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Krasner CN, Castro C, Penson RT, Roche M, Matulonis UA, Morgan MA, Drescher C, Armstrong DK, Wolfe JK, Lee H, Supko JG, Seiden M, Birrer MJ, Dizon DS. Final report on serial phase II trials of all-intraperitoneal chemotherapy with or without bevacizumab for women with newly diagnosed, optimally cytoreduced carcinoma of Müllerian origin. Gynecol Oncol 2019; 153:223-229. [PMID: 30765148 DOI: 10.1016/j.ygyno.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/20/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraperitoneal (IP) chemotherapy can improve outcomes for women with optimally cytoreduced epithelial ovarian cancer but toxicities are a concern. We conducted 2 phase 2 trials of an IV/IP regimen using carboplatin and paclitaxel without (Trial A) and with bevacizumab (Trial B). METHODS Both trials consisted of carboplatin AUC 6 day 1, and paclitaxel 60 mg/m2 on days 1,8, 15 of a 21-day cycle; in Trial B, patients received IV bevacizumab 15 mg/kg every cycle starting cycle 2. Chemotherapy was administered IV for cycle 1 and then IP for all subsequent cycles. Primary objectives included safety and tolerability, pathologic CR rate (Trial A), and the rate of completion of IP cycles of therapy (Trial B). Progression-free (PFS), overall survival (OS), and pharmacokinetic analysis were secondary endpoints. RESULTS 81 patients were treated on both trials (n = 40 and 41 in trials A and B, respectively). Median age for trials A and B was 59 (range, 36-76) and 55 (range, 19-69) years, respectively. 68% and 85% of patients, respectively for A and B, completed at least 4 cycles of treatment in both trials. Treatment with bevacizumab resulted in higher rates of grade 3 fatigue (37 versus 33%) and grade 3-4 diarrhea (22 versus 8%). Median PFS was 23.5 (95%CI 16.2-35.3) and 25 (95%CI 16.4-42.7) months, respectively; median OS was 68 (95%CI 49.5-NR) and 79.7 (95%CI 59.0-79.7) months, respectively for Trial A and B. CONCLUSIONS Weekly administered IP carboplatin and IP paclitaxel is tolerable and safe with similar activity with and without concommittant bevacizumab in these 2 trials.
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Affiliation(s)
- C N Krasner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America.
| | - C Castro
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - R T Penson
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - M Roche
- Blueprint Bio, Cambridge, MA, United States of America.
| | - U A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - M A Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - C Drescher
- Translational Research Program, Division of Gynecologic Oncology, Fred Hutchinson Cancer Center, Seattle, WA, United States of America.
| | - D K Armstrong
- Department of Medical Oncology, Johns Hopkins University Medical Center, Baltimore, MD, United States of America.
| | - J K Wolfe
- Community Health, Indianapolis, IN, United States of America.
| | - H Lee
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - J G Supko
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - M Seiden
- US Oncology, United States of America.
| | - M J Birrer
- Department of Medical Oncology, University of Alabama, Birmingham, AL, United States of America.
| | - D S Dizon
- Department of Medical Oncology, Rhode Island Hospital, United States of America.
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Ramin CA, May BJ, Roden RBS, McCullough M, Armstrong DK, Visvanathan K. Abstract P6-08-12: Understanding the etiology of osteopenia and osteoporosis in young breast cancer survivors compared to cancer-free women. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Our group previously reported that young breast cancer (BC) survivors have a higher risk of osteopenia/osteoporosis compared to their cancer-free peers. In order to develop successful interventions we need to understand the major contributing factors. Therefore, we investigated bone loss in young BC survivors by age at diagnosis, tumor characteristics and BC treatment compared to their cancer-free peers.
Methods: We studied 775 women (211 BC survivors, 564 cancer-free) with familial risk of breast and/or ovarian cancer in the Breast and Ovarian Surveillance Service (BOSS) cohort at Johns Hopkins. Survivors were diagnosed with stage 0-III BC <5 years prior to enrollment. The comparison group was cancer-free women at enrollment. Osteopenia and osteoporosis were ascertained based on self-reported physician diagnosis in baseline and follow-up questionnaires. Prevalent cases of osteopenia or osteoporosis were excluded. Multivariable (MV)-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of osteopenia and/or osteoporosis among BC survivors compared to cancer-free women. BC survivors were stratified by age at diagnosis, estrogen-receptor (ER) tumor status, and BC treatment. MV models were adjusted for age, menopausal status, body mass index, physical activity, smoking, alcohol use, hormone replacement therapy and early oophorectomy.
Results: Mean time from BC diagnosis to enrollment was 1.4 years for survivors and mean age at BC diagnosis was 47 years. At baseline, BC survivors were more likely to be slightly older, postmenopausal, and current vitamin D users and less likely to have had an early bilateral oophorectomy compared to cancer-free women. During a mean follow-up time of 5.7 years, 66% of BC survivors and 54% of cancer-free women reported having ≥1 bone density exam and 112 incident cases of osteopenia/osteoporosis were identified (75% osteopenia only). BC survivors diagnosed at age ≤50 years had a 2-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.05, 95% CI=1.24-3.40). Risk of bone loss was similar among survivors with ER-positive tumors compared to cancer-free women (HR=2.04, 95% CI=1.30-3.22). No association was observed for BC survivors treated with tamoxifen only or chemotherapy only. BC survivors treated with aromatase inhibitors (AIs) only had almost 3-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.92, 95% CI=1.38-6.17). BC survivors treated with chemotherapy + tamoxifen and chemotherapy + AIs had over 2- and 4-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.28, 95% CI=1.04-5.00; HR=4.09, 95% CI=1.99-8.42, respectively). Results suggest that risk of bone loss was highest within 5 years after BC diagnosis.
Conclusion: Our results demonstrate that osteopenia/osteoporosis incidence is higher in BC survivors compared to cancer-free women and risk varies by age at diagnosis, ER-status and BC treatment. Our findings provide support for a baseline evaluation of bone density close to diagnosis in BC survivors with familial risk. Future studies are needed to address the frequency of monitoring among specific age and treatment groups.
Citation Format: Ramin CA, May BJ, Roden RBS, McCullough M, Armstrong DK, Visvanathan K. Understanding the etiology of osteopenia and osteoporosis in young breast cancer survivors compared to cancer-free women [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-12.
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Affiliation(s)
- CA Ramin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
| | - BJ May
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
| | - RBS Roden
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
| | - M McCullough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
| | - DK Armstrong
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
| | - K Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; The Johns Hopkins School of Medicine, Baltimore, MD
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018; 29:431-438. [PMID: 29186319 PMCID: PMC6658709 DOI: 10.1093/annonc/mdx754] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018. [PMID: 29186319 DOI: 10.1093/annonc/mdx754] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Simon R, Blumenthal GM, Rothenberg ML, Sommer J, Roberts SA, Armstrong DK, LaVange LM, Pazdur R. The role of nonrandomized trials in the evaluation of oncology drugs. Clin Pharmacol Ther 2015; 97:502-7. [DOI: 10.1002/cpt.86] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 12/22/2014] [Accepted: 02/03/2015] [Indexed: 02/02/2023]
Affiliation(s)
- R Simon
- National Cancer Institute; Bethesda Maryland USA
| | - GM Blumenthal
- Food and Drug Administration (FDA); Silver Spring Maryland USA
| | | | - J Sommer
- Chordoma Foundation; Durham North Carolina USA
| | - SA Roberts
- Friends of Cancer Research; Washington DC USA
| | - DK Armstrong
- Johns-Hopkins Kimmel Cancer Center; Baltimore Maryland USA
| | - LM LaVange
- Food and Drug Administration (FDA); Silver Spring Maryland USA
| | - R Pazdur
- Pfizer, Inc.; New York New York USA
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Giuntoli RL, Bristow RE, Diaz-Montes TP, Armstrong DK. Feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of ovarian cancer. J Chemother 2011; 23:163-7. [PMID: 21742586 DOI: 10.1179/joc.2011.23.3.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The goal of this study is to determine the feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of patients with ovarian cancer. We performed a retrospective chart review of patients with primary, persistent or recurrent ovarian cancer, who received intravenous gemcitabine and an intraperitoneal platinum agent. Patients received gemcitabine (750 mg/m²) intravenous on days 1 and 8 and cisplatin (100 or 60 mg/m²) intraperitoneal on day 1 every 21 - 28 days. An alternate regimen was composed of gemcitabine (750 mg/m²) intravenous and carboplatin (AUC 5) intraperitoneal on day 1 every 21 days. Dose reductions occurred at the discretion of the prescribing physician.Intravenous gemcitabine and an intraperitoneal platinum agent were administered to 12 patients with advanced primary or recurrent ovarian cancer. Myelosuppression was the most common toxicity. Grade 3 or 4 thrombocytopenia, neutropenia and anemia occurred in 7, 8 and 2 patients respectively. Dose reductions were required in 7 of 12 patients. 10 of 12 patients received 6 cycles of the regimen. Treatment was discontinued prior to 6 cycles in 2 of 12 patients secondary to progression in one case and to grade 4 neutropenia and thrombocytopenia in another.The combination of intravenous gemcitabine and an intraperitoneal platinum agent appears to be a feasible regimen in patients with ovarian cancer. The most common toxicity was myelosuppression, which resulted in dose reductions in almost half of the patients.
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Affiliation(s)
- R L Giuntoli
- Kelly Gynecologic Oncology Service, Department of Gynecology and Onstetrics, Sidney Kimmel Comprehensive Cancer Center, 600 North Wolfe Street, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Connolly RM, Rudek MA, Mc Leod HL, Garrett-Mayer E, Jeter SC, Wright LA, Stearns V, Armstrong DK, Fetting JH, Watkins SP, Davidson NE, Wolff AC. A phase II pharmacokinetic/pharmacogenetic (PK/PG) study using fixed-dose capecitabine in metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1067] [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: 11/20/2022] Open
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Jelovac D, Armstrong DK, Weil S, Phillips M, Schwartz BM, Estes JM, Alvarez RD. Phase I safety study of farletuzumab, carboplatin, and pegylated liposomal doxorubicin (PLD) in subjects with platinum-sensitive epithelial ovarian cancer (EOC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Elit L, Konner JA, Armstrong DK, Buck M, Dean A, Finkler NJ, Hulstine A, Schweizer C, Phillips M, Weil S. A randomized, double-blind, placebo-controlled phase II study of the efficacy and safety of farletuzumab (MORAb-003) in combination with weekly paclitaxel in subjects with platinum-resistant or refractory relapsed ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Krasner CN, Seiden M, Roche M, Morgan MA, Matulonis U, Wolf J, Drescher C, Alvarez RD, Armstrong DK, Supko JG. Tolerability and pharmacokinetics of intraperitoneal carboplatin and paclitaxel with intravenous bevacizumab. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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White AJ, Coleman RL, Armstrong DK, Glenn D, Bicher A, Richards DA, Schneeweiss A, Old LJ, Schweizer C, Weil S. Efficacy and safety of farletuzumab, a humanized monoclonal antibody to folate receptor alpha, in platinum-sensitive relapsed ovarian cancer subjects: Final data from a multicenter phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Israel SA, Nassar H, Gross AL, Jacobs LK, Armstrong DK, Visvanathan K. Characterizing benign breast disease in women at high risk for breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1506] [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: 11/20/2022] Open
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Connolly RM, Jeter S, Zorzi J, Zhang Z, Armstrong DK, Fetting JH, Wolff AC, Goetz MP, Storniolo AM, Stearns V. A multi-institutional double-blind phase II study evaluating response and surrogate biomarkers to carboplatin and nab-paclitaxel (CP) with or without vorinostat as preoperative systemic therapy (PST) in HER2-negative primary operable breast cancer (TBCRC008). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Von Gruenigen VE, Huang HQ, Gil KM, Frasure HE, Armstrong DK, Wenzel LB. The association between quality of life and overall survival in ovarian cancer patients during adjuvant chemotherapy: A Gynecologic Oncology Group study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5075] [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: 11/20/2022] Open
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Armstrong DK, Herzog TJ, Reyno LM, Vincent M, Jackson L, Sabbatini P. A phase I dose escalation study of AGS-8M4 (ASP6183), an anti-AGS-8 fully human antibody, in advanced ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5059] [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: 11/20/2022] Open
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Darcy KM, Tian C, Ambrosone CB, Krivak TC, Armstrong DK, Bookman MA, Davis W, Zhao H, Moysich K, DeLoia JA. A Gynecologic Oncology Group study of associations between polymorphisms in ABC transporter genes ( ABCB1, ABCC2, and ABCG2) and outcome in advanced stage epithelial ovarian cancer treated with platinum and taxane chemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5567] [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] Open
Abstract
5567 Background: This study evaluated the relationship between known functional variants in three ATP-binding cassette (ABC) transporter genes (ABCB1 [MDR1], ABCC2 [MRP2], and ABCG2 [BCRP]) and clinical outcomes in epithelial ovarian cancer (EOC). These genes induce resistance to multiple anticancer drugs and some polymorphisms appear to affect expression, stability or activity of these transporters. Methods: Genotypes for common polymorphisms in ABCB1 (G2677T/A, A893S/T -RS2032582 and C3435T, synonymous-RS1045642), ABCC2 (G1249A, V417I-RS2273697), and ABCG2 (C421A, Q141K-RS2231138) were determined in normal blood DNA from 385 women with optimal stage III ECO who participated in a randomized phase III trial (GOG 172 or 182) and were treated with intravenous or intraperitoneal platinum+paclitaxel. Associations between polymorphisms and progression-free survival (PFS) and overall survival (OS) were examined using logrank test and adjusted Cox regression analysis. Results: The genotype distribution for the C421A polymorphism in ABCG2 was 80.7%, 18.5% and 0.8% for CC, CA and AA, respectively. Median time to disease progression or death for the CA+AA versus (vs.) CC genotype in ABCG2 was 30.3 vs. 18.1 months (p = 0.023), or 69.8 vs. 51.6 months (p = 0.172), respectively. After adjusting for clinical covariates, women with the CA+AA vs. CC genotype in ABCG2 had a significant reduction in the risk of disease progression (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.49–0.91, p = 0.01) but not death (HR = 0.77, 95% CI = 0.56–1.08, p = 0.125). The results were consistent across treatments. Adjusted Cox modeling demonstrated that polymorphisms in ABCB1 (G2677T/A or C3435T) and ABCC2 (G1249A) were not associated with PFS or OS. Conclusions: The ABCG2 C421A polymorphism, but not the ABCB1 G2677T/A, ABCB1 C3435T, or ABCC2 G1249A polymorphism, appears to be an independent prognostic factor for disease progression in optimal stage III EOC treated with platinum + paclitaxel therapy. No significant financial relationships to disclose.
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Affiliation(s)
- K. M. Darcy
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - C. Tian
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - C. B. Ambrosone
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - T. C. Krivak
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - D. K. Armstrong
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - M. A. Bookman
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - W. Davis
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - H. Zhao
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - K. Moysich
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - J. A. DeLoia
- Roswell Park Cancer Institute, Buffalo, NY; Magee Women's Hospital, Pittsburgh, PA; Johns Hopkins Oncology Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA
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Carducci MA, Armstrong DK, Collins C, Wang T, Schaefer S, Ermisch S, Musib LC, Nicol S, Thornton DE, Zhang Z. Phase I study of enzastaurin (ENZ) and bevacizumab (BV) in patients with advanced cancer: Safety, pharmacokinetics (PK), and response assessment. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
3517 Background: ENZ, an oral kinase inhibitor, suppresses tumor growth through PKC and PI-3 kinase/AKT. BV binds VEGF and inhibits angiogenesis. Since ENZ and BV are complementary in inhibiting angiogenesis, we conducted a Phase I study of ENZ / BV. Methods: Eligible patients (pts) had advanced cancer, adequate organ function and no co-morbidities for increased risk of drug-related toxicities. Six pts were enrolled per cohort; if ≤1 DLT the next cohort opened. A loading dose of ENZ 1125 mg was given on Day 1, C1. After 1 cohort combining ENZ 500 mg/QD and BV at 5mg/kg IV q 2 wks, subsequent cohorts alternated pts between BV 10 mg/kg IV q 2 wks and BV 15 mg/kg IV q 3wks with escalating doses of ENZ (500 mg/QD, 250 mg/BID, and 375 mg/BID) for a total of 7 cohorts. DLT was defined as C1: Grade (G)4 neutropenia ≥7 days, febrile neutropenia, G3 thrombocytopenia with bleeding or G4 thrombocytopenia; G3/G4 non-hematological toxicities, and toxicities associated with BV. ENZ PK was performed at steady-state on Day 1, C2. Results: 43 pts (21 with ovarian cancer) are evaluable for toxicity. Two DLTs (G3 elevated aminotransferase and intraparenchymal hemorrhage) occurred at different dose levels. No apparent increase in ENZ or BV toxicity was seen. Two SAEs (DVT and myocardial ischemia) in two pts occurred at DL 3 after 3 cycles and 13 cycles, respectively. Common toxicities included fatigue, chromaturia, dry/sore mouth, nausea and diarrhea. Nine of 43 pts (21%) had a response (CR, PR), 6 responses were in the ovarian subset (29%). Median time to progression was 3.9 mos (range 0–19.2 mos) and 7.7 mos for ovarian pts (range 0.3–19.2 mos). Overall, 43% remained on study without disease progression for >6 mos (51% of ovarian pts remained on study for >6 mos). Mean steady-state ENZ concentrations (%CV) at 500 mg/QD, 250mg/BID and 375mg/BID were 1080 nmol/L (82.8 %), 516 nmol/L (102%) and 1120 nmol/L (93.3%), respectively. Conclusions: The addition of ENZ to BV in any of the currently approved BV dosing schedules is well tolerated and clinically active in advanced cancer pts. ENZ exposures are highly variable and comparable across the three dose groups. The combination of ENZ / BV demonstrates encouraging activity, specifically in our population of ovarian cancer pts. [Table: see text]
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Affiliation(s)
- M. A. Carducci
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - D. K. Armstrong
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - C. Collins
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - T. Wang
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Schaefer
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Ermisch
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - L. C. Musib
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - S. Nicol
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - D. E. Thornton
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
| | - Z. Zhang
- Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; Eli Lilly, Indianapolis, IN
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Resta LP, Ermisch S, Collins C, Nicol SJ, Armstrong DK, Wang T, Zhang Z, Thornton D, Carducci MA. Phase I study of enzastaurin (ENZ) and bevacizumab (BV) in patients with advanced cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Armstrong DK, Bicher A, Coleman RL, Gibbon DG, Glenn D, Old L, Senzer NN, Schneeweiss A, Verheijen RH, White AJ, Weil S. Exploratory phase II efficacy study of MORAb-003, a monoclonal antibody against folate receptor alpha, in platinum-sensitive ovarian cancer in first relapse. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5500] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tewari D, Chunqiao T, Armstrong DK, Markman M, Herzog TJ, Monk BJ. The clinical-pathologic factors relevant to intraperitoneal chemotherapy in ovarian cancer: An analysis of two Gynecologic Oncology Group trials. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Balmanoukian A, Zhang Z, Jeter SC, Tsangaris TN, Wolff AC, Armstrong DK, Fetting JH, Fackler M, Gabrielson E, Stearns V. Outcomes of African American (AA) versus caucasian (CA) women with triple-negative (TN) breast cancer following preoperative anthracycline and taxane-based chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11530] [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: 11/20/2022] Open
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Laheru DA, Cohen SJ, Phillips M, Armstrong DK, Brahmer J, Jaffee EM, Weil S, Pastan I, Hassan R. A phase I study of MORab-009, a monoclonal antibody against mesothelin, in mesothelioma, pancreatic and ovarian cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Visvanathan K, Santor D, Ali SZ, Brewster A, Arnold A, Armstrong DK, Davidson NE, Helzlsouer KJ. The reliability of nipple aspirate and ductal lavage in women at increased risk for breast cancer--a potential tool for breast cancer risk assessment and biomarker evaluation. Cancer Epidemiol Biomarkers Prev 2007; 16:950-5. [PMID: 17507621 DOI: 10.1158/1055-9965.epi-06-0974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/16/2022] Open
Abstract
PURPOSE Ductal lavage, a technique used to sample epithelial cells from breast ducts, has potential use in risk assessment and biomarker evaluation among women at increased risk for breast cancer. However, little is known about the reliability of the procedure. METHODS We evaluated the reliability of nipple aspirate (NAF) and ductal lavage at two time points 6 months apart in women at increased risk for breast cancer. Eligible women had a 5-year Gail risk >or=1.66% or lifetime risk of >20%, and/or a family history or personal history of breast cancer. All ducts that produced NAF were cannulated. The kappa statistic was used to evaluate reliability of NAF production, cellular yield, and cytologic diagnosis. RESULTS Sixty-nine women (mean age, 47 years) were enrolled over 35 months. Forty-seven returned for a second visit. At baseline, 65% of premenopausal and 41% of postmenopausal women produced NAF (P = 0.05), of which 72% underwent successful lavage of at least one duct. Samples of inadequate cellular material for diagnosis were significantly more likely in postmenopausal women than in premenopausal women (P = 0.04). Of the women who returned for a second visit, 18 of 24 who produced NAF had at least one duct successfully cannulated. Twenty-four ducts in 14 women were lavaged twice. Among these ducts, cellular yield for the two time points was inconsistent (kappa = 0.33 +/- 0.13), and only fair cytologic agreement was observed (kappa = 0.32 +/- 0.15). Ductal lavage was associated with moderate discomfort. CONCLUSION Currently, the use of ductal lavage is limited by technical challenges in duct cannulation, inconsistent NAF production, a high rate of inadequate cellular material for diagnosis, fair cytologic reproducibility, and low participant return rates.
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Affiliation(s)
- K Visvanathan
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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25
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Skates SJ, Drescher CW, Isaacs C, Schildkraut JM, Armstrong DK, Buys SS, Brewster WR, Daly MB, Finkelstein DM, Lu KH. A prospective multi-center ovarian cancer screening study in women at increased risk. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5510] [Citation(s) in RCA: 2] [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] Open
Abstract
5510 Background: No proven ovarian cancer (OC) screening strategy exists for women who are at increased risk for the disease. A risk of ovarian cancer algorithm (ROCA) using serial CA125 values has previously shown greater positive predictive value (PPV) and sensitivity than a single CA125 in screening women at general population risk. We hypothesized that using ROCA would yield a reasonable PPV for ovarian cancer screening in a cohort at increased risk. Methods: Between 7/2001 and 9/2006, 25 sites (14 Cancer Genetics Network, 3 ovarian SPOREs, 1 EDRN, 7 others) prospectively enrolled patients. Inclusion criteria included: among self, 1° or 2° relatives in same lineage either (i) BRCA1/2 mutation, or (ii) two of OC or early onset (age = 50) breast cancer (BC), or (iii) Ashkenazi ethnicity and 1 of OC or BC. A previous diagnosis of OC excluded subjects. Subjects underwent CA125 every 3 months and the risk of having ovarian cancer based on the CA125 profile was recalculated after each test. ROCA referred subjects with risk > 1% to ultrasound (US), and risk > 10% additionally to a gynecologic oncologist. Objectives included PPV for study indicated surgery, sensitivity, and compliance. Sample size was chosen to observe 8 OC endpoints with a power of 80% to rule out PPV = 10% if the true PPV = 20%. Results: 2,343 high risk women enrolled, with 6,284 women years of screening and 19,549 CA125s obtained. There were 628 (10%/yr) referrals to US with 414 US performed. 38 women underwent study indicated surgeries. 9 OCs were identified during screening, 3 were prevalent (1 early, 2 late stage), and 6 were incident (5/6 = 83% early, 1 late). 3 of the 6 incident cases were found on prophylatic oophorectomy in early stage. ROCA detected 2 in early stage of remaining 3 incident cases, and 3 of 3 prevalent cases. The PPV was 5/38 = 13% (95% CI 4.4%, 28%) and sensitivity was 5/6 = 83%, CI (36%, 99%). There was high compliance with CA125 testing throughout study, with 84%, 85%, 85%, 82% subjects returning within 1 month of schedule for first 4 tests. Conclusions: Frequent CA125 testing using ROCA results in an acceptable PPV and high compliance in a cohort of women at increased risk for OC. A definitive screening study (= 30 incident cases) using ROCA with serial CA125 and possibly additional markers is required to define sensitivity for early stage OC. [Table: see text]
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Affiliation(s)
- S. J. Skates
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - C. W. Drescher
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - C. Isaacs
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - J. M. Schildkraut
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - D. K. Armstrong
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - S. S. Buys
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - W. R. Brewster
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - M. B. Daly
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - D. M. Finkelstein
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
| | - K. H. Lu
- Massachusetts General Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; Georgetown University Hospital, Washington, DC; Duke Comprehensive Cancer Center, Durham, NC; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Huntsman Cancer Institute, Salt Lake City, UT; UCI Medical Center, Irvine, CA; Fox Chase Cancer Center, Philadelphia, PA; MD Anderson Cancer Center, Houston, TX
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Krivak TC, Darcy KM, Tian C, Baysal BE, Armstrong DK, Gallion HH, Deloia JA. Relationship between polymorphisms in cordon 118 and C8092A in ERCC1 and clinical outcome in optimally-resected, stage III epithelial ovarian cancer treated with intraperitoneal or intravenous cisplatin and paclitaxel: A gynecologic oncology. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21050 Background: The association between polymorphisms in the excision nuclease ERCC1 and progression-free survival (PFS) or overall survival (OS) was examined in women with epithelial ovarian cancer (EOC) treated with cisplatin and paclitaxel. Methods: Women who were evaluable for the phase III trial, GOG-172, with sufficient leukocyte DNA for testing were eligible for this study. Participants were randomized to intraperitoneal (IP) or intravenous (IV) cisplatin and paclitaxel. Single nucleotide polymorphism (SNP) analysis was carried out by direct pyrosequencing. Results: Among the 233 eligible cases, the genotype distribution at codon 118 was 17% with C/C, 43% with C/T and 40% with T/T and at C8092A was 56% with C/C, 37% with C/A and 7% with A/A. Adjusted Cox regression analysis revealed that the codon 118 polymorphism was not significantly associated with disease progression or death, but women with the C/A or A/A genotype compared with the C/C genotype at C8092A had an increased risk of disease progression (hazard ratio [HR]=1.48, 95% confidence interval [CI]=1.09–2.00, p=0.011) and death (HR=1.46, 95% CI=1.04–2.04, p=0.029). Subset analysis stratified by treatment suggested that the C8092A polymorphism was significantly associated with increased risk of PFS and OS in the IP but not the IV arm. Conclusions: Although the ERCC1 codon 118 polymorphism does not appear to be associated with clinical outcome, the C8092A polymorphism in ERCC1 was an independent predictor of PFS and OS in optimally-resected EOC treated with cisplatin- paclitaxel chemotherapy. The preferential clinical utility of the C8092A polymorphism in the IP but not the IV arm requires validation. No significant financial relationships to disclose.
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Affiliation(s)
- T. C. Krivak
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - K. M. Darcy
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - C. Tian
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - B. E. Baysal
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - D. K. Armstrong
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - H. H. Gallion
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
| | - J. A. Deloia
- Magee-Women's Hospital, Pittsburgh, PA; GOG Biostatistics Office, Buffalo, NY; Magee-Women's Hospital, Sewickley, PA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Precision Therapeutics, Inc., Pittsburgh, PA
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Armstrong DK, Laheru D, Ma WW, Cohen SJ, Phillips M, Brahmer J, Weil SC, Hassan R. A phase 1 study of MORAb-009, a monoclonal antibody against mesothelin in pancreatic cancer, mesothelioma and ovarian adenocarcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14041 Background: MORAb-009 is a monoclonal antibody that targets mesothelin, a cell surface adhesive protein overexpressed in pancreatic, ovarian, non-small cell lung carcinomas and mesothelioma and has minimal expression in normal tissue. The target is over-expressed by tumor cells. It was identified as one of the most prominent, differentially expressed cell surface antigens on pancreatic adenocarcinoma using SAGE of primary tumors vs. normal pancreatic tissue. In vitro studies show MORAb-009 to be effective in mediating cell killing by ADCC and inhibiting cell adhesion.. In xenograft models, MORAb-009 has single agent anti-tumor activity enhanced by the addition of chemotherapy. Toxicology studies show no toxicity in non-human primates and no significant binding to non-tumor tissues. Methods: Sequential cohorts of 3 patients received MORAb-009 intravenously on days 1, 8, 15 and 22 at doses of 12.5, 25, 50 and 100 mg/m2. Major inclusion criteria are the presence of a mesothelin-positive tumor with progression on primary therapy, acceptable organ function, ECOG PS 0–2, and measurable disease by CT. Safety pharmacology studies include chemistry, hematology, urinalysis and EKG. Tumors were re-imaged at day 35. Results: 11 patients have received MORAb-009 at doses up to 100 mg/m2. 6 patients had mesothelioma, 3 had pancreatic cancer and 2 had mesothelin-positive ovarian cancer. 4 patients exhibited grade 1 (3) or 2 (1) infusion reactions; no dose limiting toxicity was observed. A subject in the 50 mg/m2 cohort with pancreatic cancer who progressed on gemcitabine showed stable disease by CT and a drop in CA 19/9. Based on the response, this patient continues on extended MORAb-009 therapy. Enrollment to the final cohort of 200mgs/m2 is ongoing, as are pharmacokinetic and anti-MORAb-009 antibody analysis. Conclusion: MORAb-009, a monoclonal antibody against mesothelin is safe and well tolerated at doses up to 100 mg/m2. One subject with previously progressive pancreatic cancer had disease stabilization. In light of the positive preclinical data and safe clinical profile, this study supports further evaluation of the efficacy of MORAb-009 in mesothelin-positive tumors. No significant financial relationships to disclose.
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Affiliation(s)
- D. K. Armstrong
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - D. Laheru
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - W. W. Ma
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - S. J. Cohen
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - M. Phillips
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - J. Brahmer
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - S. C. Weil
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
| | - R. Hassan
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Fox Chase Cancer Center, Philadelphia, PA; Morphotek, Exton, PA; NIH, Bethesda, MD
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Seiden MV, Burris HA, Matulonis U, Hall JB, Armstrong DK, Speyer J, Weber JDA, Muggia F. A phase II trial of EMD72000 (matuzumab), a humanized anti-EGFR monoclonal antibody, in patients with platinum-resistant ovarian and primary peritoneal malignancies. Gynecol Oncol 2006; 104:727-31. [PMID: 17126894 DOI: 10.1016/j.ygyno.2006.10.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [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: 08/15/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the rate of response to matuzumab in patients with recurrent, EGFR-positive ovarian, or primary peritoneal cancer. Secondary end points included safety and tolerability, time to tumor progression, duration of response, and overall survival. METHODS A multi-institutional single arm phase II trial. RESULTS Of 75 women screened for the study, 37 were enrolled and treated. Median age of the treated patient population was 58 years, and most patients had more than four prior lines of chemotherapy. Therapy was well tolerated, the most common toxicities being a constellation of skin toxicities, including rash, acne, dry skin, and paronychia, as well as headache, fatigue, and diarrhea. Serious adverse events were very rare but included a single episode of pancreatitis that may have been drug related. All patients completed therapy, receiving 1 to 30 infusions of matuzumab. There were no formal responses (RR=0%, 95% CI: 0-9.5%), although 7 patients (21%) were on therapy for more than 3 months with stable disease. CONCLUSIONS Matuzumab at the dose and schedule selected is well tolerated. In this population of very heavily pretreated patients with epithelial ovarian and primary peritoneal malignancies, there was no evidence of significant clinical activity when matuzumab was administered as monotherapy.
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Affiliation(s)
- M V Seiden
- Massachusetts General Hospital, 100 Blossom Street, Cox 640, Boston, MA 02114, USA.
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Zellars RC, Frassica D, Stearns V, Fetting JH, Armstrong DK, Myers L, Tsangaris TN, Jacobs L, Lange JR, Wolf AC. Partial breast irradiation (PBI) concurrent with adjuvant dose-dense doxorubicin and dyclophosphamide (ddAC) chemotherapy in early-stage breast cancer: Preliminary safety results from a feasibility trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10675 Background: Adjuvant anthracycline-based chemotherapy regimens and radiation therapy as part of breast conservation therapy (BCT) are given sequentially to avoid excessive skin toxicity. PBI employs a shorter course of radiation therapy to a smaller breast field and is the subject of randomized efficacy trials. Concurrent administration of PBI and adjuvant chemotherapy would decrease duration of therapy, allow more women to pursue BCT, improve compliance, and potentially enhance local control. Methods: To examine the feasibility, safety, and short-term risk of recurrence of concurrent PBI with adjuvant ddAC, we are conducting a prospective one-stage, single-arm trial of PBI during the first 2 of 4 cycles of ddAC (60 and 600 mg/m2, respectively) delivered q14d with growth factor support. Patients (pts) with T1–2 N0–1 breast cancer and lumpectomy margins ≥ 3mm are eligible. PBI starts within 3 days of first chemo dose and treats the lumpectomy bed plus margin with 270 cGy fractions × 15 (4050 cGy total). Primary endpoints (skin/soft tissue toxicity and cosmetic outcome) are graded by a panel of physicians using commonly accepted scales. Digital images at baseline, during, and q 3–6 months after PBI are obtained for comparison. Additional chemo and endocrine Rx post ddAC given at the physician’s discretion. We report preliminary safety data. Results: Between 11/04 and 9/05, 10 pts were enrolled and received study therapy (accrual goal = 42); 2 pts also received dd paclitaxel 175 mg/m2 post ddAC. All pts received planned PBI (med. f/u 6 mos, range 3–12 mos). 2 pts missed 1 and 2 cycles of ddAC because of stomatitis (Gr 3) and diverticulitis, respectively. 3 other pts had 1–2 wk chemo delay because of hand-foot syndrome, brief pulmonary syndrome, and febrile neutropenia. No pts developed radiation dermatitis > Gr 1 or radiation recall. All pts had cosmetic outcome grades of good or excellent shortly after completion of therapy. No pts with ≥ 6 mos f/u since PBI had late skin toxicity. Conclusion: Early results suggest that PBI concurrent with ddAC appears feasible and safe. Trial enrolment continues and longer f/u is required. (Funded by The Breast Cancer Research Foundation). No significant financial relationships to disclose.
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Salani R, Santillan A, Zahurak M, Giuntoli R, Gardner GJ, Armstrong DK, Bristow RE. Secondary cytoreductive surgery for localized recurrent epithelial ovarian cancer: Analysis of prognostic factors and survival outcome. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5029 Background: To evaluate prognostic factors and survival outcome of patients undergoing secondary cytoreductive surgery for recurrent epithelial ovarian cancer with ≤ 5 sites of recurrence on pre-operative imaging studies. Methods: Patients undergoing secondary cytoreduction for recurrent epithelial ovarian carcinoma between 9/1997–3/2005 were retrospectively identified from tumor registry databases. Inclusion required: complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on pre-operative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinico-pathologic variables on overall post-recurrence survival. Results: Fifty-five patients met study inclusion criteria. The median age at recurrence was 57.7 years and the median diagnosis-to-recurrence interval was 32 months (range 12 to 164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were diagnosis-to-recurrence interval ≥18 months (median survival=49 months vs 3 months, p = 0.001), the number of radiographic recurrence sites (median survival: 1–2 sites=50.0 months vs 3–5 sites=12.0 months, p < 0.03) and residual disease (median survival: no gross residual=50 months vs macroscopic residual=7.2 months, p < 0.01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not significantly associated with survival. Conclusions: These data support the definition of localized recurrent ovarian cancer as patients with 1–2 radiographic recurrence sites. In this select population, a diagnosis-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of cases, were associated with a median post-recurrence survival time of approximately 50 months. No significant financial relationships to disclose.
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Affiliation(s)
- R. Salani
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - A. Santillan
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - M. Zahurak
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - R. Giuntoli
- Johns Hopkins Medical Institutions, Baltimore, MD
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Wenzel LB, Huang HQ, Armstrong DK, Walker JL, Cella D. Baseline quality of life (QOL) as a predictor of tolerance to intraperitoneal (IP) chemotherapy for advanced epithelial ovarian cancer (EOC): A Gynecologic Oncology Group (GOG) study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5007 Background: A recent GOG randomized phase III trial demonstrated a 16 month improvement in survival for women with optimally debulked stage III EOC. Patients on the IP chemotherapy arm experienced a survival advantage but significantly worse toxicities, worse QOL during treatment, and more neurotoxicity (NTX) one year later, compared to those on the IV arm. We sought to determine whether baseline QOL and NTX and abdominal discomfort (AD) predict severity of IP treatment-related adverse effects and number of cycles completed. Methods: Three self-report QOL measures were utilized: the FACT-O (39 items), and FACT/GOG-NTX (11 items) and FACT/GOG-AD (4 items) subscales. Scoring was on a 5-point scale, with higher scores representing better QOL (FACT-O) whereas higher scores indicated worse symptoms (-NTX and -AD subscales). In addition to NTX and AD, we explored associations with fatigue. A logistic regression model was used for the analyses. Results: Of 205 patients randomly assigned to receive IP chemotherapy, 198 (97%) completed baseline QOL assessments, of whom 83 (42%) completed all 6 cycles and 16 (8%) completed none. Adjusting for age, performance status and residual disease, patients reporting higher baseline FACT-O and lower -NTX and -AD scores were more likely to complete more IP cycles. Categorizing FACT-O scores by quartiles (≤92, 93 to ≤108.8, 109 to ≤121.1, and >121.1), patients in the lowest quartile were significantly less likely to complete 6 cycles of IP therapy (odds ratio [OR] = 4.46; 95% CI: 1.95–10.21, p < 0.001). Higher FACT-O scores were also associated with less grade 3–4 fatigue (OR = 0.81 per 10 points; 95% CI: 0.67–0.99; p = 0.037); however, there was no relationship between baseline NTX and AD subscale scores and severity of physician-rated NTX and AD. Conclusions: Baseline patient-reported QOL and NTX and AD symptoms predict tolerance to IP chemotherapy. Patients with the poorest baseline QOL (FACT-O score <92) were least likely to complete IP therapy. No significant financial relationships to disclose.
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Affiliation(s)
- L. B. Wenzel
- University of California Irvine, Irvine, CA; GOG Statistical and Data Center, Buffalo, NY; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Oklahoma, Oklahoma City, OK; Northwestern University Feinberg School of Medicine, Evanston, IL
| | - H. Q. Huang
- University of California Irvine, Irvine, CA; GOG Statistical and Data Center, Buffalo, NY; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Oklahoma, Oklahoma City, OK; Northwestern University Feinberg School of Medicine, Evanston, IL
| | - D. K. Armstrong
- University of California Irvine, Irvine, CA; GOG Statistical and Data Center, Buffalo, NY; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Oklahoma, Oklahoma City, OK; Northwestern University Feinberg School of Medicine, Evanston, IL
| | - J. L. Walker
- University of California Irvine, Irvine, CA; GOG Statistical and Data Center, Buffalo, NY; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Oklahoma, Oklahoma City, OK; Northwestern University Feinberg School of Medicine, Evanston, IL
| | - D. Cella
- University of California Irvine, Irvine, CA; GOG Statistical and Data Center, Buffalo, NY; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Oklahoma, Oklahoma City, OK; Northwestern University Feinberg School of Medicine, Evanston, IL
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Thrall M, Gallion HH, Kryscio R, Kapali M, Armstrong DK, DeLoia JA. BRCA1 expression in a large series of sporadic ovarian carcinomas: a Gynecologic Oncology Group study. Int J Gynecol Cancer 2006; 16 Suppl 1:166-71. [PMID: 16515585 DOI: 10.1111/j.1525-1438.2006.00504.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 11/26/2022] Open
Abstract
BRCA1 is a tumor suppressor gene that, when mutated, is associated with the development of hereditary ovarian cancer. A role for BRCA1 in the pathoetiology of sporadic ovarian epithelial cancer (OEC) development has been suggested, although spontaneous mutations of the BRCA1 gene in this disease are uncommon. Loss of gene function by epigenetic alteration is observed more commonly, while other means of gene inactivation have not been intensively investigated. We examined expression and localization of the BRCA1 gene product by immunohistochemistry and sought to clarify the relationship between protein expression and tumor stage, grade, histopathologic subtype, and outcome. Among 230 spontaneous OEC tumors, we found a statistically significant decrease in BRCA1 protein expression with advancing stages of OEC. There was no relationship between expression and tumor grade. There was a statistically significant relationship between the pathologic subtypes of OEC and BRCA1 expression. Minimal BRCA1 expression was protective for survival. These findings confirm a high rate of loss of BRCA1 protein expression in sporadic OEC and suggest a role of BRCA1 in the progression of sporadic ovarian carcinoma.
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Affiliation(s)
- M Thrall
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania 15213, USA
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Thrall M, Gallion HH, Kryscio R, Kapali M, Armstrong DK, Deloia JA. BRCA1 expression in a large series of sporadic ovarian carcinomas: a Gynecologic Oncology Group study. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200602001-00026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BRCA1 is a tumor suppressor gene that, when mutated, is associated with the development of hereditary ovarian cancer. A role for BRCA1 in the pathoetiology of sporadic ovarian epithelial cancer (OEC) development has been suggested, although spontaneous mutations of the BRCA1 gene in this disease are uncommon. Loss of gene function by epigenetic alteration is observed more commonly, while other means of gene inactivation have not been intensively investigated. We examined expression and localization of the BRCA1 gene product by immunohistochemistry and sought to clarify the relationship between protein expression and tumor stage, grade, histopathologic subtype, and outcome. Among 230 spontaneous OEC tumors, we found a statistically significant decrease in BRCA1 protein expression with advancing stages of OEC. There was no relationship between expression and tumor grade. There was a statistically significant relationship between the pathologic subtypes of OEC and BRCA1 expression. Minimal BRCA1 expression was protective for survival. These findings confirm a high rate of loss of BRCA1 protein expression in sporadic OEC and suggest a role of BRCA1 in the progression of sporadic ovarian carcinoma.
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Wenzel LB, Huang HQ, Armstrong DK, Walker J, Cella D. Validation of a FACT/GOG-Abdominal Discomfort (AD) subscale: A Gynecologic Oncology Group (GOG) study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8101] [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)
- L. B. Wenzel
- Univ of CA at Irvine, Irvine, CA; Roswell Park Cancer Institute, Buffalo, NY; Johns Hopkins, Baltimore, MD; Univ of Oklahoma, Oklahoma City, OK; Northwestern Univ, Evanston, IL
| | - H. Q. Huang
- Univ of CA at Irvine, Irvine, CA; Roswell Park Cancer Institute, Buffalo, NY; Johns Hopkins, Baltimore, MD; Univ of Oklahoma, Oklahoma City, OK; Northwestern Univ, Evanston, IL
| | - D. K. Armstrong
- Univ of CA at Irvine, Irvine, CA; Roswell Park Cancer Institute, Buffalo, NY; Johns Hopkins, Baltimore, MD; Univ of Oklahoma, Oklahoma City, OK; Northwestern Univ, Evanston, IL
| | - J. Walker
- Univ of CA at Irvine, Irvine, CA; Roswell Park Cancer Institute, Buffalo, NY; Johns Hopkins, Baltimore, MD; Univ of Oklahoma, Oklahoma City, OK; Northwestern Univ, Evanston, IL
| | - D. Cella
- Univ of CA at Irvine, Irvine, CA; Roswell Park Cancer Institute, Buffalo, NY; Johns Hopkins, Baltimore, MD; Univ of Oklahoma, Oklahoma City, OK; Northwestern Univ, Evanston, IL
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35
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Isaacs C, Skates SJ, Lehman C, Marcom K, Bowen DJ, Domchek S, Tomlinson G, Armstrong DK, Schnall M. Mammographic, MRI, and ultrasound characteristics of BRCA1, BRCA2, and other genetically high-risk women enrolled in a prospective multi-institution breast cancer screening trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9588] [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)
- C. Isaacs
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - S. J. Skates
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - C. Lehman
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - K. Marcom
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - D. J. Bowen
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - S. Domchek
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - G. Tomlinson
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - D. K. Armstrong
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - M. Schnall
- Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; University of Washington, Seattle, WA; Duke University, Durham, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA; U Texas Southwestern, Dallas, TX; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
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Messersmith WA, Baker SD, Dinh K, Lassiter LK, Akdamar RA, Wright JJ, Donehower RC, Carducci MA, Armstrong DK. Phase I trial of bortezomib (PS-341) in combination with docetaxel in patients with advanced solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3052] [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)
| | - S. D. Baker
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - K. Dinh
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - L. K. Lassiter
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - R. A. Akdamar
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - J. J. Wright
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - R. C. Donehower
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - M. A. Carducci
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
| | - D. K. Armstrong
- Johns Hopkins University, Baltimore, MD; NCI/CTEP, Bethesda, MD
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Rudek MA, Sparreboom A, Garrett-Mayer ES, Armstrong DK, Wolff AC, Verweij J, Baker SD. Factors affecting pharmacokinetic variability following doxorubicin and docetaxel-based therapy. Eur J Cancer 2004; 40:1170-8. [PMID: 15110880 DOI: 10.1016/j.ejca.2003.12.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 12/09/2003] [Accepted: 12/23/2003] [Indexed: 10/26/2022]
Abstract
Current dosing strategies for anticancer drugs result in wide interindividual pharmacokinetic variability. Here, we explored the influence of age, body size, concomitant drugs, dose, infusion duration, and sex on the clearance for doxorubicin and docetaxel in 243 individual patients. Patients received doxorubicin (n=110) or docetaxel (n=152) as monotherapy or in combination chemotherapy regimens. The mean (+/-S.D.) clearance was 63.6+/-22.7 L/h for doxorubicin and 42.8+/-14.9 L/h for docetaxel. Normalisation for body surface area (BSA) reduced the interindividual variability by only <1.7%. Doxorubicin clearance was significantly reduced when administered at doses >50 mg/m(2) or in combination with cyclophosphamide. Upper extremes of body size were associated with increased clearance for both drugs, whereas no consistent effect of age on clearance was discerned. Overall, these findings suggest that incorporation of variables in addition to BSA should be considered in routine dosing strategies for doxorubicin and docetaxel.
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Affiliation(s)
- M A Rudek
- Division of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231-1000, USA
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McGuire WP, Rowinsky EK, Rosenhein NB, Grumbine FC, Ettinger DS, Armstrong DK, Donehower RC. Taxol: A unique antineoplastic agent with significant activity in advanced ovarian epithelial neoplasms. Int J Gynaecol Obstet 2004. [DOI: 10.1016/0020-7292(90)91032-l] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim JW, Hung CF, Juang J, He L, Kim TW, Armstrong DK, Pai SI, Chen PJ, Lin CT, Boyd DA, Wu TC. Comparison of HPV DNA vaccines employing intracellular targeting strategies. Gene Ther 2004; 11:1011-8. [PMID: 14985791 DOI: 10.1038/sj.gt.3302252] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intradermal vaccination via gene gun efficiently delivers DNA vaccines into dendritic cells (DCs) of the skin, resulting in the activation and priming of antigen-specific T cells in vivo. In the context of DNA vaccines, we previously used the gene gun approach to test several intracellular targeting strategies that are able to route a model antigen, such as the human papillomavirus type-16 (HPV-16) E7, to desired subcellular compartments in order to enhance antigen processing and presentation to T cells. These strategies include the use of the sorting signal of lysosome-associated membrane protein (LAMP-1), Mycobacterium tuberculosis heat-shock protein 70 (HSP70), calreticulin (CRT) and the translocation domain (dII) of Pseudomonas aeruginosa exotoxin A (ETA). Vaccination with DNA vaccines encoding E7 antigen linked to any of these molecules all led to a significant enhancement of E7-specific CD8(+) T-cell immune responses and strong antitumor effects against an E7-expressing tumor, TC-1. However, we were interested in identifying the most potent DNA vaccine for our future clinical trials. Thus, we performed a series of experiments to directly compare the potency of the various DNA vaccines. Among the DNA vaccines we tested, we found that vaccination with pcDNA3-CRT/E7 generated the highest number of E7-specific CD8(+) T cells and potent long-term protection and treatment effects against E7-expressing tumors in mice. Interestingly, we observed that pcDNA3-CRT/E7 is also capable of protecting against an E7-expressing tumor with downregulated MHC class I expression, a common feature associated with most HPV-associated cervical cancers. Our data suggest that the DNA vaccine linking CRT to E7 (CRT/E7) may be a suitable candidate for human trials for the control of HPV infections and HPV-associated lesions.
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Affiliation(s)
- J W Kim
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
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Heath EI, O'Reilly S, Humphrey R, Sundaresan P, Donehower RC, Sartorius S, Kennedy MJ, Armstrong DK, Carducci MA, Sorensen JM, Kumor K, Kennedy S, Grochow LB. Phase I trial of the matrix metalloproteinase inhibitor BAY12-9566 in patients with advanced solid tumors. Cancer Chemother Pharmacol 2001; 48:269-74. [PMID: 11710626 DOI: 10.1007/s002800100330] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that are believed to be involved in primary and metastatic tumor growth by degrading the basement membrane and changing the extracellular matrix to facilitate invasion of malignant cells and angiogenesis. Overexpression of MMPs has been documented in various solid tumors. BAY12-9566 is a selective inhibitor of MMPs, in particular MMP-2, -3. and -9. The purpose of this trial was to define the maximum tolerated dose (MTD), dose-limiting toxicities (DLT), safety profile, pharmacokinetics and pharmacodynamics of orally administered BAY12-9566 in patients with incurable solid tumors. METHODS The starting dose of BAY12-9566 for this single institution, outpatient phase I study was 100 mg/day orally. Patients were allowed to receive drug for up to 12 months. A total of 27 patients with various solid malignancies including colorectal, breast, lung, cervical and ovarian cancers were enrolled at doses from 100 to 1,600 mg/day. Patients were evaluated weekly while on treatment. Relevant radiologic examination was performed every 8 weeks to document and follow sites of measurable or evaluable disease. RESULTS Toxicities from BAY12-9566 included liver injury test abnormalities, anemia, shoulder and back pain. thrombocytopenia, mild nausea and fatigue, diarrhea, rash and deep vein thrombosis. No toxicity greater than grade III was observed. As doses were increased from 100 to 400 to 1,600 mg/day, even in divided doses, less than proportional increases in AUC were observed. At the highest dose level of 1600 mg/day, the day 29 AUC (3778.00 mg x h/l) remained similar to the day 29 AUC (3312.60 mg x h/l) at the dose level of 1200 mg/day. No responses were seen, but 14 patients remained on study with stable disease for 4 to 26 months. CONCLUSIONS BAY12-9566 was well tolerated at doses as high as 800 mg orally twice daily. Although mild alterations in liver injury tests, platelet count and hematocrit were noted, these were not dose-limiting. The drug was well absorbed. However, the absence of proportional increases in AUC with doses greater than 800 mg and the achievement of Css in the range associated with biologic activity in preclinical models led to the selection of 800 mg twice daily for further evaluation in phase III trials.
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Affiliation(s)
- E I Heath
- Johns Hopkins Oncology Center, Baltimore, MD 21231, USA.
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Armstrong DK, Davidson NE. Dose intensity for breast cancer. Oncology (Williston Park) 2001; 15:701-8, 712; discussion 712-4, 717-8. [PMID: 11430205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Despite nearly 20 years of study, the importance of chemotherapy dose intensity in breast cancer remains unclear. Substantial preclinical data suggest a dose-response relationship, and consistent data document that recipients of substandard dosing have inferior outcomes. The use of increased dose-intensive therapies is costly, may require the use of hematopoietic growth factor support, and can result in significant increases in both short- and long-term toxicities. In patients with metastatic disease, increased dose intensity frequently results in increased response rates. However, these increased responses have not translated into consistent improvements in time to progression or overall survival benefit. In the adjuvant setting, increases in the dose intensities of alkylating agents and anthracyclines have failed to support the concept of dose escalation beyond standard doses. Certain subgroups of patients, such as those whose tumors overexpress HER2/neu, may derive a benefit from more dose-intensive therapies. Early results of randomized trials of high-dose chemotherapy in the treatment of metastatic breast cancer and adjuvant therapy for high-risk, early-stage breast cancer, are provocative. However, the often conflicting data do not support the routine use of this modality outside of the study setting.
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Affiliation(s)
- D K Armstrong
- Johns Hopkins Oncology Center, Baltimore, Maryland, USA
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Hunt DM, Rickman L, Whittock NV, Eady RA, Simrak D, Dopping-Hepenstal PJ, Stevens HP, Armstrong DK, Hennies HC, Küster W, Hughes AE, Arnemann J, Leigh IM, McGrath JA, Kelsell DP, Buxton RS. Spectrum of dominant mutations in the desmosomal cadherin desmoglein 1, causing the skin disease striate palmoplantar keratoderma. Eur J Hum Genet 2001; 9:197-203. [PMID: 11313759 DOI: 10.1038/sj.ejhg.5200605] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2000] [Revised: 10/27/2000] [Accepted: 11/01/2000] [Indexed: 11/09/2022] Open
Abstract
The adhesive proteins of the desmosome type of cell junction consist of two types of cadherin found exclusively in that structure, the desmogleins and desmocollins, coded by two closely linked loci on human chromosome 18q12.1. Recently we have identified a mutation in the DSG1 gene coding for desmoglein 1 as the cause of the autosomal dominant skin disease striate palmoplantar keratoderma (SPPK) in which affected individuals have marked hyperkeratotic bands on the palms and soles. In the present study we present the complete exon-intron structure of the DSG1 gene, which occupies approximately 43 kb, and intron primers sufficient to amplify all the exons. Using these we have analysed the mutational changes in this gene in five further cases of SPPK. All were heterozygotic mutations in the extracellular domain leading to a truncated protein, due either to an addition or deletion of a single base, or a base change resulting in a stop codon. Three mutations were in exon 9 and one in exon 11, both of which code for part of the third and fourth extracellular domains, and one was in exon 2 coding for part of the prosequence of this processed protein. This latter mutation thus results in the mutant allele synthesising only 25 amino acid residues of the prosequence of the protein so that this is effectively a null mutation implying that dominance in the case of this mutation was caused by haploinsufficiency. The most severe consequences of SPPK mutations are in regions of the body where pressure and abrasion are greatest and where desmosome function is most necessary. SPPK therefore provides a very sensitive measure of desmosomal function.
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Affiliation(s)
- D M Hunt
- Division of Membrane Biology, National Institute for Medical Research, Mill Hill, London, NW7 1AA, UK
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Hahm HA, Armstrong DK, Chen TL, Grochow L, Passos-Coelho J, Goodman SN, Davidson NE, Kennedy MJ. Novobiocin in combination with high-dose chemotherapy for the treatment of advanced breast cancer: a phase 2 study. Biol Blood Marrow Transplant 2001; 6:335-43. [PMID: 10905771 DOI: 10.1016/s1083-8791(00)70059-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
We conducted the first phase 2 and pharmacologic study to evaluate the combination of novobiocin (a coumeromycin antibiotic that has been shown to augment alkylating agent cytotoxicity in experimental models) and high-dose cyclophosphamide and thiotepa followed by autologous marrow support in women with chemosensitive advanced breast cancer. Its aims were (1) to determine progression-free survival (PFS) and overall survival (OS), (2) to evaluate the pharmacokinetics of cyclophosphamide and thiotepa, and (3) to measure the ability of novobiocin to reverse alkylator drug resistance in vitro. Forty-one women with chemotherapy-responsive advanced breast cancer received cyclophosphamide (4 g/m2) for peripheral blood stem cell mobilization (treatment 1) followed by high-dose cyclophosphamide (1.5 g/m2 per day for 4 days), thiotepa (200 mg/m2 per day for 4 days), and novobiocin (4 g/day orally for 7 days) (treatment 2) and autologous marrow support. The median PFS was 10 months (range, 0.2-70.6 months) and OS, 21.5 months (range, 0.2-70.6 months). There was no statistically significant relationship between PFS or OS and area-under-the-curve values of cyclophosphamide, thiotepa, or 4-hydroxycyclophosphamide. Patient plasma samples (n = 12) obtained during novobiocin therapy were able to reverse alkylator drug resistance in an in vitro colony-forming assay. Correlative laboratory studies in an in vitro model system demonstrated that patient plasma after novobiocin treatment resulted in the magnitude of resistance reversal that had been predicted by prior preclinical experiments. Clinically, however, this activity of novobiocin did not translate into a substantial increase in PFS or OS compared with historical controls treated with high-dose alkylator therapy alone.
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Affiliation(s)
- H A Hahm
- The Johns Hopkins Oncology Center, Baltimore, Maryland, USA
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Abstract
Strategies utilizing high-dose chemotherapy for treatment of breast cancer have been the subject of significant controversy over the past decade. Disappointing results from randomized phase III trials in metastatic and high-risk, early stage breast cancer have tempered enthusiasm for this approach. A significant problem with large, randomized phase III trials is that improvements in therapy and supportive care cannot be rapidly incorporated into treatment, and the question under study may quickly become obsolete. The most appropriate approach for testing newer treatments may be to build on the information gained from sequential phase I and phase II studies until there is sufficient promise to warrant randomized phase III studies. The basis of most past clinical trials of high-dose therapy in breast cancer has been the use of chemotherapeutic agents at doses that are poorly tolerated without hematopoietic support. It is clear, however, that high-dose chemotherapy has significant effects on the immune system. Immune reconstitution after high-dose, marrow ablative chemotherapy is associated with transient alterations in immune surveillance, immune recognition, and immune responses. Immune therapy represents a distinct mechanism that has the potential to eradicate chemotherapy-resistant tumor cells. The development of graft-versus-host disease after allogeneic transplantation has been associated with a decreased risk of recurrence in hematologic malignancies. Breast cancer is a potential target for this graft-versus-tumor effect in allogeneic transplantation and in trials designed to induce a transient immune antitumor effect by pharmacologic means. Circulating tumor cell antigens are elevated after high-dose chemotherapy, providing a rationale for studies evaluating vaccine strategies after high-dose therapy. The minimal tumor burden after high-dose therapy also presents an opportunity to evaluate the use of non-myelosuppressive, targeted therapies in conjunction with high-dose therapy. Finally, the use of multiple cycles of high-dose therapy to replace standard-dose therapy has the potential to avoid the development of drug resistance. It is clear that there are multiple, promising avenues of investigation that utilize high-dose chemotherapy for the treatment of breast cancer. The most significant question is whether the climate exists to support these studies.
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Affiliation(s)
- D K Armstrong
- The Johns Hopkins Oncology Center, The Bunting Blaustein Cancer Research Building Room 190, 1650 Orleans Street, Baltimore, MD 21231-1000, USA
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Ishida-Yamamoto A, Kato H, Kiyama H, Armstrong DK, Munro CS, Eady RA, Nakamura S, Kinouchi M, Takahashi H, Iizuka H. Mutant loricrin is not crosslinked into the cornified cell envelope but is translocated into the nucleus in loricrin keratoderma. J Invest Dermatol 2000; 115:1088-94. [PMID: 11121146 DOI: 10.1046/j.1523-1747.2000.00163.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Loricrin is a major constituent of the epidermal cornified cell envelope. We have recently identified heterozygous loricrin gene mutations in two dominantly inherited skin diseases, the ichthyotic variant of Vohwinkel syndrome and progressive symmetric erythrokeratoderma, collectively termed loricrin keratoderma. In order to see whether the mutant loricrin molecules predicted by DNA sequencing are expressed in vivo and to define their pathologic effects, we raised antibodies against synthetic peptides corresponding to the mutated sequences of loricrin. Immunoblotting of horny cell extracts from loricrin keratoderma patients showed specific bands for mutant loricrin. Immunohistochemistry of loricrin keratoderma skin biopsies showed positive immunoreactivity to the mutant loricrin antibodies in the nuclei of differentiated epidermal keratinocytes. The immunostaining was localized to the nucleoli of the lower granular cell layer. As keratinocyte differentiation progressed the immunoreactivity moved gradually into the nucleoplasm leaving nucleoli mostly nonimmunoreactive. No substantial staining was observed along the cornified cell envelope. This study confirmed that mutant loricrin was expressed in the loricrin keratoderma skin. Mutant loricrin, as a dominant negative disrupter, is not likely to affect cornified cell envelope crosslinking directly, but seems to interfere with nuclear/nucleolar functions of differentiating keratinocytes. In addition, detection of the mutant loricrin in scraped horny layer could provide a simple noninvasive screening test for loricrin keratoderma. J Invest Dermatol 115:1088-1094 2000
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Affiliation(s)
- A Ishida-Yamamoto
- Department of Dermatology, Asahikawa Medical College, Asahikawa, Japan.
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van der Wall E, Horn T, Bright E, Passos-Coehlo JL, Bond S, Clarke B, Altomonte V, McIntyre K, Vogelsang G, Noga SJ, Davis JM, Thomassen J, Ohly KV, Lee SM, Fetting J, Armstrong DK, Davidson NE, Hess AD, Kennedy MJ. Autologous graft-versus-host disease induction in advanced breast cancer: role of peripheral blood progenitor cells. Br J Cancer 2000; 83:1405-11. [PMID: 11076645 PMCID: PMC2363431 DOI: 10.1054/bjoc.2000.1499] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of the present study was to investigate the impact of the use of peripheral blood progenitor cells (PBPCs) on the induction of autologous graft-versus-host disease (GVHD) in patients with advanced breast cancer. 14 women with stage IIIB and 36 women with stage IV breast cancer received cyclosporine (CsA) 2.5 mg kg-1 i.v. daily, d 0-28, and interferon-gamma (IFNg) 0.025 mg/m2 s.c. qod, d7-28, following PBPC-T +/- bone marrow transplantation (BMT). Preceding high-dose chemotherapy consisted of cyclophosphamide 6 g/m2 and thiotepa 800 mg/m2. Histologically proven > or = grade II cutaneous GVHD was induced in18/50 (36%) of patients and was independent of the source of haematopoietic support. In vitro studies showed that post-transplant, 76% of patients had developed auto-cytotoxicity against their own pre-transplant PHA-lymphoblasts. A significant correlation between the occurrence of GVHD > or = grade II and cytolysis was observed in the NK cell-line K562 and the T47D breast cancer cell-line. With a median follow-up of 2(1/2) years, the overall survival (OS) is 58%, the disease-free survival (DFS) 26%, both independent of the development of GVHD and similar to what has been observed in other studies on high-dose chemotherapy in advanced breast cancer. It therefore remains unclear whether the induction of autologous GVHD with the occurrence of auto-cytotoxic lymphocytes can result in an anti-tumour effect in this group of patients.
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Affiliation(s)
- E van der Wall
- Bunting-Blaustein Cancer Research Building, Baltimore, MD 21231, USA
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Armstrong DK, Thornton C, Bingham EA. Infantile umbilical polyp: important diagnostic considerations. Dermatology 2000; 197:94. [PMID: 9711438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Smith HR, Armstrong DK, Wakelin SH, Rycroft RJ, White IR, McFadden JP. Descriptive epidemiology of hand dermatitis at the St John's contact dermatitis clinic 1983-97. Br J Dermatol 2000; 142:284-7. [PMID: 10730762 DOI: 10.1046/j.1365-2133.2000.03299.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For 15 years, hand dermatitis accounted for a quarter of patients seen in this clinic. The highest proportion occurred in women aged 17-30 years. Overall, the male to female ratio was 0.8, which contrasts with population-based studies. Catering was most frequently associated with occupational hand dermatitis. Other frequent occupational associations included metalworking, hairdressing, healthcare and mechanical work.
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Affiliation(s)
- H R Smith
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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Abstract
The factors which determine individual susceptibility to the development of allergic contact dermatitis (ACD) are not well defined. Since it is known that the presence of skin irritation is well-documented as a promoter of sensitization, the sensitivity to irritation of subjects with ACD has been compared with a normal control group. Whilst 78% of those with a positive patch test reaction to the contact allergen colophony (colophonium) responded to a concentration of no higher than 2.5% sodium lauryl sulfate (SLS), only 44% of the matched control group reacted at this level of SLS. Thus, the results are consistent with the hypothesis that individuals with enhanced susceptibility to skin irritation are also more liable to develop allergic skin reactivity.
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Affiliation(s)
- H R Smith
- St John's Institute of Dermatology, St Thomas's Hospital, London, UK
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Smith HR, Holloway D, Armstrong DK, Whittam L, White IR, Rycroft RJ, McFadden JP. Association between tinea manuum and male manual workers. Contact Dermatitis 2000; 42:45. [PMID: 10644027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- H R Smith
- St John's Institute of Dermatology, St Thomas's Hospital, London, UK
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