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Schröder CP, van Leeuwen-Stok E, Cardoso F, Linderholm B, Poncet C, Wolff AC, Bjelic-Radisic V, Werutsky G, Abreu MH, Bozovic-Spasojevic I, den Hoed I, Honkoop AH, Los M, Leone JP, Russell NS, Smilde TJ, van der Velden AWG, Van Poznak C, Vleugel MM, Yung RL, Coens C, Giordano SH, Ruddy KJ. Quality of Life in Male Breast Cancer: Prospective Study of the International Male Breast Cancer Program (EORTC10085/TBCRC029/BIG2-07/NABCG). Oncologist 2023; 28:e877-e883. [PMID: 37310797 PMCID: PMC10546813 DOI: 10.1093/oncolo/oyad152] [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: 08/29/2022] [Accepted: 04/22/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Prospective data about quality of life (QoL) in men with breast cancer (BC) are lacking. A prospective registry (EORTC10085) of men with all BC stages, including a QoL correlative study, was performed as part of the International Male Breast Cancer Program. METHODS Questionnaires at BC diagnosis included the EORTC QLQ-C30 and BR23 (BC specific module), adapted for men. High functioning and global health/QoL scores indicate high functioning levels/high QoL; high symptom-focused measures scores indicate high symptoms/problems levels. EORTC reference data for healthy men and women with BC were used for comparisons. RESULTS Of 422 men consenting to participate, 363 were evaluable. Median age was 67 years, and median time between diagnosis and survey was 1.1 months. A total of 114 men (45%) had node-positive early disease, and 28 (8%) had advanced disease. Baseline mean global health status score was 73 (SD: 21), better than in female BC reference data (62, SD: 25). Common symptoms in male BC were fatigue (22, SD: 24), insomnia (21, SD: 28), and pain (16, SD: 23), for which women's mean scores indicated more burdensome symptoms at 33 (SD: 26), 30 (SD: 32), and 29 (SD: 29). Men's mean sexual activity score was 31 (SD: 26), with less sexual activity in older patients or advanced disease. CONCLUSIONS QoL and symptom burden in male BC patients appears no worse (and possibly better) than that in female patients. Future analyses on impact of treatment on symptoms and QoL over time, may support tailoring of male BC management.
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Affiliation(s)
- Carolien P Schröder
- Department Medical Oncology, Netherlands Cancer Institute Amsterdam and University Medical Center Groningen, The Netherlands
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Barbro Linderholm
- Department of Oncologym, Sahlgrenska University Hospital, Gothenburg, Sweden and Swedish Association of Breast Oncologists (SABO), Sweden
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Antonio C Wolff
- Department of Medical Oncology, Johns Hopkins, Baltimore, MD, USA
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | | | - Miguel H Abreu
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | | | - Irma den Hoed
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala, Zwolle, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Jose P Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Nicola S Russell
- Department of Radiotherapy, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis’s Hertogenbosch, The Netherlands
| | | | | | - Marije M Vleugel
- Department of Medical Oncology, Waterlandziekenhuis, Purmerend, The Netherlands
| | - Rachel L Yung
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Sharon H Giordano
- Department of Health Services Research and Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Wytiaz V, Van Poznak C. Checkpoint Inhibitors in Bone Metastatic Disease in Solid Tumors. Curr Osteoporos Rep 2023:10.1007/s11914-023-00798-3. [PMID: 37294479 DOI: 10.1007/s11914-023-00798-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW Bone is a common site of metastatic spread for solid tumors. Bone as an organ serves unique roles in the body's structural integrity, hematopoiesis, and the development of immune modulating cells. With the increasing use of immunotherapy, specifically immune checkpoint inhibitors, understanding the response of bone metastases is necessary. RECENT FINDINGS The data on checkpoint inhibitors used for managing solid tumors are reviewed here with a focus on bone metastases. Albeit with limited available data, there is a trend toward poorer outcomes in this setting, presumably due to the unique immune microenvironment within bone and bone marrow. Despite the potential to improve cancer outcomes with use of ICIs, bone metastases remain challenging to manage and may have different responses to ICIs than other disease sites. Areas for future investigation include a nuanced understanding of the bone microenvironment and dedicated research aimed at specific bone metastases outcomes.
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Affiliation(s)
- Victoria Wytiaz
- Division of Hematology Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Catherine Van Poznak
- Division of Hematology Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Freedman R, Ren S, Tayob N, Gelman R, Smith KL, Davis R, Pereslete A, Attaya V, Cotter C, Chen WY, Santa-Maria CA, Van Poznak C, Moy B, Brufsky AM, Melisko M, O’Sullivan CC, Ashai N, Rauf Y, Nangia J, Trapani D, Savoie J, Burns R, Wolff AC, Winer E, Rimawi M, Krop I, Lin NU. Abstract PD7-03: Translational Breast Cancer Research Consortium Trial 022: Neratinib and Trastuzumab-Emtansine for HER2+ Breast Cancer Brain Metastases (BCBM). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd7-03] [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: 03/06/2023]
Abstract
Abstract
PURPOSE: Treatment options for patients (pts) with HER2+ BCBM remain limited. We previously reported that neratinib monotherapy is associated with a volumetric central nervous system objective response rate (CNS ORR) of 8%, whereas the combination of neratinib and capecitabine resulted in a volumetric CNS ORR of 49% (in lapatinib-naïve pts). Preclinical data suggest that neratinib may overcome resistance to trastuzumab-emtansine (T-DM1) and that the combination has potential CNS efficacy. Here, we report results of neratinib plus T-DM1 in pts with HER2+ BCBM. PATIENTS AND METHODS: In this prospective, multicenter, phase II study, pts with measurable HER2+ BCBM received neratinib 160 mg orally once daily plus T-DM1 3.6 mg/kg IV every 21 days in three parallel-enrolling cohorts. Cohort 4A enrolled pts with previously untreated brain metastases. Cohort 4B enrolled pts with BCBM progressing after prior local CNS-directed therapy without prior exposure to T-DM1. Cohort 4C enrolled pts with BCBM progressing after prior local CNS-directed therapy who had previous exposure to T-DM1. Diarrhea prophylaxis with colestipol and loperamide was required during cycle 1. Cohorts 4A and 4B were single-stage with a planned enrollment of 20 patients; cohort 4C had a two-stage design, with a requirement for at least 1 of the first 9 pts to achieve a response in order to enroll a total of 24 patients. The primary endpoint was Response Assessment in Neuro-Oncology-Brain Metastases (RANO BM) in each cohort separately. Correlative studies included patient-reported outcomes (PROs) for gastrointestinal toxicity. RESULTS: We enrolled 6, 17, and 21 patients to cohorts 4A, 4B, and 4C, during 11/07/2018 – 11/01/2021. Enrollment was stopped prematurely due to slow accrual. Across Cohorts 4A-4C, the median number of prior lines of chemotherapy prior to enrollment was 2 (range 1-10); 25% received prior lapatinib and no patients received prior tucatinib. In cohorts 4B and 4C (prior CNS-treated cohorts), 33% had prior CNS surgery and >94% had prior CNS radiation. Among evaluable patients, CNS ORR in cohorts 4A (n=6), 4B (n=16), and 4C (n=21) was 50.0% (95% CI 18.8- 81.2%), 25.0% (95% CI 8.3-52.6%), and 38.1% (95% CI 19.0-61.3%), respectively. Median (range) number of cycles completed for 4A, 4B, and 4C was 4.5 (1-15), 4 (range 0-49+), and 6 (0-23); three patients on Cohort 4B remain on protocol therapy (cycles 14, 45, and 49). The overall survival at 12-months for cohorts 4A, 4B, and 4C was 83.3% (95% CI, 58.3-100%), 86.2% (95% CI 70-100%), and 83.3% (95% CI 67.6-100%). Diarrhea was the most common grade 3 toxicity (19.0–33.3% across cohorts); one grade 4 liver function event occurred in cohort 4B. Updated efficacy results will be reported at the meeting; PRO analyses are ongoing. CONCLUSION: Intracranial activity was observed for the combination of neratinib plus T-DM1 across all three enrolled cohorts, including those with prior T-DM1 exposure, suggesting synergistic effects of this treatment combination. Our data provide additional evidence for consideration of neratinib-based combinations in pts with HER2+ BCBM.
Citation Format: Rachel Freedman, Siyang Ren, Nabihah Tayob, Rebecca Gelman, Karen L. Smith, Raechel Davis, Alyssa Pereslete, Victoria Attaya, Christine Cotter, Wendy Y. Chen, Cesar Augusto Santa-Maria, Catherine Van Poznak, Beverly Moy, Adam M. Brufsky, Michelle Melisko, Ciara C. O’Sullivan, Nadia Ashai, Yasmeen Rauf, Julie Nangia, Dario Trapani, Jennifer Savoie, Robyn Burns, Antonio C. Wolff, Eric Winer, Mothaffar Rimawi, Ian Krop, Nancy U. Lin. Translational Breast Cancer Research Consortium Trial 022: Neratinib and Trastuzumab-Emtansine for HER2+ Breast Cancer Brain Metastases (BCBM) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD7-03.
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Affiliation(s)
| | | | | | | | - Karen L. Smith
- 5Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | | | | | | | | | | | | | | | - Adam M. Brufsky
- 14UPMC Hillman Cancer Center, University of Pittsburgh Medical Center
| | - Michelle Melisko
- 15University of California at San Francisco, San Francisco, California
| | | | | | | | | | | | | | - Robyn Burns
- 22Translational Breast Cancer Research Consortium
| | | | | | | | - Ian Krop
- 26Yale School of Medicine, New Haven, Connecticut
| | - Nancy U. Lin
- 27Dana-Farber Cancer Institute, Boston, Massachusetts
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Tarantino P, Tayob N, Dang CT, Yardley D, Isakoff SJ, Valero V, Faggen M, Mulvey T, Bose R, Weckstein D, Wolff AC, Reeder-Hayes K, Rugo H, Ramaswamy B, Zuckerman D, Hart L, Gadi VK, Constantine M, Cheng K, Garrett AM, Marcom PK, Albain KS, DeFusco P, Tung N, Ardman B, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu MC, Ruddy K, Zheng Y, Barroso-Sousa R, Waks A, DeMeo MK, DiLullo MK, Curigliano G, Burstein H, Partridge A, Winer E, Viale G, Hui W, Mittendorf EA, Schneider BP, Prat A, Krop I, Tolaney S. Abstract PD18-01: Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd18-01] [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: 03/06/2023]
Abstract
Abstract
Background: The ATEMPT trial primary analysis found that one year of adjuvant trastuzumab emtansine (T-DM1) achieved a 3-year iDFS of 97.8% for patients with stage I HER2+ breast cancer, but was not associated with fewer clinically relevant toxicities (CRTs) compared with paclitaxel and trastuzumab (TH). In this end-of-study analysis, we report 5-year survival outcomes and correlative analyses from the trial. Methods: Patients with stage I centrally confirmed HER2+ breast cancer were randomly assigned 3:1 to adjuvant T-DM1 for one year or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or paclitaxel 80 mg/m2 IV with weekly trastuzumab IV followed by trastuzumab for 9 months. The co-primary objectives were to compare the incidence of CRTs between the 2 arms and to evaluate iDFS in patients receiving T-DM1. To investigate proteomic correlates of recurrence, spatial proteomic analyses were performed on samples from 13 patients experiencing iDFS events (cases) and 24 matched controls using the NanoString GeoMx Digital Spatial Profiler. The impact of HER2 heterogeneity on outcomes was investigated among 17 cases and 51 matched controls by fluorescence in-situ hybridization (FISH). HER2 genetic heterogeneity was assessed by scrutinizing the whole tumor area and defined as the occurrence of HER2 gene amplification in >5% but < 50% invasive tumor cells. The risk of recurrence was evaluated centrally with the HER2DX genomic assay from 225 primary tumor samples. Germline whole genome sequencing (WGS) was conducted among 55 patients experiencing T-DM1-induced thrombocytopenia and/or bleeding and 55 matched controls to identify genomic correlates for this side effect. Results: A total of 497 patients who initiated protocol therapy were included in this analysis (383 T-DM1 and 114 TH). After a median follow up 5.8 years, among patients receiving T-DM1 there were a total of 11 iDFS events, with 3 distant recurrences. The 5-year iDFS for T-DM1 was 97.0% (95% CI, 95.3-98.8%), the 5-year recurrence-free interval (RFI) was 98.6% (95% CI: 97.4-99.8%) and the 5-year overall survival (OS) for T-DM1 was 97.8 % (95% CI, 96.3-99.3%). Although the study was not powered to evaluate the efficacy of TH, among the 114 patients receiving TH, a total of 9 iDFS events were observed, including 2 distant events; the 5-year iDFS with TH was 91.3% (95% CI: 86.0-96.9%), 5-year RFI was 93.3% (95% CI: 88.6-98.2%) and 5-year OS was 97.9% (95% CI: 95.2-100%). A total of 56 samples were evaluable for heterogeneity analyses, among which 14% (n=8) harbored HER2 genetic heterogeneity. Spatial proteomic analyses found that NF1 (adjusted p=0.72 × 10-6) and CTLA-4 (adjusted p=0.15 × 10-3) were significantly upregulated in primary samples from cases, while cleaved caspase 9, CD25, GITR, ICOS, p53 and PD-L2 were significantly upregulated in controls (all with adjusted p< 0.05). Germline WGS found that the top gene associations with thrombocytopenia and thrombocytopenia or bleeding were ALMS1 (p=0,19 × 10-3) and APBA3 (p=0,23 × 10-3), respectively, although none reaching the threshold for genome wide significance. rs62143195 and rs114169776 were the top single nucleotide polymorphisms associated with thrombocytopenia and thrombocytopenia or bleeding, respectively. Data on the impact of HER2 heterogeneity and of HER2DX score on survival outcomes will be presented. Conclusion: With longer follow-up, adjuvant T-DM1 confirmed outstanding long-term outcomes among patients with stage I HER2+ breast cancer, demonstrating a 5-year RFI of 98.6%. Spatial proteomic analyses identified a potential association between NF1 and CTLA-4 expression with recurrence. Details on the impact of HER2 heterogeneity and HER2DX assay on prognosis will be presented.
Citation Format: Paolo Tarantino, Nabihah Tayob, Chau T Dang, Denise Yardley, Steven J. Isakoff, Vicente Valero, Meredith Faggen, Therese Mulvey, Ron Bose, Douglas Weckstein, Antonio C. Wolff, Katherine Reeder-Hayes, Hope Rugo, Bhuvaneswari Ramaswamy, Dan Zuckerman, Lowell Hart, Vijayakrishna K. Gadi, Michael Constantine, Kit Cheng, Audrey Merrill Garrett, Paul K. Marcom, Kathy S. Albain, Patricia DeFusco, Nadine Tung, Blair Ardman, Rita Nanda, Rachel C. Jankowitz, Mothaffar Rimawi, Vandana Abramson, Paula R. Pohlmann, Catherine Van Poznak, Andres Forero-Torres, Minetta C. Liu, Kathryn Ruddy, Yue Zheng, Romualdo Barroso-Sousa, Adrienne Waks, Michelle K. DeMeo, Molly K. DiLullo, Giuseppe Curigliano, Harold Burstein, Ann Partridge, Eric Winer, Giuseppe Viale, Winnie Hui, Elizabeth A. Mittendorf, Bryan P. Schneider, Aleix Prat, Ian Krop, Sara Tolaney. Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-01.
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Affiliation(s)
- Paolo Tarantino
- 1Breast Oncology Program, Dana-Farber Cancer Institute; Harvard Medical School, Boston, Massachusetts
| | | | | | - Denise Yardley
- 4Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | | | - Vicente Valero
- 6Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Therese Mulvey
- 8Massachusetts General Hospital North Shore Cancer Center
| | - Ron Bose
- 9Washington University in St Louis School of Medicine
| | | | | | | | - Hope Rugo
- 13University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Kathy S. Albain
- 22Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center
| | | | - Nadine Tung
- 24Beth Israel Deaconess Medical Center, Boston
| | | | - Rita Nanda
- 26University of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giuseppe Viale
- 44European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | | | | | | | | | - Ian Krop
- 49Yale School of Medicine, New Haven, Connecticut
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El-Hajj Fuleihan G, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T, Van Poznak C, Wu JY, Drake MT. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:507-528. [PMID: 36545746 DOI: 10.1210/clinem/dgac621] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercalcemia of malignancy (HCM) is the most common metabolic complication of malignancies, but its incidence may be declining due to potent chemotherapeutic agents. The high mortality associated with HCM has declined markedly due to the introduction of increasingly effective chemotherapeutic drugs. Despite the widespread availability of efficacious medications to treat HCM, evidence-based recommendations to manage this debilitating condition are lacking. OBJECTIVE To develop guidelines for the treatment of adults with HCM. METHODS A multidisciplinary panel of clinical experts, together with experts in systematic literature review, identified and prioritized 8 clinical questions related to the treatment of HCM in adult patients. The systematic reviews (SRs) queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. An independent SR was conducted in parallel to assess patients' and physicians' values and preferences, costs, resources needed, acceptability, feasibility, equity, and other domains relevant to the Evidence-to-Decision framework as well as to enable judgements and recommendations. RESULTS The panel recommends (strong recommendation) in adults with HCM treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP). The following recommendations were based on low certainty of the evidence. The panel suggests (conditional recommendation) (1) in adults with HCM, the use of Dmab rather than an IV BP; (2) in adults with severe HCM, a combination of calcitonin and an IV BP or Dmab therapy as initial treatment; and (3) in adults with refractory/recurrent HCM despite treatment with BP, the use of Dmab. The panel suggests (conditional recommendation) the addition of an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. The panel suggests (conditional recommendation) in adult patients with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab). The panel judges the treatments as probably accessible and feasible for most recommendations but noted variability in costs, resources required, and their impact on equity. CONCLUSIONS The panel's recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders. Treatment of the primary malignancy is instrumental for controlling hypercalcemia and preventing its recurrence. The recommendations provide a framework for the medical management of adults with HCM and incorporate important decisional and contextual factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
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Affiliation(s)
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- MacGRADE Centre, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Department of Family Medicine, Queens University, Kingston, ON, K7L 3G2, Canada
- Peterborough Public Health, Peterborough, ON, K9J 2R8, Canada
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joy Y Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Drake
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Bone is a common site of metastases, particularly in advanced breast and prostate cancer. Skeletal related events associated with bone metastases include pathologic fracture, need for surgery/radiation to bone and cord compression. These events cause significant morbidity and mortality. Bisphosphonates as well as denosumab act on the bone microenvironment and reduce the rate of skeletal related events by approximately 25%-40%. Hence, these therapies are an important adjunctive therapy in cancer care. Despite the established efficacy and recommendations for their use in many international guidelines, these bone modifying agents are underutilized. This review examines the currently available guidelines on bone modifying agents in metastatic bone disease and summarizes their efficacy, risk and comparative benefits.
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Affiliation(s)
- Eric Schwartz
- Michigan Medicine: Rogel Cancer Center, United States of America.
| | - Zachery Reichert
- Michigan Medicine: Rogel Cancer Center, United States of America
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Bassatne A, Bou Khalil A, Chakhtoura M, Arabi A, Van Poznak C, El-Hajj Fuleihan G. Effect of antiresorptive therapy on aromatase inhibitor induced bone loss in postmenopausal women with early-stage breast cancer: A systematic review and meta-analysis of randomized controlled trials. Metabolism 2022; 128:154962. [PMID: 34958816 DOI: 10.1016/j.metabol.2021.154962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/30/2021] [Accepted: 12/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are routinely used to treat postmenopausal women with early-stage breast cancer. Although AIs improve breast cancer outcomes, they increase the risk of osteoporosis and fractures. This systematic review and meta-analysis assesses the effect of antiresorptive drugs on AI induced bone loss in postmenopausal women with non-metastatic breast cancer. METHODS We searched four databases until November 4th 2020. We included Randomized controlled trials (RCTs) of antiresorptive drugs in postmenopausal women with breast cancer treated with AI. Two authors screened studies, extracted data and assessed the risk of bias independently and in duplicate. RESULTS We identified 14 RCTs: 7 on zoledronic acid, 6 on oral bisphosphonates and 1 on denosumab. The mean difference in bone mineral density (BMD) was 5% at the lumbar spine and 4% at the total hip, at 12 months, favoring zoledronic acid compared to control. The certainty of the evidence was low for lumbar spine and moderate for total hip BMD. Similarly, the mean difference was 3% at the lumbar spine and 2% at the total hip, favoring oral bisphosphonates with moderate certainty. The mean difference was 6% at the lumbar spine, and 4% at the total hip BMD favoring denosumab compared to placebo. In addition, zoledronic acid resulted in a mean difference in bone turnover marker levels of -35-41%, and the relarive risk for morphometric vertebral fractures was 0.7 [0.3-1.4], compared to control. Denosumab reduced fracture incidence by 50% compared to placebo. CONCLUSION Evidence suggests a protective effect of antiresorptive drugs on BMD and bone turnover markers in postmenopausal women with non-metastatic breast cancer on AI. However, data on fracture risk reduction remains unclear.
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Affiliation(s)
- Aya Bassatne
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abir Bou Khalil
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asma Arabi
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Van Poznak C, Reynolds EL, Estilo CL, Hu M, Schneider BP, Hertz DL, Gersch C, Thibert J, Thomas D, Banerjee M, Rae JM, Hayes DF. Osteonecrosis of the jaw risk factors in bisphosphonate-treated patients with metastatic cancer. Oral Dis 2022; 28:193-201. [PMID: 33274559 PMCID: PMC8284838 DOI: 10.1111/odi.13746] [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: 05/04/2020] [Revised: 07/06/2020] [Accepted: 11/27/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND A case-control study was performed to define clinical and genetic risk factors associated with osteonecrosis of the jaw in patients with metastatic cancer treated with bisphosphonates. METHODS Clinical data and tissues were collected from patients treated with bisphosphonates for metastatic bone disease who were diagnosed with osteonecrosis of the jaw (cases) and matched controls. Clinical data included patient, behavioral, disease, and treatment information. Genetic polymorphisms in CYP2C8 (rs1934951) and other candidate genes were genotyped. Odds ratios from conditional logistic regression models were examined to identify clinical and genetic characteristics associated with case or control status. RESULTS The study population consisted of 76 cases and 126 controls. In the final multivariable clinical model, patients with osteonecrosis of the jaw were less likely to have received pamidronate than zoledronic acid (odds ratio = 0.18, 95% Confidence interval: 0.03-0.97, p = .047) and more likely to have been exposed to bevacizumab (OR = 5.15, 95% CI: 1.67-15.95, p = .005). The exploratory genetic analyses suggested a protective effect for VEGFC rs2333496 and risk effects for VEGFC rs7664413 and PPARG rs1152003. CONCLUSIONS We observed patients with ONJ were more likely to have been exposed to bevacizumab and zoledronic and identified potential genetic predictors that require validation prior to clinical translation.
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Affiliation(s)
- Catherine Van Poznak
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan
| | | | - Cherry L. Estilo
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Mimi Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center
| | - Bryan Paul Schneider
- Divisions of Hematology/Oncology and Clinical Pharmacology, Department of Medicine with a secondary appointment in the Department of Medical and Molecular Genetics, Indiana University
| | - Daniel L. Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy
| | - Christina Gersch
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan
| | | | | | | | - James M. Rae
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan
| | - Daniel F. Hayes
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan
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9
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Falvello V, Van Poznak C. Updates in Management of Bone Metastatic Disease in Primary Solid Tumors with Systemic Therapies. Curr Osteoporos Rep 2021; 19:452-461. [PMID: 34191239 DOI: 10.1007/s11914-021-00689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight novel and impactful discoveries in systemic treatment of bone metastatic disease in solid tumors published within the past 5 years. RECENT FINDINGS Major developments in systemic treatment of bone metastatic disease in solid tumors include evidence that decreasing frequency of dosing zoledronic acid in metastatic breast and prostate cancer maintains efficacy in preventing skeletal-related events while decreasing costs. The landmark findings on the use of Radium-223 to treat metastatic prostate cancer were reported in 2013. Recently, it has been found that not all systemic therapy combinations with Radium-223 are necessarily safe or effective unless bone-targeted therapy is also included in the regimen. More cost-effective dosing intervals of zoledronic acid and efficacy and safety nuances of combination radiopharmaceutical and chemotherapy treatment have been better delineated.
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Affiliation(s)
- Virginia Falvello
- Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA.
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10
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Ruddy KJ, Zheng Y, Tayob N, Hu J, Dang CT, Yardley DA, Isakoff SJ, Valero VV, Faggen MG, Mulvey TM, Bose R, Sella T, Weckstein DJ, Wolff AC, Reeder-Hayes KE, Rugo HS, Ramaswamy B, Zuckerman DS, Hart LL, Gadi VK, Constantine M, Cheng KL, Briccetti FM, Schneider BP, Merrill Garrett A, Kelly Marcom P, Albain KS, DeFusco PA, Tung NM, Ardman BM, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu MC, Rosenberg S, DeMeo MK, Burstein HJ, Winer EP, Krop IE, Partridge AH, Tolaney SM. Chemotherapy-related amenorrhea (CRA) after adjuvant ado-trastuzumab emtansine (T-DM1) compared to paclitaxel in combination with trastuzumab (TH) (TBCRC033: ATEMPT Trial). Breast Cancer Res Treat 2021; 189:103-110. [PMID: 34120223 DOI: 10.1007/s10549-021-06267-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemotherapy-related amenorrhea (CRA) is a surrogate for ovarian toxicity and associated risk of infertility and premature menopause. Here, we compare CRA rate with paclitaxel (T)-trastuzumab (H) to that with ado-trastuzumab emtansine (T-DM1). METHODS Patients with T1N0 HER2 + early-stage breast cancer (eBC) enrolled on the ATEMPT trial and were randomized 3:1 to T-DM1 3.6 mg/kg IV every (q) 3 weeks (w) × 17 vs. T 80 mg/m2 with H IV qw × 12 (4 mg/kg load → 2 mg/kg), followed by H (6 mg/kg IV q3w × 13). Enrollees who self-reported as premenopausal were asked to complete menstrual surveys at baseline and every 6-12 months for 60 months. 18-month CRA (no periods reported during prior 6 months on 18-month survey) was the primary endpoint of this analysis. RESULTS Of 512 ATEMPT enrollees, 123 who began protocol therapy and answered baseline and at least one follow-up menstrual survey were premenopausal at enrollment. 76 had menstrual data available at 18 months without having received a gonadotropin-releasing hormone agonist or undergone hysterectomy and/or oophorectomy. Median age was 45 (range 23-53) among 18 who had received TH and 46 (range 34-54) among 58 who had received T-DM1. The 18-month rate of CRA was 50% after TH and 24% after T-DM1 (p = 0.045). CONCLUSION Amenorrhea at 18 months was less likely in recipients of adjuvant T-DM1 than TH. Future studies are needed to understand how T-DM1 impacts risk of infertility and permanent menopause, and to assess amenorrhea rates when T-DM1 is administered after standard HER2-directed chemotherapy regimens.
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Affiliation(s)
- Kathryn J Ruddy
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yue Zheng
- Dana-Farber Cancer Institute, Boston, USA
| | | | - Jiani Hu
- Dana-Farber Cancer Institute, Boston, USA
| | - Chau T Dang
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | | | | | | | - Ron Bose
- Siteman Cancer Center, St. Louis, USA
| | - Tal Sella
- Dana-Farber Cancer Institute, Boston, USA
| | | | | | | | - Hope S Rugo
- Diller Family Comprehensive Cancer Center, University of California San Francisco Helen, San Francisco, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel C Jankowitz
- Penn Medicine Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mothaffar Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Minetta C Liu
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | | | - Ian E Krop
- Dana-Farber Cancer Institute, Boston, USA
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11
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Tolaney SM, Tayob N, Dang C, Yardley DA, Isakoff SJ, Valero V, Faggen M, Mulvey T, Bose R, Hu J, Weckstein D, Wolff AC, Reeder-Hayes K, Rugo HS, Ramaswamy B, Zuckerman D, Hart L, Gadi VK, Constantine M, Cheng K, Briccetti F, Schneider B, Garrett AM, Marcom K, Albain K, DeFusco P, Tung N, Ardman B, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu M, Ruddy K, Zheng Y, Rosenberg SM, Gelber RD, Trippa L, Barry W, DeMeo M, Burstein H, Partridge A, Winer EP, Krop I. Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT): A Randomized Clinical Trial. J Clin Oncol 2021; 39:2375-2385. [PMID: 34077270 DOI: 10.1200/jco.20.03398] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ATEMPT trial was designed to determine if treatment with trastuzumab emtansine (T-DM1) caused less toxicity than paclitaxel plus trastuzumab (TH) and yielded clinically acceptable invasive disease-free survival (iDFS) among patients with stage I human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC). METHODS Patients with stage I centrally confirmed HER2+ BC were randomly assigned 3:1 to T-DM1 or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or T 80 mg/m2 IV with H once every week × 12 weeks (4 mg/kg load →2 mg/kg), followed by H × 39 weeks (6 mg/kg once every 3 weeks). The co-primary objectives were to compare the incidence of clinically relevant toxicities (CRTs) in patients treated with T-DM1 versus TH and to evaluate iDFS in patients receiving T-DM1. RESULTS The analysis population includes all 497 patients who initiated protocol therapy (383 T-DM1 and 114 TH). CRTs were experienced by 46% of patients on T-DM1 and 47% of patients on TH (P = .83). The 3-year iDFS for T-DM1 was 97.8% (95% CI, 96.3 to 99.3), which rejected the null hypothesis (P < .0001). Serially collected patient-reported outcomes indicated that patients treated with T-DM1 had less neuropathy and alopecia and better work productivity compared with patients on TH. CONCLUSION Among patients with stage I HER2+ BC, one year of adjuvant T-DM1 was associated with excellent 3-year iDFS, but was not associated with fewer CRT compared with TH.
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Affiliation(s)
- Sara M Tolaney
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Denise A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ron Bose
- Washington University, St Louis, MO
| | - Jiani Hu
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | - Dan Zuckerman
- St Luke's Mountain States Tumor Institute, Boise, ID
| | - Lowell Hart
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Vijayakrishna K Gadi
- University of Washington, Seattle, WA. Currently at University of Illinois at Chicago, Chicago, IL
| | | | - Kit Cheng
- North Shore-LIJ Cancer Institute, Lake Success, NY
| | | | | | | | | | | | | | - Nadine Tung
- Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Mothaffar Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | | | | | - Yue Zheng
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Harold Burstein
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ann Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Eric P Winer
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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12
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Hassett MJ, Somerfield MR, Baker ER, Cardoso F, Kansal KJ, Kwait DC, Plichta JK, Ricker C, Roshal A, Ruddy KJ, Safer JD, Van Poznak C, Yung RL, Giordano SH. Management of Male Breast Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1849-1863. [PMID: 32058842 DOI: 10.1200/jco.19.03120] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To develop recommendations concerning the management of male breast cancer. METHODS ASCO convened an Expert Panel to develop recommendations based on a systematic review and a formal consensus process. RESULTS Twenty-six descriptive reports or observational studies met eligibility criteria and formed the evidentiary basis for the recommendations. RECOMMENDATIONS Many of the management approaches used for men with breast cancer are like those used for women. Men with hormone receptor-positive breast cancer who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years; those with a contraindication to tamoxifen may be offered a gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor. Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of therapy. Men with early-stage disease should not be treated with bone-modifying agents to prevent recurrence, but could still receive these agents to prevent or treat osteoporosis. Men with advanced or metastatic disease should be offered endocrine therapy as first-line therapy, except in cases of visceral crisis or rapidly progressive disease. Targeted systemic therapy may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women. Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy regardless of genetic predisposition; contralateral annual mammogram may be offered to men with a history of breast cancer and a genetic predisposing mutation. Breast magnetic resonance imaging is not recommended routinely. Genetic counseling and germline genetic testing of cancer predisposition genes should be offered to all men with breast cancer.
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Affiliation(s)
| | | | | | - Fatima Cardoso
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
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13
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O'Donnell PH, Trubetskoy V, Nurhussein-Patterson A, Hall JP, Nath A, Huo D, Fleming GF, Ingle JN, Abramson VG, Morrow PK, Storniolo AM, Forero A, Van Poznak C, Liu MC, Chang JC, Merkel DE, Peppercorn JM, Rugo HS, Dees EC, Hahn OM, Hoffman PC, Rosner GL, Huang RS, Ratain MJ, Cox N, Olopade OI, Wolff AC, Dolan ME, Nanda R. Clinical evaluation of germline polymorphisms associated with capecitabine toxicity in breast cancer: TBCRC-015. Breast Cancer Res Treat 2020; 181:623-633. [PMID: 32378051 DOI: 10.1007/s10549-020-05603-8] [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: 11/09/2019] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Capecitabine is important in breast cancer treatment but causes diarrhea and hand-foot syndrome (HFS), affecting adherence and quality of life. We sought to identify pharmacogenomic predictors of capecitabine toxicity using a novel monitoring tool. METHODS Patients with metastatic breast cancer were prospectively treated with capecitabine (2000 mg/m2/day, 14 days on/7 off). Patients completed in-person toxicity questionnaires (day 1/cycle) and automated phone-in assessments (days 8, 15). Correlation of genotypes with early and overall toxicity was the primary endpoint. RESULTS Two hundred and fifty-nine patients were enrolled (14 institutions). Diarrhea and HFS occurred in 52% (17% grade 3) and 69% (9% grade 3), respectively. Only 29% of patients completed four cycles without dose reduction/interruption. In 39%, the highest toxicity grade was captured via phone. Three single nucleotide polymorphisms (SNPs) associated with diarrhea-DPYD*5 (odds ratio [OR] 4.9; P = 0.0005), a MTHFR missense SNP (OR 3.3; P = 0.02), and a SNP upstream of MTRR (OR 3.0; P = 0.03). GWAS elucidated a novel HFS SNP (OR 3.0; P = 0.0007) near TNFSF4 (OX40L), a gene implicated in autoimmunity including autoimmune skin diseases never before implicated in HFS. Genotype-gene expression analyses of skin tissues identified rs11158568 (associated with HFS via GWAS) with expression of CHURC1, a transcriptional activator controlling fibroblast growth factor (beta = - 0.74; P = 1.46 × 10-23), representing a previously unidentified mechanism for HFS. CONCLUSIONS This is the first cancer pharmacogenomic study to use phone-in self-reporting, permitting augmented toxicity characterization. Three germline toxicity SNPs were replicated, and several novel SNPs/genes having strong functional relevance were discovered. If further validated, these markers could permit personalized capecitabine dosing.
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Affiliation(s)
- Peter H O'Donnell
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.
| | - Vassily Trubetskoy
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.,Universitatsmedizin Berlin Campus Charite Mitte, Berlin, Germany
| | | | - Julianne P Hall
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Aritro Nath
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Dezheng Huo
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Gini F Fleming
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | | | | | - P K Morrow
- MD Anderson Cancer Center, Houston, USA.,Amgen Inc, Thousand Oaks, USA
| | | | | | | | - Minetta C Liu
- Mayo Clinic, Rochester, USA.,Georgetown University, Washington, USA
| | | | | | | | - Hope S Rugo
- University of California, San Francisco, USA
| | | | - Olwen M Hahn
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Philip C Hoffman
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | | | - R Stephanie Huang
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.,University of Minnesota, Minneapolis, USA
| | - Mark J Ratain
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Nancy Cox
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.,Vanderbilt University, Nashville, USA
| | | | | | - M Eileen Dolan
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Rita Nanda
- The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
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14
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Lehmann BD, Abramson VG, Sanders ME, Mayer EL, Haddad TC, Nanda R, Van Poznak C, Storniolo AM, Nangia J, Gonzalez-Ericsson PI, Sanchez V, Johnson KN, Abramson RG, Chen SC, Shyr Y, Arteaga CL, Wolff AC, Pietenpol JA. TBCRC 032 IB/II Multicenter Study: Molecular Insights to AR Antagonist and PI3K Inhibitor Efficacy in Patients with AR + Metastatic Triple-Negative Breast Cancer. Clin Cancer Res 2020; 26:2111-2123. [PMID: 31822498 PMCID: PMC7196503 DOI: 10.1158/1078-0432.ccr-19-2170] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 07/01/2019] [Revised: 08/23/2019] [Accepted: 12/04/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Preclinical data demonstrating androgen receptor (AR)-positive (AR+) triple-negative breast cancer (TNBC) cells are sensitive to AR antagonists, and PI3K inhibition catalyzed an investigator-initiated, multi-institutional phase Ib/II study TBCRC032. The trial investigated the safety and efficacy of the AR-antagonist enzalutamide alone or in combination with the PI3K inhibitor taselisib in patients with metastatic AR+ (≥10%) breast cancer. PATIENTS AND METHODS Phase Ib patients [estrogen receptor positive (ER+) or TNBC] with AR+ breast cancer received 160 mg enzalutamide in combination with taselisib to determine dose-limiting toxicities and the maximum tolerated dose (MTD). Phase II TNBC patients were randomized to receive either enzalutamide alone or in combination with 4 mg taselisib until disease progression. Primary endpoint was clinical benefit rate (CBR) at 16 weeks. RESULTS The combination was tolerated, and the MTD was not reached. The adverse events were hyperglycemia and skin rash. Overall, CBR for evaluable patients receiving the combination was 35.7%, and median progression-free survival (PFS) was 3.4 months. Luminal AR (LAR) TNBC subtype patients trended toward better response compared with non-LAR (75.0% vs. 12.5%, P = 0.06), and increased PFS (4.6 vs. 2.0 months, P = 0.082). Genomic analyses revealed subtype-specific treatment response, and novel FGFR2 fusions and AR splice variants. CONCLUSIONS The combination of enzalutamide and taselisib increased CBR in TNBC patients with AR+ tumors. Correlative analyses suggest AR protein expression alone is insufficient for identifying patients with AR-dependent tumors and knowledge of tumor LAR subtype and AR splice variants may identify patients more or less likely to benefit from AR antagonists.
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Affiliation(s)
- Brian D. Lehmann
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vandana G. Abramson
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda E. Sanders
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, Vanderbilt University, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
| | | | | | - Rita Nanda
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | | | - Paula I. Gonzalez-Ericsson
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, Vanderbilt University, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Kimberly N. Johnson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard G. Abramson
- Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Center for Quantitative Sciences, Division of Cancer Biostatistics, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Center for Quantitative Sciences, Division of Cancer Biostatistics, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Carlos L. Arteaga
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Antonio C. Wolff
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer A. Pietenpol
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
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15
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Marcath LA, Kidwell KM, Vangipuram K, Gersch CL, Rae JM, Burness ML, Griggs JJ, Van Poznak C, Hayes DF, Smith EML, Henry NL, Beutler AS, Hertz DL. Genetic variation in EPHA contributes to sensitivity to paclitaxel-induced peripheral neuropathy. Br J Clin Pharmacol 2020; 86:880-890. [PMID: 31823378 DOI: 10.1111/bcp.14192] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/22/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS Chemotherapy-induced peripheral neuropathy (PN) is a treatment limiting toxicity of paclitaxel. We evaluated if EPHA genetic variation (EPHA4, EPHA5, EPHA6, and EPHA8) is associated with PN sensitivity by accounting for variability in systemic paclitaxel exposure (time above threshold). METHODS Germline DNA from 60 patients with breast cancer was sequenced. PN was measured using the 8-item sensory subscale (CIPN8) of the patient-reported CIPN20. Associations for 3 genetic models were tested by incorporating genetics into previously published PN prediction models integrating measured paclitaxel exposure and cumulative treatment. Significant associations were then tested for association with PN-related treatment disruption. RESULTS EPHA5 rs7349683 (minor allele frequency = 0.32) was associated with increased PN sensitivity (β-coefficient = 0.39, 95% confidence interval 0.11-0.67, p = 0.007). Setting a maximum tolerable threshold of CIPN8 = 30, optimal paclitaxel exposure target is shorter for rs7349683 homozygous (11.6 h) than heterozygous (12.6 h) or wild-type (13.6 h) patients. Total number of missense variants (median = 0, range 0-2) was associated with decreased PN sensitivity (β-coefficient: -0.42, 95% confidence interval -0.72 to -0.12, P = .006). No association with treatment disruption was detected for the total number of missense variants or rs7349683. CONCLUSION Isolating toxicity sensitivity by accounting for exposure is a novel approach, and rs7349683 represents a promising marker for PN sensitivity that may be used to individualize paclitaxel treatment.
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Affiliation(s)
- Lauren A Marcath
- Department of Pharmacotherapy, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Kelley M Kidwell
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kiran Vangipuram
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - James M Rae
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Monika L Burness
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine Van Poznak
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ellen M Lavoie Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andreas S Beutler
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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16
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Shapiro CL, Van Poznak C, Lacchetti C, Kirshner J, Eastell R, Gagel R, Smith S, Edwards BJ, Frank E, Lyman GH, Smith MR, Mhaskar R, Henderson T, Neuner J. Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2916-2946. [DOI: 10.1200/jco.19.01696] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The aim of this work is to provide evidence-based guidance on the management of osteoporosis in survivors of adult cancer. METHODS ASCO convened a multidisciplinary Expert Panel to develop guideline recommendations based on a systematic review of the literature. RESULTS The literature search of the 2018 systematic review by the US Preventive Services Task Force in the noncancer population was used as the evidentiary base upon which the Expert Panel based many of its recommendations. A total of 61 additional studies on topics and populations not covered in the US Preventive Services Task Force review were also included. Patients with cancer with metastatic disease and cancer survival outcomes related to bone-modifying agents are not included in this guideline. RECOMMENDATIONS Patients with nonmetastatic cancer may be at risk for osteoporotic fractures due to baseline risks or due to the added risks that are associated with their cancer therapy. Clinicians are advised to assess fracture risk using established tools. For those patients with substantial risk of osteoporotic fracture, the clinician should obtain a bone mineral density test. The bone health of all patients may benefit from optimizing nutrition, exercise, and lifestyle. When a pharmacologic agent is indicated, bisphosphonates or denosumab at osteoporosis-indicated dosages are the preferred interventions.
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Affiliation(s)
| | | | | | - Jeffrey Kirshner
- Hematology-Oncology Associates of Central New York, Syracuse, NY
| | | | | | | | - Beatrice J. Edwards
- University of Texas Dell Med School and Central Texas Veterans Healthcare System, Austin, TX
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17
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Swartz L, Egloff H, Morikawa A, Van Poznak C. OTHR-12. DRIVING RECOMMENDATIONS IN PATIENTS WITH NEWLY DIAGNOSED BREAST CANCER BRAIN METASTASES. Neurooncol Adv 2019. [PMCID: PMC7213238 DOI: 10.1093/noajnl/vdz014.089] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Approximately 5% of all patients with breast cancer develop breast cancer brain metastases (BCBM). Medical and legal guidance on health conditions associated with driving may vary by state. The paucity of data to guide clinicians’ recommendations on driving in the setting of BCBM prompted this review of clinical practice. The primary objective is to determine the frequency of provider-documented driving recommendations with secondary objectives to define associated clinical factors. METHODS: University of Michigan’s (UM) DataDirect tool retrospectively searched records dated 11/30/2012 to 11/30/2018 using ICD 9 and 10 codes for breast cancer (C50.912, C50.911, C50.919, 174.9, 175.9) and for brain metastases (C79.31, D49.6, D43.2, 198.3, 239.6). Eligibility criteria were: age ≥ 18, BCBM, UM pathology confirmation of breast cancer, CNS imaging at time of diagnosis performed or reviewed at UM, and UM consultation with medical oncology, radiation oncology, neuro-oncology, neurosurgery, or neurology within 4 weeks of BCBM diagnosis. Chart abstraction included clinical and demographic factors for descriptive analysis. RESULTS: Only 87 of the 188 identified subjects (46%) met eligibility criteria. The most common exclusions were non-breast cancer brain lesion (n=40), neither UM imaging nor pathology (n=23) and no intra-parenchymal brain metastases (n=22). Of the 87 eligible subjects, 21 (24%) had documented recommendations against driving. Five of the 7 subjects with documented seizure history within 4 weeks of diagnosis also had documented recommendations against driving. There were 32 of 87 subjects on anti-epileptics of which 13 had documented driving recommendations. CONCLUSIONS: The minority of patients (24%) with newly diagnosed BCBM had a documented recommendation against driving. Seizure activity was strongly associated with documentation of driving recommendations. Other than seizure activity, general parameters regarding the safety of driving with newly diagnosed BCBM are not well defined. Prospective study is indicated to provide data supported recommendations regarding driving with BCBM.
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18
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Andre F, Ismaila N, Henry NL, Somerfield MR, Bast RC, Barlow W, Collyar DE, Hammond ME, Kuderer NM, Liu MC, Van Poznak C, Wolff AC, Stearns V. Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: ASCO Clinical Practice Guideline Update—Integration of Results From TAILORx. J Clin Oncol 2019; 37:1956-1964. [DOI: 10.1200/jco.19.00945] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [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 This focused update addresses the use of Onco type DX in guiding decisions on the use of adjuvant systemic therapy. METHODS ASCO uses a signals approach to facilitate guideline updating. For this focused update, the publication of the Trial Assigning Individualized Options for Treatment (TAILORx) evaluating noninferiority of endocrine therapy alone versus chemoendocrine therapy for invasive disease–free survival in women with Onco type DX scores provided a signal. An expert panel reviewed the results of TAILORx along with other published literature on the Onco type DX assay to assess for evidence of clinical utility. UPDATED RECOMMENDATIONS For patients with hormone receptor–positive, axillary node–negative breast cancer whose tumors have Onco type DX recurrence scores of less than 26, there is little to no benefit from chemotherapy, especially for patients older than age 50 years. Clinicians may recommend endocrine therapy alone for women older than age 50 years. For patients 50 years of age or younger with recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy. Patients with recurrence scores greater than 30 should be considered candidates for chemoendocrine therapy. Based on informal consensus, the panel recommends that oncologists may offer chemoendocrine therapy to these patients with recurrence scores of 26 to 30. Additional information can be found at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
- Fabrice Andre
- Institute Gustave Roussy, Paris Sud University, Paris, France
| | | | - N. Lynn Henry
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Robert C. Bast
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Nicole M. Kuderer
- Advanced Cancer Research Group and University of Washington, Seattle, WA
| | | | | | - Antonio C. Wolff
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Vered Stearns
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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19
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Morikawa A, de Stanchina E, Pentsova E, Kemeny MM, Li BT, Tang K, Patil S, Fleisher M, Van Poznak C, Norton L, Seidman AD. Phase I Study of Intermittent High-Dose Lapatinib Alternating with Capecitabine for HER2-Positive Breast Cancer Patients with Central Nervous System Metastases. Clin Cancer Res 2019; 25:3784-3792. [PMID: 30988080 PMCID: PMC6773251 DOI: 10.1158/1078-0432.ccr-18-3502] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/25/2019] [Accepted: 04/09/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Lapatinib and capecitabine cross the blood-tumor barrier in breast cancer brain metastasis but have modest clinical efficacy. Administration of high-dose tyrosine kinase inhibitor has been evaluated in brain metastases and primary brain tumors as a strategy to improve drug exposure in the central nervous system (CNS). We derived a rational drug scheduling of intermittent high-dose lapatinib alternating with capecitabine based on our preclinical data and Norton-Simon mathematical modeling. We tested this intermittent, sequential drug schedule in patients with breast cancer with CNS metastasis. PATIENTS AND METHODS We conducted a phase I trial using an accelerated dose escalation design in patients with HER2-positive (HER2+) breast cancer with CNS metastasis. Lapatinib was given on day 1-3 and day 15-17 with capecitabine on day 8-14 and day 22-28 on an every 28-day cycle. Lapatinib dose was escalated, and capecitabine given as a flat dose at 1,500 mg BID. Toxicity and efficacy were evaluated. RESULTS Eleven patients were enrolled: brain only (4 patients, 36%), leptomeningeal (5 patients, 45%), and intramedullary spinal cord (2 patients, 18%). Grade 3 nausea and vomiting were dose-limiting toxicities. The MTD of lapatinib was 1,500 mg BID. Three patients remained on therapy for greater than 6 months. CONCLUSIONS High-dose lapatinib is tolerable when given intermittently and sequentially with capecitabine. Antitumor activity was noted in both CNS and non-CNS sites of disease. This novel administration regimen is feasible and efficacious in patients with HER2+ breast cancer with CNS metastasis and warrants further investigation.
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Affiliation(s)
- Aki Morikawa
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elisa de Stanchina
- Antitumor Assessment Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret M Kemeny
- Queens Cancer Center of New York City Health and Hospitals, Queens, New York
| | - Bob T Li
- Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kendrick Tang
- Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sujata Patil
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin Fleisher
- Clinical Chemistry Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Van Poznak
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Larry Norton
- Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Seidman
- Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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20
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Awan AA, Hutton B, Hilton J, Mazzarello S, Van Poznak C, Vandermeer L, Bota B, Stober C, Sienkiewicz M, Fergusson D, Shorr R, Clemons M. De-escalation of bone-modifying agents in patients with bone metastases from breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2019; 176:507-517. [PMID: 31079283 DOI: 10.1007/s10549-019-05265-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Bone-modifying agents (BMAs) such as bisphosphonates and denosumab are usually administered every 4 weeks (standard) in patients with bone metastases from breast cancer to prevent skeletal-related events (SREs). Recent randomized controlled trials suggest every 12-week (de-escalated) dosing interval may be non-inferior. The objective of this systematic review and meta-analysis was to compare the efficacy and harms of standard with de-escalated administration of BMA's in patients with bone metastases from breast cancer. METHODS We searched Medline, PubMed, and the Cochrane Register of Controlled Trials from 1947 to March 14, 2018 and conference abstracts from (2014-March 14, 2018) for randomized clinical trials comparing every 4-week and every 12-week dosing interval of bone-modifying agents. Using PRISMA guidelines, meta-analyses were performed using random-effects models, with findings reported as risk ratios with 95% confidence intervals (CI). RESULTS From a total of 1311 citations, we identified 8 full-text articles and 1 abstract comprising data from 5 completed randomized clinical trials (n = 1807). Zoledronate administration every 12 weeks compared to every 4 weeks produced a summary risk ratio of 1.05 (95% CI 0.88-1.25) for patients with ≥ 1 on-study SRE indicating similar efficacy. These results did not differ whether patients had received prior intravenous bisphosphonate. De-escalation was associated with a non-statistically significant lower risk of increased creatinine (summary risk ratio 0.41 [95% CI 0.15-1.16]). Currently, there are insufficient data for pamidronate and denosumab de-escalation. CONCLUSIONS These data are supportive of de-escalation of zoledronate from onset for patients with bone metastases from breast cancer.
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Affiliation(s)
- Arif Ali Awan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Department of Medicine and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - John Hilton
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Sasha Mazzarello
- Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Lisa Vandermeer
- Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brianne Bota
- Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Carol Stober
- Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marta Sienkiewicz
- Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dean Fergusson
- Department of Medicine and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | | | - Mark Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada. .,Department of Medicine and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. .,Cancer Research Group, Ottawa Hospital Research Institute, Ottawa, Canada.
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21
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Messer JG, Jiron JM, Mendieta Calle JL, Castillo EJ, Israel R, Phillips EG, Yarrow JF, Van Poznak C, Kesavalu L, Kimmel DB, Aguirre JI. Zoledronate treatment duration is linked to bisphosphonate-related osteonecrosis of the jaw prevalence in rice rats with generalized periodontitis. Oral Dis 2019; 25:1116-1135. [PMID: 30712276 PMCID: PMC6487955 DOI: 10.1111/odi.13052] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the extent that zoledronate (ZOL) dose and duration is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) prevalence in rice rats with generalized periodontitis (PD), characterize structural and tissue-level features of BRONJ-like lesions in this model, and examine the specific anti-resorptive role of ZOL in BRONJ. MATERIALS AND METHODS Rice rats (n = 228) consumed high sucrose-casein diet to enhance generalized PD. Groups of rats received 0, 8, 20, 50 or 125 µg/kg IV ZOL/4 weeks encompassing osteoporosis and oncology ZOL doses. Rats from each dose group (n = 9-16) were necropsied after 12, 18, 24 and 30 weeks of treatment. BRONJ-like lesion prevalence and tissue-level features were assessed grossly, histopathologically and by MicroCT. ZOL bone turnover effects were assessed by femoral peripheral quantitative computed tomography, serum bone turnover marker ELISAs and osteoclast immunolabelling. RESULTS Prevalence of BRONJ-like lesions was significantly associated with (a) ZOL treatment duration, but plateaued at the lowest oncologic dose, and (b) there was a similar dose-related plateau in the systemic anti-resorptive effect of ZOL. ZOL and BRONJ-like lesions also altered the structural and tissue-level features of the jaw. CONCLUSION The relationship between BRONJ-like lesion prevalence and ZOL dose and duration varies depending on the co- or pre-existing oral risk factor. At clinically relevant doses of ZOL, BRONJ-like lesions are associated with anti-resorptive activity.
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Affiliation(s)
- Jonathan G Messer
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Jessica M Jiron
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | | | - Evelyn J Castillo
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Ronnie Israel
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Ean G Phillips
- Research Service, VA Medical Center, Gainesville, Florida
| | | | | | - Lakshmyya Kesavalu
- Department of Periodontology and Oral Biology, College of Dentistry, Gainesville, Florida
| | - Donald B Kimmel
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - J Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
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22
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Marcath LA, Kidwell KM, Robinson AC, Vangipuram K, Burness ML, Griggs JJ, Poznak CV, Schott AF, Hayes DF, Henry NL, Hertz DL. Patients carrying CYP2C8*3 have shorter systemic paclitaxel exposure. Pharmacogenomics 2018; 20:95-104. [PMID: 30520341 DOI: 10.2217/pgs-2018-0162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM First, evaluate if patients carrying putatively diminished activity CYP2C8 genotype have longer paclitaxel exposure (e.g., time above threshold concentration of 0.05 μM [Tc >0.05]). Second, screen additional pharmacogenes for associations with Tc >0.05. Methods: Pharmacogene panel genotypes were translated into genetic phenotypes for associations with Tc >0.05 (n = 58). RESULTS Patients with predicted low-activity CYP2C8 had shorter Tc >0.05 after adjustment for age, body surface area and race (9.65 vs 11.03 hrs, β = 5.47, p = 0.02). This association was attributed to CYP2C8*3 (p = 0.006), not CYP2C8*4 (p = 0.58). Patients with predicted low-activity SLCO1B1 had longer Tc >0.05 (12.12 vs 10.15 hrs, β = 0.85, p = 0.012). CONCLUSION Contrary to previous publications, CYP2C8*3 may confer increased paclitaxel metabolic activity. SLCO1B1 and CYP2C8 genotype may explain some paclitaxel pharmacokinetic variability.
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Affiliation(s)
- Lauren A Marcath
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| | - Kelley M Kidwell
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Adam C Robinson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| | - Kiran Vangipuram
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| | - Monika L Burness
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jennifer J Griggs
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Catherine Van Poznak
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Anne F Schott
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Norah Lynn Henry
- Department of Internal Medicine, Division of Oncology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, MI 48109, USA
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23
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Choksi P, Rothberg A, Kraftson A, Miller N, Zurales K, Burant C, Van Poznak C, Peterson M. Weight loss and bone mineral density in obese adults: a longitudinal analysis of the influence of very low energy diets. Clin Diabetes Endocrinol 2018; 4:14. [PMID: 29946482 PMCID: PMC6006774 DOI: 10.1186/s40842-018-0063-6] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Background The long-term effect of weight reduction on skeletal health is not well understood. The purpose of this study was to examine the impact of an intensive medical weight loss intervention using very low energy diet (VLED) (~ 800 cal/day) that result in significant changes in body weight, on total body bone mineral density (BMD) over 2 years. Methods We examined the impact of VLED-induced weight loss on BMD and FFM (Fat-free Mass) after 3–6 months and again while in weight maintenance at 2 years in 49 subjects. The effects of absolute and relative rate of weight reduction assessed by change in weight in kilograms were assessed using general linear modeling, with baseline BMD (or FFM) as a covariate, and age, sex and changes in body weight as primary model predictors. Results At the end of 2 years, the average weight loss was greater for men (weight: 23.51 ± 12.5 kg) than women (weight: 16.8 ± 19.2 kg) and BMD loss was greater among women (0.03 ± 0.04 g/cm2 vs 0.01 ± 0.04 g/cm2) (all p < 0.05). After adjusting for baseline BMD, age, and sex, there was a small but significant association between total weight loss and 2-year BMD (β = − 0.001 g/cm2; p = 0.01). Similarly, there was a significant independent association between total weight loss and 2-year FFM (β = − 116.5 g; p < 0.01). Conclusions Despite significant weight loss with VLED, there was only a small loss is BMD.
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Affiliation(s)
- Palak Choksi
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA
| | - Amy Rothberg
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA.,4Department of Nutritional Sciences, University of Michigan, Ann Arbor, USA
| | - Andrew Kraftson
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA
| | - Nicole Miller
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA
| | - Katherine Zurales
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA
| | - Charles Burant
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA.,2Molecular and Integrative Physiology, University of Michigan, Ann Arbor, USA.,4Department of Nutritional Sciences, University of Michigan, Ann Arbor, USA
| | - Catherine Van Poznak
- 1Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106 USA
| | - Mark Peterson
- 3Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA
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24
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Taxel P, Faircloth E, Idrees S, Van Poznak C. Cancer Treatment-Induced Bone Loss in Women With Breast Cancer and Men With Prostate Cancer. J Endocr Soc 2018; 2:574-588. [PMID: 29942922 PMCID: PMC6007245 DOI: 10.1210/js.2018-00052] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Cancer and cancer therapies can have a negative impact on bone health. Because cancer is a common diagnosis, survivorship concerns for osteoporosis and fragility fractures are an important component of care. This review addresses management of bone health in nonmetastatic cancer survivorship with a focus on breast cancer and prostate cancer.
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Affiliation(s)
| | | | - Sana Idrees
- Saint Vincent's Hospital, Bridgeport, Connecticut
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25
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Hertz DL, Kidwell KM, Vangipuram K, Li F, Pai MP, Burness M, Griggs JJ, Schott AF, Van Poznak C, Hayes DF, Lavoie Smith EM, Henry NL. Paclitaxel Plasma Concentration after the First Infusion Predicts Treatment-Limiting Peripheral Neuropathy. Clin Cancer Res 2018; 24:3602-3610. [PMID: 29703818 DOI: 10.1158/1078-0432.ccr-18-0656] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/28/2022]
Abstract
Purpose: Paclitaxel exposure, specifically the maximum concentration (Cmax) and amount of time the concentration remains above 0.05 μmol/L (Tc>0.05), has been associated with the occurrence of paclitaxel-induced peripheral neuropathy. The objective of this study was to validate the relationship between paclitaxel exposure and peripheral neuropathy.Experimental Design: Patients with breast cancer receiving paclitaxel 80 mg/m2 × 12 weekly doses were enrolled in an observational clinical study (NCT02338115). Paclitaxel plasma concentration was measured at the end of and 16-26 hours after the first infusion to estimate Cmax and Tc>0.05 Patient-reported peripheral neuropathy was collected via CIPN20 at each dose, and an 8-item sensory subscale (CIPN8) was used in the primary analysis to test for an association with Tc>0.05 Secondary analyses were conducted using Cmax as an alternative exposure parameter and testing each parameter with a secondary endpoint of the occurrence of peripheral neuropathy-induced treatment disruption.Results: In 60 subjects included in the analysis, the increase in CIPN8 during treatment was associated with baseline CIPN8, cumulative dose, and relative dose intensity (P < 0.05), but neither Tc>0.05 (P = 0.27) nor Cmax (P = 0.99). In analyses of the secondary endpoint, cumulative dose (OR = 1.46; 95% confidence interval (CI), 1.18-1.80; P = 0.0008) and Tc>0.05 (OR = 1.79; 95% CI, 1.06-3.01; P = 0.029) or Cmax (OR = 2.74; 95% CI, 1.45-5.20; P = 0.002) were associated with peripheral neuropathy-induced treatment disruption.Conclusions: Paclitaxel exposure is predictive of the occurrence of treatment-limiting peripheral neuropathy in patients receiving weekly paclitaxel for breast cancer. Studies are warranted to determine whether exposure-guided dosing enhances treatment effectiveness and/or prevents peripheral neuropathy in these patients. Clin Cancer Res; 24(15); 3602-10. ©2018 AACR.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan. .,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Kelley M Kidwell
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kiran Vangipuram
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Feng Li
- Department of Pharmaceutical Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Manjunath P Pai
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Monika Burness
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer J Griggs
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anne F Schott
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Catherine Van Poznak
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ellen M Lavoie Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
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Van Poznak C, Somerfield MR, Barlow WE, Biermann JS, Bosserman LD, Clemons MJ, Dhesy-Thind SK, Dillmon MS, Eisen A, Frank ES, Jagsi R, Jimenez R, Theriault RL, Vandenberg TA, Yee GC, Moy B. Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology–Cancer Care Ontario Focused Guideline Update. J Clin Oncol 2017; 35:3978-3986. [DOI: 10.1200/jco.2017.75.4614] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management—analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management—be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Catherine Van Poznak
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Mark R. Somerfield
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - William E. Barlow
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - J. Sybil Biermann
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Linda D. Bosserman
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Mark J. Clemons
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Sukhbinder K. Dhesy-Thind
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Melissa S. Dillmon
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Andrea Eisen
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Elizabeth S. Frank
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Reshma Jagsi
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Rachel Jimenez
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Richard L. Theriault
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Theodore A. Vandenberg
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Gary C. Yee
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Beverly Moy
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
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Van Poznak C, Somerfield MR, Moy B. Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology–Cancer Care Ontario Focused Guideline Update Summary. J Oncol Pract 2017; 13:822-824. [DOI: 10.1200/jop.2017.027672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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)
- Catherine Van Poznak
- University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Massachusetts General Hospital, Boston, MA
| | - Mark R. Somerfield
- University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Massachusetts General Hospital, Boston, MA
| | - Beverly Moy
- University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and Massachusetts General Hospital, Boston, MA
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Calinescu A, Clines K, Moon HS, Taichman R, Van Poznak C, Clines G, Szerlip N. TMIC-05. THE DURA MATER MODULATES THE SURROUNDING MICROENVIRONMENT TO PROMOTE TUMOR GROWTH AND IMMUNE EVASION. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hortobagyi GN, Van Poznak C, Harker WG, Gradishar WJ, Chew H, Dakhil SR, Haley BB, Sauter N, Mohanlal R, Zheng M, Lipton A. Continued Treatment Effect of Zoledronic Acid Dosing Every 12 vs 4 Weeks in Women With Breast Cancer Metastatic to Bone: The OPTIMIZE-2 Randomized Clinical Trial. JAMA Oncol 2017; 3:906-912. [PMID: 28125763 DOI: 10.1001/jamaoncol.2016.6316] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Zoledronic acid, a potent bisphosphonate, is commonly administered to patients with bone metastases to reduce the risk of skeletal-related events (SREs). However, there have been concerns regarding its long-term monthly administration. Objective To examine whether zoledronic acid every 12 weeks was noninferior to zoledronic acid every 4 weeks in patients with metastatic breast cancer that involved the bone who had previously received a standard dosing regimen of zoledronic acid and/or pamidronate disodium. Design, Setting, and Participants OPTIMIZE-2 was a prospective, randomized, double-blind, multicenter phase 3 trial of intention-to-treat (full analysis set), evaluable (per protocol), and safety populations. Patients were randomized (1:1) to receive 4.0 mg of intravenous zoledronic acid every 4 or every 12 weeks with placebo for interim infusions for 1 year. The study was conducted at 102 clinical trial centers in the United States from March 3, 2006, to July 25, 2013. Data analysis was performed from October 7, 2013, to March 24, 2014. The study randomized 416 women (≥18 years old) with bone metastases from breast cancer who previously received 9 or more doses of zoledronic acid and/or pamidronate during the first 10 to 15 months of therapy. Main Outcomes and Measures The primary end point was the proportion of patients with 1 or more SRE on study (SRE rate). The key secondary end points included time to first SRE and skeletal morbidity rate (SMR). Results A total of 416 women were randomized: 200 patients received zoledronic acid every 4 weeks (mean [SD] age, 59.2 [11.1] years; 173 were white [86.5%]), 203 patients received zoledronic acid every 12 weeks (mean [SD] age, 58.6 [11.2] years; 178 were white [87.7%]), and 13 patients received placebo (mean [SD] age, 60.8 [12.2] years; 13 were white [100%]). Baseline characteristics were similar in both zoledronic acid treatment arms. After 1 year of follow-up, SREs occurred in 44 patients (22.0%) in the zoledronic acid every 4 weeks group and 47 patients (23.2%) in the zoledronic acid every 12 weeks group (proportional difference of -1.2%; 1-sided 97.5% CI bound of the difference in SRE rate between arms, -9.8%; noninferiority P = .02). The time to first SRE between treatment groups was not statistically significantly different (hazard ratio [HR], 1.06; 95% CI, 0.70-1.60; P = .79). The mean (SD) SMR was 0.46 (1.06) vs 0.50 (1.50) events per year in the every 4 weeks vs every 12 weeks groups (P = .85). The safety profiles of the every 4 weeks and every 12 weeks groups were comparable, with 189 patients (95.5%) in the every 4 weeks group having at least 1 adverse event compared with 189 (93.5%) in the every 12 weeks group. Conclusions and Relevance The every 12 weeks regimen of zoledronic acid was noninferior to the every 4 weeks regimen for the proportion of patients experiencing 1 or more SRE. These results may have a substantial influence on current clinical practice for treatment of patients with bone metastasis from breast cancer. Trial Registration clinicaltrials.gov Identifier: NCT00320710.
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Affiliation(s)
- Gabriel N Hortobagyi
- Department of Breast Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston
| | - Catherine Van Poznak
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - William J Gradishar
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Helen Chew
- Department of Internal Medicine-Hematology/Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Shaker R Dakhil
- Department of Hematology/Oncology, Cancer Center of Kansas, Wichita
| | - Barbara B Haley
- Department of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Nicholas Sauter
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey
| | - Ramon Mohanlal
- Consultant, AstraZeneca, London, England10Consultant, BeyondSpring Pharmaceuticals, New York, New York
| | - Ming Zheng
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey
| | - Allan Lipton
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Dhesy-Thind S, Fletcher GG, Clemons M, Van Poznak C. Reply to T.J. Powles et al. J Clin Oncol 2017; 35:2720-2721. [DOI: 10.1200/jco.2017.73.8567] [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: 11/20/2022] Open
Affiliation(s)
- Sukhbinder Dhesy-Thind
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; Glenn G. Fletcher, McMaster University, Hamilton, Ontario, Canada; Mark Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; and Catherine Van Poznak, University of Michigan, Ann Arbor, MI
| | - Glenn G. Fletcher
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; Glenn G. Fletcher, McMaster University, Hamilton, Ontario, Canada; Mark Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; and Catherine Van Poznak, University of Michigan, Ann Arbor, MI
| | - Mark Clemons
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; Glenn G. Fletcher, McMaster University, Hamilton, Ontario, Canada; Mark Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; and Catherine Van Poznak, University of Michigan, Ann Arbor, MI
| | - Catherine Van Poznak
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; Glenn G. Fletcher, McMaster University, Hamilton, Ontario, Canada; Mark Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; and Catherine Van Poznak, University of Michigan, Ann Arbor, MI
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Krop I, Ismaila N, Andre F, Bast RC, Barlow W, Collyar DE, Hammond ME, Kuderer NM, Liu MC, Mennel RG, Van Poznak C, Wolff AC, Stearns V. Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update. J Clin Oncol 2017; 35:2838-2847. [PMID: 28692382 DOI: 10.1200/jco.2017.74.0472] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose This focused update addresses the use of MammaPrint (Agendia, Irvine, CA) to guide decisions on the use of adjuvant systemic therapy. Methods ASCO uses a signals approach to facilitate guideline updates. For this focused update, the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study to evaluate the MammaPrint assay in 6,693 women with early-stage breast cancer provided a signal. An expert panel reviewed the results of the MINDACT study along with other published literature on the MammaPrint assay to assess for evidence of clinical utility. Recommendations If a patient has hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer, the MammaPrint assay may be used in those with high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy due to its ability to identify a good-prognosis population with potentially limited chemotherapy benefit. Women in the low clinical risk category did not benefit from chemotherapy regardless of genomic MammaPrint risk group. Therefore, the MammaPrint assay does not have clinical utility in such patients. If a patient has hormone receptor-positive, HER2-negative, node-positive breast cancer, the MammaPrint assay may be used in patients with one to three positive nodes and a high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy. However, such patients should be informed that a benefit from chemotherapy cannot be excluded, particularly in patients with greater than one involved lymph node. The clinician should not use the MammaPrint assay to guide decisions on adjuvant systemic therapy in patients with hormone receptor-positive, HER2-negative, node-positive breast cancer at low clinical risk, nor any patient with HER2-positive or triple-negative breast cancer, because of the lack of definitive data in these populations. Additional information can be found at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Ian Krop
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Nofisat Ismaila
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Fabrice Andre
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Robert C Bast
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - William Barlow
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Deborah E Collyar
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - M Elizabeth Hammond
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Nicole M Kuderer
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Minetta C Liu
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Robert G Mennel
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Catherine Van Poznak
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Antonio C Wolff
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
| | - Vered Stearns
- Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD
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Gnant M, Van Poznak C, Schnipper L. Therapeutic Bone-Modifying Agents in the Nonmetastatic Breast Cancer Setting: The Controversy and a Value Assessment. Am Soc Clin Oncol Educ Book 2017; 37:116-122. [PMID: 28561722 DOI: 10.1200/edbk_177357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical trials and meta-analyses investigating bisphosphonates as an adjuvant breast cancer therapy have shown a consistent trend, with postmenopausal women and women receiving ovarian suppression with gonadotropin-releasing hormone therapy gaining improved breast cancer outcomes with the use of adjuvant bisphosphonate therapy. The interpretation of these data is controversial, because the primary endpoints of the majority of adjuvant bisphosphonate studies have been negative. Pros and cons as well as the value of adjuvant bisphosphonate therapy are discussed here.
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Affiliation(s)
- Michael Gnant
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Catherine Van Poznak
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lowell Schnipper
- From the Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel, Austria; University of Michigan, Ann Arbor, MI; Hematology/Oncology Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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Eagle I, Benavides E, Eber R, Kolenic G, Jung Y, Van Poznak C, Taichman LS. Periodontal health in breast cancer patients on aromatase inhibitors versus postmenopausal controls: a longitudinal analysis. J Clin Periodontol 2016; 43:659-67. [PMID: 27062507 DOI: 10.1111/jcpe.12562] [Citation(s) in RCA: 10] [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] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to determine periodontal changes in postmenopausal breast cancer (BCa) survivors using aromatase inhibitors (AI) as compared to postmenopausal women without BCa. METHODS An 18-month prospective examination of periodontal health in postmenopausal women (29 receiving AI therapy; 29 women without BCa) was conducted at University of Michigan. Comprehensive periodontal examinations including alveolar bone height (ABH) were conducted at baseline, 6, 12, and 18 months. Bisphosphonate, vitamin D, and calcium supplementation were collected via chart review. Linear mixed models were utilized to investigate the relationship between AI and periodontal measures. RESULTS Aromatase inhibitor users had significantly deeper probing depths, more dental plaque and clinical attachment loss as compared to controls at the 6, 12, and 18 month study visits (p < 0.05). ABH loss was seen over time within the AI group. The linear mixed model showed a significant effect of time as well as an interaction between aromatase inhibitor use and calcium supplement status. AI users taking calcium experienced less ABH loss over the study than AI users not taking calcium (p = 0.005). CONCLUSION Aromatase inhibitor therapy has a negative impact on the periodontal health of postmenopausal BCa patients. Calcium supplementation appears to mitigate ABH loss in women on AI.
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Affiliation(s)
- Iwonka Eagle
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Robert Eber
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giselle Kolenic
- Division of Obstetrics and Gynecology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Younghun Jung
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Catherine Van Poznak
- Hematology and Oncology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - L Susan Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Mitri Z, Nanda R, Blackwell K, Costelloe CM, Hood I, Wei C, Brewster AM, Ibrahim NK, Koenig KB, Hortobagyi GN, Van Poznak C, Rimawi MF, Moulder-Thompson S. TBCRC-010: Phase I/II Study of Dasatinib in Combination with Zoledronic Acid for the Treatment of Breast Cancer Bone Metastasis. Clin Cancer Res 2016; 22:5706-5712. [PMID: 27166393 DOI: 10.1158/1078-0432.ccr-15-2845] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/23/2015] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Osteoclast-mediated bone resorption through src kinase releases growth factors, sustaining bone metastases. This trial determined the recommended phase II dose (RP2D) and clinical efficacy of the src kinase inhibitor dasatinib combined with zoledronic acid in bone predominant, HER2-negative breast cancer metastases. EXPERIMENTAL DESIGN A 3+3 lead in phase I design confirmed the RP2D allowing activation of the single-arm, phase II trial. Zoledronic acid was administered intravenously on day 1, and dasatinib was given orally once daily for 28 days each cycle as twice daily administration caused dose-limiting toxicity (DLT). Response was assessed every three cycles. N-telopeptide (NTx) was serially measured. RESULTS A total of 25 patients were enrolled. No DLTs were noted at the RP2D of dasatinib = 100 mg/d. Common adverse events were grade 1-2: rash (9/25, 36%), fatigue (9/25, 36%), pain (9/25, 36%), nausea (6/25, 20%). The objective response rate in bone was 5/22 (23%), all partial responses (PR). The clinical benefit rate [PRs + stable disease (SD) ≥ 6 months] in bone was 8/22 (36%). Median time to treatment failure was 2.70 months [95% confidence interval (CI), 1.84-5.72] in the general cohort, 3.65 months (95% CI, 1.97-7.33) in patients with hormone receptor (HR)-positive breast cancer and 0.70 months (95% CI, 0.30-NA) in those with HR-negative disease. Factors associated with response in bone included lower tumor grade, HR-positive status, and pretreatment high NTx levels. CONCLUSIONS Combination therapy was well tolerated and produced responses in bone in patients with HR-positive tumors. Clin Cancer Res; 22(23); 5706-12. ©2016 AACR.
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Affiliation(s)
- Zahi Mitri
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rita Nanda
- The University of Chicago, Chicago, Illinois
| | | | | | - Ilona Hood
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Nuhad K Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Harris LN, Ismaila N, McShane LM, Andre F, Collyar DE, Gonzalez-Angulo AM, Hammond EH, Kuderer NM, Liu MC, Mennel RG, Van Poznak C, Bast RC, Hayes DF. Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:1134-50. [PMID: 26858339 PMCID: PMC4933134 DOI: 10.1200/jco.2015.65.2289] [Citation(s) in RCA: 560] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. METHODS A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. RECOMMENDATIONS In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor/analysis
- Breast Neoplasms/chemistry
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Chemotherapy, Adjuvant
- Clinical Decision-Making/methods
- Comorbidity
- Disease-Free Survival
- Evidence-Based Medicine
- Female
- Humans
- Neoplasm Staging
- Plasminogen Activator Inhibitor 1/analysis
- Predictive Value of Tests
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Reproducibility of Results
- Survival Analysis
- Urokinase-Type Plasminogen Activator/analysis
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Affiliation(s)
- Lyndsay N Harris
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Nofisat Ismaila
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
| | - Lisa M McShane
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Fabrice Andre
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Deborah E Collyar
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Ana M Gonzalez-Angulo
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Elizabeth H Hammond
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Nicole M Kuderer
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Minetta C Liu
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Robert G Mennel
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Catherine Van Poznak
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Robert C Bast
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Daniel F Hayes
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Choksi P, Williams ME, Kidwel KM, Stella J, Soyster M, Hanauer D, Van Poznak C. Adjuvant Aromatase Inhibitors in Early Breast Cancer May Not Increase the Risk of Falls. Bone Rep Recommendations 2016; 2. [PMID: 27689141 PMCID: PMC5036389 DOI: 10.4172/2469-6684.100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Falling increases the risk for fracture. The impact of adjuvant aromatase inhibitors (AI) on the risk of falls is undefined. Methods A retrospective case control study was performed examining women with early stage breast cancer on adjuvant AI and matched controls without cancer. Fall and fracture data were abstracted from the medical record. Results Matched pairs of 332 women were identified (total N = 664). There was no statistically significant difference in the odds of a fall between cases and controls, p = 0.86. Similarly, the odds of a fracture between cases and controls was not significantly different, p = 1.0. There were 35 pairs in which the case fractured but the control did not and equal number of pairs where the control fractured but the case did not. For pairs in which control fractured but case did not, the median age at fracture was significant higher than that for pairs in which case fractured but the control did not (71 vs. 63 years p = 0.0003). Conclusion This study did not identify a difference in the incidence of falls or fractures in women on adjuvant AI compared to their age matched controls without breast cancer. Prospective studies of falls and fracture in women on adjuvant AI therapy compared to age match controls would aid in the identification of fracture risk.
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Affiliation(s)
- Palak Choksi
- Department of Internal Medicine, University of Michigan Health Systems, USA
- Corresponding author: Palak Choksi, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Health Systems, 24 Frank Lloyd Wright Drive, Suite 1300, Lobby C, Ann Arbor, MI 48106, USA, Tel: 734-647-5400; Fax: 734-647-2145;
| | | | - Kelley M Kidwel
- Department of Biostatistics, School of Public Health, University of Michigan, USA
| | | | - Mary Soyster
- University of Connecticut School of Medicine, USA
| | - David Hanauer
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, USA
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Van Poznak C, Harris LN, Somerfield MR. Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Oncol Pract 2015; 11:514-516. [DOI: 10.1200/jop.2015.005215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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)
- Catherine Van Poznak
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and American Society of Clinical Oncology, Alexandria, VA
| | - Lyndsay N. Harris
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and American Society of Clinical Oncology, Alexandria, VA
| | - Mark R. Somerfield
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and American Society of Clinical Oncology, Alexandria, VA
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Abstract
Breast cancer is one of the most common malignancies of women. The majority of breast cancers express estrogen and/or progesterone receptors, permitting anticancer targeting strategies to reduce estrogen signaling in the cancer cells and thereby lowering the risk of breast cancer recurrence. The development of the selective estrogen receptor modulator (SERM) tamoxifen marked a significant milestone in breast cancer care that transcended older estrogen ablative strategies such as oophorectomy and ovarian irradiation. An unintended benefit of tamoxifen in postmenopausal women was bone density preservation. The third generation of aromatase inhibitors (AIs) have demonstrated superior efficacy to tamoxifen in improving disease-free survival in postmenopausal women. However, the AIs significantly increase bone resorption, reduce bone mineral density, and increase the risk of fracture above that of tamoxifen. As a consequence of this, clinical oncologists have assumed a larger role in the screening and treatment of the skeletal complications of breast cancer therapies. The key features of managing bone health in women with early stage breast cancer receiving adjuvant endocrine therapy are reviewed here.
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Affiliation(s)
- Gregory A Clines
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA,
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Van Poznak C, Somerfield MR, Bast RC, Cristofanilli M, Goetz MP, Gonzalez-Angulo AM, Hicks DG, Hill EG, Liu MC, Lucas W, Mayer IA, Mennel RG, Symmans WF, Hayes DF, Harris LN. Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2015. [PMID: 26195705 DOI: 10.1200/jco.2015.61.1459] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To provide recommendations on the appropriate use of breast tumor biomarker assay results to guide decisions on systemic therapy for metastatic breast cancer. METHODS A literature search and prospectively defined study selection identified systematic reviews, meta-analyses, randomized controlled trials (RCTs), prospective-retrospective studies, and prospective comparative observational studies published from 2006 through September 2014. RESULTS The literature search revealed 17 articles that met criteria for further review: 11 studies reporting discordances between primary tumors and metastases in expression of hormone receptors or human epidermal growth factor receptor 2 (HER2), one RCT that addressed the use of a biomarker to decide whether to change or continue a treatment regimen, and five prospective-retrospective studies that evaluated the clinical utility of biomarkers. RECOMMENDATIONS In patients with accessible metastases, biopsy for confirmation of disease process and retesting of estrogen receptor, progesterone receptor, and HER2 status should be offered, but evidence is lacking to determine whether changing anticancer treatment on the basis of change in receptor status affects clinical outcomes. With discordance of results between primary and metastatic tissues, the Panel consensus is to use preferentially the estrogen receptor, progesterone receptor, and HER2 status of the metastasis to direct therapy if supported by the clinical scenario and patient's goals for care. Carcinoembryonic antigen, cancer antigen 15-3, and cancer antigen 27-29 may be used as adjunctive assessments, but not alone, to contribute to decisions regarding therapy. Recommendations for tumor rebiopsy and use of circulating tumor markers are based on clinical experience and Panel informal consensus in the absence of studies designed to evaluate the clinical utility of the markers. As such, it is also reasonable for clinicians to not use these markers as adjunctive assessments.
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Affiliation(s)
- Catherine Van Poznak
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Mark R Somerfield
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Robert C Bast
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Massimo Cristofanilli
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Matthew P Goetz
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Ana M Gonzalez-Angulo
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - David G Hicks
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Elizabeth G Hill
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Minetta C Liu
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Wanda Lucas
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Ingrid A Mayer
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Robert G Mennel
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - William F Symmans
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Daniel F Hayes
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Lyndsay N Harris
- Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Robert C. Bast, Ana M. Gonzalez-Angulo, and William F. Symmans, University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Texas Oncology, Dallas, TX; Massimo Cristofanilli, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA; Matthew P. Goetz and Minetta C. Liu, Mayo Clinic, Rochester, MN; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Elizabeth G. Hill, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC; Wanda Lucas, Georgetown University, Washington, DC; Ingrid A. Mayer, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN; and Lyndsay N. Harris, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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Lo SSM, Ryu S, Chang EL, Galanopoulos N, Jones J, Kim EY, Kubicky CD, Lee CP, Rose PS, Sahgal A, Sloan AE, Teh BS, Traughber BJ, Van Poznak C, Vassil AD. ACR Appropriateness Criteria® Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis. J Palliat Med 2015; 18:573-84. [DOI: 10.1089/jpm.2015.28999.sml] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Samuel Ryu
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Eric L. Chang
- University of Southern California-Keck School of Medicine, Los Angeles, California
| | | | - Joshua Jones
- University of Pennsylvania Perelman Center, Philadelphia, Pennsylvania
| | | | | | | | - Peter S. Rose
- Mayo Clinic, American Academy of Orthopaedic Surgeons, Rochester, Minnesota
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Bryan J. Traughber
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Catherine Van Poznak
- University of Michigan Comprehensive Cancer Center, American Society of Clinical Oncology, Ann Arbor, Michigan
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Body JJ, Bone HG, de Boer RH, Stopeck A, Van Poznak C, Damião R, Fizazi K, Henry DH, Ibrahim T, Lipton A, Saad F, Shore N, Takano T, Shaywitz AJ, Wang H, Bracco OL, Braun A, Kostenuik PJ. Hypocalcaemia in patients with metastatic bone disease treated with denosumab. Eur J Cancer 2015; 51:1812-21. [PMID: 26093811 DOI: 10.1016/j.ejca.2015.05.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [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: 03/09/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND This analysis was performed to further characterise treatment-emergent hypocalcaemia in patients with bone metastases receiving denosumab. METHODS Laboratory abnormalities and adverse events of hypocalcaemia in patients with metastatic bone disease were analysed using data from three identically designed phase 3 trials of subcutaneous denosumab 120 mg (n = 2841) versus intravenous zoledronic acid 4 mg (n = 2836). RESULTS The overall incidence of laboratory events of hypocalcaemia grade ⩾ 2 was higher with denosumab (12.4%) than with zoledronic acid (5.3%). Hypocalcaemia events were primarily grade 2 in severity and usually occurred within the first 6 months of treatment. Patients who reported taking calcium and/or vitamin D supplements had a lower incidence of hypocalcaemia. Prostate cancer or small-cell lung cancer, reduced creatinine clearance and higher baseline bone turnover markers of urinary N-telopeptide of type I collagen (uNTx; > 50 versus ⩽ 50 nmol/mmol) and bone-specific alkaline phosphatase (BSAP; > 20.77 μg/L [median] versus ⩽ 20.77 μg/L) values were important risk factors for developing hypocalcaemia. The risk associated with increased baseline BSAP levels was greater among patients who had > 2 bone metastases at baseline versus those with ⩽ 2 bone metastases at baseline. CONCLUSION Hypocalcaemia was more frequent with denosumab versus zoledronic acid, consistent with denosumab's greater antiresorptive effect. Low serum calcium levels and potential vitamin D deficiency should be corrected before initiating treatment with a potent osteoclast inhibitor, and corrected serum calcium levels should be monitored during treatment. Adequate calcium and vitamin D intake appears to substantially reduce the risk of hypocalcaemia.
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Affiliation(s)
- Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - Henry G Bone
- Michigan Bone and Mineral Clinic, Detroit, MI, USA.
| | - Richard H de Boer
- Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | | | - Catherine Van Poznak
- Department of Medical Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
| | - Ronaldo Damião
- Department of Urology, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil.
| | - Karim Fizazi
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
| | - David H Henry
- Department of Medicine, Joan Karnell Cancer Center at Pennsylvania Hospital, Philadelphia, PA, USA.
| | - Toni Ibrahim
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS-Osteoncology and Rare Tumors Center, Meldola, Italy.
| | - Allan Lipton
- Division of Oncology, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Fred Saad
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada.
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA.
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
| | - Adam J Shaywitz
- Department of Hematology/Oncology, Amgen Inc., Thousand Oaks, CA, USA.
| | - Huei Wang
- Department of Hematology/Oncology, Amgen Inc., Thousand Oaks, CA, USA.
| | - Oswaldo L Bracco
- Department of Hematology/Oncology, Amgen Inc., Thousand Oaks, CA, USA.
| | - Ada Braun
- Department of Hematology/Oncology, Amgen Inc., Thousand Oaks, CA, USA.
| | - Paul J Kostenuik
- Department of Hematology/Oncology, Amgen Inc., Thousand Oaks, CA, USA.
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Caram MEV, Guo C, Leja M, Smerage J, Henry NL, Giacherio D, Rubenfire M, Schott A, Davis M, Hayes DF, Van Poznak C, Cooney KA, Hertz DL, Banerjee M, Griggs JJ. Doxorubicin-induced cardiac dysfunction in unselected patients with a history of early-stage breast cancer. Breast Cancer Res Treat 2015; 152:163-172. [PMID: 26050157 DOI: 10.1007/s10549-015-3454-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Cardiomyopathy is a known complication of anthracycline-based adjuvant chemotherapy and is more commonly reported in population-based studies of breast cancer survivors than in clinical trials. This study prospectively evaluated the prevalence of elevated cardiac biomarkers in unselected patients who had been treated with doxorubicin for early-stage breast cancer and the prevalence of reduced LVEF in patients with an elevated biomarker. All participants underwent an examination, symptom inventory, medical record review, and biomarker analysis for BNP, troponin, and plasma and urine NT-proBNP. Patients who had one or more elevated biomarkers were referred for echocardiogram; systolic dysfunction was defined as LVEF less than 55 %. Multivariable logistic regression was used to determine the associations between age, BMI, cumulative dose of doxorubicin, diabetes, hypertension, and left-sided radiation therapy and the risk of reduced LVEF. Among the 269 patients who underwent lab testing (mean age 56 years, mean time since completion of doxorubicin-based chemotherapy 6 years), 192 (72 %) had one or more elevated biomarker. Among the 166 patients who completed an echocardiogram, 11.5 % had a LVEF < 55 %. After adjusting for covariates known to affect cardiac function, multivariable logistic regression revealed plasma NT-proBNP to be the only measured cardiac biomarker associated with systolic dysfunction. There is a relationship between NT-proBNP and the frequency of reduced LVEF in women treated with doxorubicin for curative intent; further study of NT-proBNP as a potential biomarker for subclinical cardiac dysfunction after exposure to anthracyclines is warranted.
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Affiliation(s)
- Megan E V Caram
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.
| | - Cui Guo
- Department of Biostatistics, University of Michigan School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Monika Leja
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Jeffrey Smerage
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Donald Giacherio
- Department of Pathology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Anne Schott
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Melinda Davis
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Daniel F Hayes
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Catherine Van Poznak
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Kathleen A Cooney
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.,Department of Urology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Daniel L Hertz
- Department of Pharmacology, College of Pharmacy, University of Michigan , 428 Church Street, Ann Arbor, MI, 48104-1065, United States
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Jennifer J Griggs
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.,Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, United States
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Hertz DL, Kidwell KM, Thibert JN, Gersch CL, Regan MM, Skaar TC, Henry NL, Hayes D, Van Poznak C, Rae JM. Comparison of genotyping performance in DNA extracted from matched FFPE tumor, FFPE lymph node, and whole blood for pharmacogenetic analyses. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1528] [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: 11/20/2022] Open
Affiliation(s)
| | - Kelley M Kidwell
- University of Michigan, Department of Biostatistics, Ann Arbor, MI
| | | | | | | | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, MD
| | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Daniel Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - James M. Rae
- University of Michigain Health System, Ann Arbor, MI
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Taichman LS, Inglehart MR, Giannobile WV, Braun T, Kolenic G, Van Poznak C. Periodontal Health in Women With Early-Stage Postmenopausal Breast Cancer Newly on Aromatase Inhibitors: A Pilot Study. J Periodontol 2015; 86:906-16. [PMID: 25672657 DOI: 10.1902/jop.2015.140546] [Citation(s) in RCA: 18] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND Aromatase inhibitor (AI) use results in low estrogen levels, which in turn affect bone mineral density (BMD). Periodontitis, alveolar bone loss, and tooth loss are associated with low BMD. The goal of this study is to assess the prevalence of periodontitis and perceived oral health and evaluate salivary biomarkers in postmenopausal women who are survivors of early-stage (I to IIIA) breast cancer (BCa) and receive adjuvant AI therapy. METHODS Participants included 58 postmenopausal women: 29 with BCa on AIs and 29 controls without BCa diagnoses. Baseline periodontal status was assessed with: 1) periodontal probing depth (PD); 2) bleeding on probing (BOP); and 3) attachment loss (AL). Demographic and dental utilization information was gathered by questionnaire. Linear regression modeling was used to analyze the outcomes. RESULTS No differences were found in mean PD or number of teeth. The AI group had significantly more sites with BOP (27.8 versus 16.7; P = 0.02), higher worst-site AL (5.2 versus 4.0 mm; P <0.01), and more sites with dental calculus (18.2 versus 6.4; P <0.001) than controls. Linear regression adjusted for income, tobacco use, dental insurance, and previous radiation and chemotherapy exposure demonstrated that AI use increased AL by >2 mm (95% confidence interval, 0.46 to 3.92). Median salivary osteocalcin and tumor necrosis factor-α levels were significantly higher in the AI group than the control group. CONCLUSION This first investigation of the periodontal status of women initiating adjuvant AI therapy identifies this population as having an increased risk for periodontitis.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI.,Department of Psychology; College of Literature, Science, and the Arts; University of Michigan
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Giselle Kolenic
- Center for Statistical Consultation and Research, University of Michigan
| | - Catherine Van Poznak
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan
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Morikawa A, Van Poznak C. Osteoclast inhibitors: a multifaceted tool in the management of breast cancer. Oncology (Williston Park) 2015; 29:39-42. [PMID: 25595285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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46
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Kim EY, Chapman TR, Ryu S, Chang EL, Galanopoulos N, Jones J, Kubicky CD, Lee CP, Teh BS, Traughber BJ, Van Poznak C, Vassil AD, Weber K, Lo SSM. ACR Appropriateness Criteria® Non-Spine Bone Metastases. J Palliat Med 2015; 18:11-7. [DOI: 10.1089/jpm.2014.9395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | - Samuel Ryu
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Eric L. Chang
- University of Southern California-Keck School of Medicine, Los Angeles, California
| | | | - Joshua Jones
- University of Pennsylvania Perelman Center, Philadelphia, Pennsylvania
| | | | | | | | - Bryan J. Traughber
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Kristy Weber
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Anders C, Deal AM, Abramson V, Liu MC, Storniolo AM, Carpenter JT, Puhalla S, Nanda R, Melhem-Bertrandt A, Lin NU, Kelly Marcom P, Van Poznak C, Stearns V, Melisko M, Smith JK, Karginova O, Parker J, Berg J, Winer EP, Peterman A, Prat A, Perou CM, Wolff AC, Carey LA. TBCRC 018: phase II study of iniparib in combination with irinotecan to treat progressive triple negative breast cancer brain metastases. Breast Cancer Res Treat 2014; 146:557-66. [PMID: 25001612 PMCID: PMC4112043 DOI: 10.1007/s10549-014-3039-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/30/2022]
Abstract
Nearly half of patients with advanced triple negative breast cancer (TNBC) develop brain metastases (BM) and most will also have uncontrolled extracranial disease. This study evaluated the safety and efficacy of iniparib, a small molecule anti-cancer agent that alters reactive oxygen species tumor metabolism and penetrates the blood brain barrier, with the topoisomerase I inhibitor irinotecan in patients with TNBC-BM. Eligible patients had TNBC with new or progressive BM and received irinotecan and iniparib every 3 weeks. Time to progression (TTP) was the primary end point; secondary endpoints were response rate (RR), clinical benefit rate (CBR), overall survival (OS), toxicity, and health-related quality of life. Correlative endpoints included molecular subtyping and gene expression studies on pre-treatment archival tissues, and determination of germline BRCA1/2 status. Thirty-seven patients began treatment; 34 were evaluable for efficacy. Five of 24 patients were known to carry a BRCA germline mutation (4 BRCA1, 1 BRCA2). Median TTP was 2.14 months and median OS was 7.8 months. Intracranial RR was 12 %, while intracranial CBR was 27 %. Treatment was well-tolerated; the most common grade 3/4 adverse events were neutropenia and fatigue. Grade 3/4 diarrhea was rare (3 %). Intrinsic subtyping revealed 19 of 21 tumors (79 %) were basal-like, and intracranial response was associated with high expression of proliferation-related genes. This study suggests a modest benefit of irinotecan plus iniparib in progressive TNBC-BM. More importantly, this trial design is feasible and lays the foundation for additional studies for this treatment-refractory disease.
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Affiliation(s)
- Carey Anders
- Lineberger Comprehensive Cancer Center, University of North Carolina, 450 West Drive, Campus Box 7295, Chapel Hill, NC, 27599, USA,
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Hortobagyi GN, Lipton A, Chew HK, Gradishar WJ, Sauter NP, Mohanlal RW, Zheng M, McGrain B, Van Poznak C. Efficacy and safety of continued zoledronic acid every 4 weeks versus every 12 weeks in women with bone metastases from breast cancer: Results of the OPTIMIZE-2 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.18_suppl.lba9500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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
LBA9500^ Background: Zoledronic acid (ZOL, 4 mg) every (q) 4 wk reduces the risk of skeletal-related events (SREs) in patients (pts) with bone metastases from breast cancer (BC). The OPTIMIZE-2 trial examined whether ZOL q12 wk was non-inferior to ZOL q4 wk in pts who had previously received monthly IV bisphosphonate (BP) therapy for ~1 year or longer. Methods: This was a prospective, randomized, double-blind, multicenter trial in female pts with bone metastases from BC who previously received ≥9 doses of IV BP (ZOL or pamidronate) during the first 10-15 months of therapy. Pts were randomized (1:1) to receive ZOL 4 mg IV q4 wk or q12 wk (placebo between ZOL doses to maintain blind) for 1 year. The primary endpoint was the proportion of pts with ≥1 SRE on study (SRE rate). Primary analysis was non-inferiority (pre-defined margin of 10%) for the difference in SRE rates. Secondary endpoints included time to first SRE, skeletal morbidity rate (SMR), bone pain score, change in bone turnover markers, and safety. Results: 403 pts were randomized to ZOL q4 wk (n = 200) or q12 wk (n = 203). Median age was 59 years, and baseline characteristics were similar between arms. The SRE rate was 22% and 23.2% in the ZOL q4 and q12 wk arms, respectively. The difference in SRE rate between arms was 1.2% (95% CI, –7.5% to 9.8%; P = .724). The upper limit of this 95% CI (9.8%) is less than the predefined margin of 10%, which indicates non-inferiority of ZOL q12 wk vs q4 wk. Times to first on-study SRE (HR, 1.06; 95% CI, 0.70 to 1.60; P = .792) were similar in the ZOL q4 and q12 wk arms, and mean SMRs were also similar (0.46 vs 0.50, respectively; P = .854). Overall, changes from baseline in bone turnover markers, and the incidence of treatment-emergent adverse events (TEAEs), were similar in the 2 arms. Numerically more renal TEAEs were reported in the ZOL q4 wk vs q12 wk arm (9.6% vs 7.9%, respectively). Two cases (1.0%) of osteonecrosis of the jaw (ONJ) were reported in the q4 wk arm. Conclusions: Among pts who had received monthly IV BP therapy for 1 year or longer, the efficacy of continuing ZOL for an additional year at q12 wk was non-inferior to ZOL q4 wk. Fewer renal AEs and none of the ONJ events were observed in the ZOL q12 wk vs ZOL q4 wk arm. Clinical trial information: NCT00320710.
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Affiliation(s)
| | | | | | | | | | | | - Ming Zheng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Beth McGrain
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Hortobagyi GN, Lipton A, Chew HK, Gradishar WJ, Sauter NP, Mohanlal RW, Zheng M, McGrain B, Van Poznak C. Efficacy and safety of continued zoledronic acid every 4 weeks versus every 12 weeks in women with bone metastases from breast cancer: Results of the OPTIMIZE-2 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.lba9500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | | | | | | | | | | | - Ming Zheng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Beth McGrain
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Peereboom DM, Murphy C, Ahluwalia MS, Conlin A, Eichler A, Van Poznak C, Baar J, Elson P, Seidman AD. Phase II trial of patupilone in patients with brain metastases from breast cancer. Neuro Oncol 2014; 16:579-83. [PMID: 24470546 DOI: 10.1093/neuonc/not305] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND For patients with progressive breast cancer brain metastasis (BCBM) after whole brain radiotherapy (WBRT), few options exist. Patupilone is an epothilone that crosses the blood-brain barrier. We hypothesized that patupilone would produce a 35% 3-month CNS progression-free survival in women with BCBM after WBRT. METHODS This multicenter phase II trial included 2 cohorts. Group A included women with progressive BCBM after WBRT. Group B was an exploratory cohort of patients with either leptomeningeal metastases or untreated brain metastases. The primary goal was to observe a 35% 3-month CNS progression-free survival in Group A. The sample size was 45 for Group A and 10 for Group B. Patients received patupilone 10 mg/m(2) once every 3 weeks until progression. Responses were scored according to the Macdonald criteria. RESULTS Fifty-five patients (45 in Group A, 10 in Group B) enrolled. In Group A, the 3-month CNS progression-free survival was 27%, the median overall survival was 12.7 months, and the overall response rate was 9%. In Group B, which enrolled 5 patients with leptomeningeal disease and 5 with no prior WBRT, no responses occurred and 8 patients had CNS progression before 3 months. Systemic responses occurred in 15% of patients, including a complete response in liver metastases. Diarrhea occurred in 87% of patients; 25% had grade 3 and 4 adverse events. CONCLUSIONS Patupilone in patients with BCBM did not meet the efficacy criteria and had significant gastrointestinal toxicity. Further study of brain-penetrant agents is warranted for patients with CNS metastases from breast cancer.
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Affiliation(s)
- David M Peereboom
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (D.M.P., M.S.A.); The Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Neurological Institute, Cleveland Clinic (D.M.P., M.S.A.); Taussig Cancer Institute, Cleveland Clinic (D.M.P., M.S.A., P.E.); Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio(P.E.); Memorial Sloan-Kettering Cancer Center, New York, New York(C.M., A.C., A.D.S.); Massachusetts General Hospital, Boston, Massachusetts(A.E.); Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan(C.V.P.); Seidman Cancer Center of University Hospitals, Case Medical Center, Cleveland, Ohio(J.B.)
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