a selective antagonist for TRPA1 (HC-030031). RESULTS The system easily discerned coughs from other respiratory events like sneezes. System suitability test results are as follows: AITC caused 10.7 (SEM=1.4592) coughs vs. 5.8 (SEM=1.6553) when pre-treated with HC-030031 (P<0.05). Citric acid caused 12.4 (SEM=1.4697) coughs vs. 3.2 (SEM=1.3928) when pre-treated with BCTC (P<0.002). DISCUSSION We have described in detail an inexpensive system for evaluating the tussive and anti-tussive potential of chemicals in conscious, unrestrained guinea pigs. Suitability testing indicates that the system is comparable to a commercial whole-body plethysmography system for detecting and differentiating between coughs and sneezes. This system may provide some investigators a cost-conscious alternative to more expensive commercial whole-body plethysmography systems.
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Affiliation(s)
- J R Daller
- Technology Resources, Baxter Healthcare Corporation, Round Lake, IL 60073, USA.
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Patt DA, Espirito JL, Turnwald B, Hoverman JR, Neubauer MA, Busby LT, Brooks BD, Kolodziej MA, Anderson RW, Beveridge RA. PD06-05: Primary and Secondary Pegfilgrastim Utilization in Adjuvant Chemotherapy for Breast Cancer in the Community. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd06-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Various factors are taken into consideration in the selection of adjuvant breast cancer (BC) chemotherapy (CT) regimens for patients. Choice of CT, schedule, duration, and supportive care affects costs and toxicity. Understanding clinical practice utilization patterns are important when making cost estimates of adjuvant therapy. Because pegfilgrastim is a large driver of cost it is important to understand the utilization characteristics. We aimed to characterize primary and secondary pegfilgrastim use during neoadjuvant/adjuvant (N/Ad) chemotherapy by regimen type. While initial data suggests the incidence of febrile neutropenia (FN) is low among some docetaxel containing regimens, we wanted to further characterize pegfilgrastim utilization, as previous utilization studies suggested it was higher than expected.
Methods: Using the US Oncology iKnowMed™ EHR database, we retrospectively identified female BC patients (pts) diagnosed with stage I-III BC, between 7/2006 and 11/2010. Secondary diagnoses were excluded. Pts were characterized by age, ER and HER2 status, tumor size, grade, and nodes. CT utilization was determined by the number of pts assigned an N/Ad line of therapy (LOT) during the study period. Regimens were categorized by CT title and drugs. Clinical trial pts were included. Pegfilgrastim utilization was characterized if administered within 6 months of being assigned to an N/Ad CT regimen, and was captured as primary prophylaxis if the first dose was administered <5 days of C1D1 of a regimen, and secondary prophylaxis if >5days.
Results: General chemotherapy and pegfilgrastim utilization characteristics were previously reported. This report captures primary vs. secondary pegfilgrastim use. During the time period, 40,881 BC pts were identified. Of these, 15,328 pts (37%) were assigned an N/Ad CT regimen and 72% (11, 022 pts) received pegfilgrastim at any time within 6 months of their N/Ad regimen. Docetaxel containing regimens (TC, TAC, TCH) and dose-dense regimens accounted for the majority of all pegfilgrastim use. Pegfilgrastim utilization with the TC regimen was 70%, and represented 25% of all N/Ad pegfilgrastim utilization. The vast majority of utilization for TC and TCH was primary prophylaxis as detailed below:
Conclusions: While primary prophylaxis in regimens like dose-dense AC and TAC are expected, the primary utilization of pegfilgrastim in TC and TCH is higher than expected based on published clinical trial experience. The incidence of FN has been reported at 5% in the clinical trial by Jones et al with TC, however subsequent reports suggest the incidence of FN may be higher than expected. Our results demonstrate high primary prophylaxis utilization adoption in clinical practice. With the availability of generic docetaxel, commonly used drugs in adjuvant BC except trastuzumab have generic equivalents. Pegfilgrastim will be the largest cost driver in women receiving adjuvant chemotherapy and should be considered among cost estimates. This study may underestimate utilization of pegfilgrastim if it was administered outside of the cancer center.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD06-05.
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Affiliation(s)
- DA Patt
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - JL Espirito
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - B Turnwald
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - JR Hoverman
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - MA Neubauer
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - LT Busby
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - BD Brooks
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - MA Kolodziej
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - RW Anderson
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
| | - RA Beveridge
- 1Texas Oncology, TX; US Oncology, TX; Kansas City Cancer Center, KS; Rocky Mountain Cancer Center, CO; New York Oncology Hematology, NY
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Mues G, Tong AW, Mack MJ, O'Brien JC, Taylor W, Lieberman ZH, Stone MJ, Agura E, Preskitt JT, Kuhn JA, Brooks BD, Solano MO, Jain V, Pederson J, Courtney A, Nemunaitis J. Therapeutic Aspects of Oncogene Determination. Proc (Bayl Univ Med Cent) 1994. [DOI: 10.1080/08998280.1994.11929879] [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] Open
Affiliation(s)
- Gabriele Mues
- Mary C. Crowley Laboratory, Baylor Research Institute
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Gonda T, Daniel EE, McDonald TJ, Fox JE, Brooks BD, Oki M. Distribution and function of enteric GAL-IR nerves in dogs: comparison with VIP. Am J Physiol 1989; 256:G884-96. [PMID: 2470259 DOI: 10.1152/ajpgi.1989.256.5.g884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The distribution of nerves containing galanin-immunoreactive (GAL-IR) material was compared to the distribution of neurons containing vasoactive intestinal polypeptide (VIP) immunoreactivity in the canine gastrointestinal tract. The actions of intra-arterially administered galanin and VIP on motility in the gastric antrum and corpus and the intestines were also studied. All sphincter muscles contained galanin- and VIP-immunoreactive nerve profiles. VIP-immunoreactive nerve profiles were present in all layers of the stomach, small intestine, and colon. GAL-IR nerve somata were common in the submucous plexus of ileum and colon and in the myenteric plexus of the terminal antrum, as were nerve processes in various layers. In the small intestine, galanin inhibited contractile responses to field stimulation of intrinsic nerves and also reduced the contractions after nerve blockade with tetrodotoxin (TTX). VIP often enhanced field-stimulated contractions at low doses but inhibited these and the contractions after TTX at higher doses. In the stomach and colon, both peptides inhibited responses to field stimulation; whether these effects were due to actions on smooth muscle was not tested. The distribution and actions of galanin in gut are consistent with the hypothesis that it acts at smooth muscle sites and possibly at prejunctional sites.
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Affiliation(s)
- T Gonda
- Department of Biomedical Sciences, McMaster University Health Sciences Center, Hamilton, Ontario, Canada
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Jones SE, Mennel RG, Peters GN, Westrick MA, Brooks BD, Knox SM, McGuffey P. Phase I trial of adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil (CEF) for stage II breast cancer. Invest New Drugs 1988; 6:195-8. [PMID: 2847991 DOI: 10.1007/bf00175397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Epirubicin is a new anthracycline with a potentially more favorable toxicity profile than the parent compound, doxorubicin. Accordingly, the feasibility and toxicity of 6 courses of adjuvant chemotherapy with cyclophosphamide (C), epirubicin (E), and 5-fluorouracil (F) were assessed in 10 patients with Stage 2 (node positive) breast cancer. Doses of C and F were 600 mg/m2 and E was 75 mg/m2. Moderate granulocytopenia (median count = 610/mm3) occurred on day 14 of the first 21 day treatment course and was the main toxicity encountered with treatment, although there were no episodes of granulocytopenic fever. Grade 3 or 4 vomiting occurred in 40% and significant alopecia in 30% of patients. Four patients experienced transient asymptomatic decreases in calculated radionuclide cardiac ejection fraction of greater than or equal to 10% but no signs or symptoms of cardiac failure were observed. If epirubicin proves to be less cardiotoxic than doxorubicin, this combination would merit further evaluation as potential adjuvant therapy for early breast cancer.
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Affiliation(s)
- S E Jones
- Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas
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McDonald TJ, Christofi FL, Brooks BD, Barnett W, Cook MA. Characterization of content and chromatographic forms of neuropeptides in purified nerve varicosities prepared from guinea pig myenteric plexus. Regul Pept 1988; 21:69-83. [PMID: 2455923 DOI: 10.1016/0167-0115(88)90092-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Partially purified nerve varicosities (PV) prepared from guinea pig ileal myenteric plexus were found to contain, by radioimmunoassay, gastrin-releasing polypeptide (GRP), substance P (SP), galanin, Leu-enkephalin (LE), Met-enkephalin (ME), and vasoactive intestinal polypeptide (VIP). SP was present in the highest concentration followed by, in descending order, ME, LE, VIP, GRP and galanin. On reverse-phase HPLC, SP-, LE- and ME-like immunoreactivity in the PV preparation eluted at retention times similar to their synthetic analogues, galanin-like immunoreactivity eluted at a retention time different from that of synthetic porcine galanin and VIP-like immunoreactivity eluted at the retention time of synthetic guinea pig VIP. GRP-like immunoreactivity, on reverse-phase HPLC, eluted at retention times close to that of synthetic porcine GRP-(1-27) and its major oxidized form. Evidence was obtained for the presence of an alpha-neurokinin-like immunoreactive entity and an unidentified SP-like immunoreactive entity in guinea pig myenteric plexus.
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Affiliation(s)
- T J McDonald
- Department of Medicine, Robarts Research Institute University of Western Ontario, London, Canada
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