1
|
Rosenberg SM, O'Neill A, Sepucha K, Miller KD, Dang CT, Northfelt DW, Sledge GW, Schneider BP, Partridge AH. Abstract GS6-05: The impact of breast cancer surgery on quality of life: Long term results from E5103. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) treatment, including surgery, can impact not only short-term health outcomes but may also affect longer term health-related and psychosocial quality of life (QOL). We sought to describe the impact of BC surgery on QOL among breast cancer survivors followed in a large randomized trial.
Methods: The ECOG-ACRIN protocol E5103 was a phase III trial that randomized BC patients (pts) who had undergone definitive BC surgery to receive adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab (bev) or placebo. Telephone based surveys were administered to all pts enrolled between 01/Jan/10 and 08/Jun/10 as part of a Decision-Making/QOL component until 18 mos post enrollment. Functional/psychosocial QOL domains were assessed by the EQ-5D-3L and the FACT B+G. Fisher's exact test compared categorical and Wilcoxon rank sum test compared continuous variables between subgroups. Multivariable regression was used to evaluate factors in addition to primary surgery at enrollment (age, race, ER/PgR status, tumor size, nodal status) associated with overall FACT score at 18 mos.
Results: Patient reported outcomes at 18 mos were available from 89.6% (465/519) pts. At enrollment, 57% (266/465) had a mastectomy; 43% (199/465) breast conserving surgery (BCS). Median age at enrollment was 52 (range: 25-76) years. There were no differences in QOL between bev vs placebo treatment arms (EQ-5D-3L Index Score p=0.65; FACT B+G Score p=0.23) at 18 mos so groups were combined. Using EQ-5D-3L, over half of the pts (58%) reported at least some pain/discomfort; 38% symptoms of anxiety/depression. A higher proportion of mastectomy pts reported problems with usual activities compared to BCS pts (Table). Compared to BCS pts, mastectomy pts had lower average EQ5D-3L scores 0.80 vs. 0.84, p=0.04 and FACT B+G scores 109 vs. 114, p=0.01, indicating worse QOL. In univariate analyses, non-white race (p=0.03), ER/PgR+ status (p=0.04) and mastectomy as primary surgery (p=0.01) were significantly associated with worse QOL (lower FACT B+G scores). In multivariable analyses, non-white race (p=0.02) and ER/PgR+ status (p=0.05) remained associated with worse QOL; mastectomy was borderline significant (p=0.06).
Conclusions: Among women participating in a contemporary adjuvant BC chemotherapy trial, a substantial proportion of survivors experience symptoms that may be amenable to intervention, including referral to physical rehabilitation, especially among pts undergoing more extensive surgery. Attention to psychosocial health is also essential both during and after completion of active treatment to optimize QOL outcomes.
N(%) reporting problems* 5 DimensionsBCSMastectomyOverallp**Mobility44(23)59(23)103(23)1.00Self-care11(6)23(9)34(7)0.21Usual activities49(25)90(34)139(30)0.04Pain/discomfort104(53)161(61)265(58)0.08Anxiety/depression70(36)105(40)175(38)0.44*3L: 3 possible answers: 1) no problems 2) some/moderate problems 3) problems; responses then collapsed into no problems vs. any problems' (=some/moderate problems and problems). ** Fisher's exact test p-value.
Citation Format: Rosenberg SM, O'Neill A, Sepucha K, Miller KD, Dang CT, Northfelt DW, Sledge GW, Schneider BP, Partridge AH. The impact of breast cancer surgery on quality of life: Long term results from E5103 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-05.
Collapse
Affiliation(s)
- SM Rosenberg
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - A O'Neill
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - K Sepucha
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - KD Miller
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - CT Dang
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - DW Northfelt
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - GW Sledge
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - BP Schneider
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| | - AH Partridge
- Dana-Farber Cancer Institute, Boston, MA; ECOG-ACRIN Biostatistics Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University, Indianapolis, IN; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Stanford University, Stanford, CA
| |
Collapse
|
2
|
Ertz-Archambault N, Rogoff L, Kosiorek H, Ernst B, Anderson K, Pockaj B, Gray R, Northfelt D. Abstract P1-11-13: Depomedroxyprogesterone therapy for hot flashes in survivors of ER-expressing breast cancer: Impact on recurrence and survival. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-11-13] [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
Survivors of ER-expressing operable breast cancer (ER+BC) generally do not receive hormone replacement therapy for menopausal symptoms due to concern about provoking recurrence of disease. Single dose depomedroxyprogesterone acetate (MPA) 400 mg IM has previously been shown (Loprinzi CL, et al. J Clin Oncol 2006;24:1409) to be the most effective non-estrogen therapy available for menopausal hot flashes (HF) but long-term evidence of safety in survivors of ER+BC is lacking.
Methods
Consecutive patients previously diagnosed with ER+BC who received MPA for HF between January 2007 and December 2012 were retrospectively identified in the breast cancer patient database at Mayo Clinic Arizona. Medical records were audited for breast cancer outcomes in these cases and in contemporaneous control patients with ER+BC who did not receive MPA, matched for age, stage of disease, and year of diagnosis. Statistical comparisons of local-regional recurrence and event-free survival were performed.
Results
92 patients who received MPA were identified and matched 1:1 with contemporaneous controls. Median follow-up duration was 5.7 years in cases and 4.5 years in controls. Estimated local-regional recurrence free survival at 10 years was 85% (95% CI, 72-100%) in cases and 95% (95% CI, 86-100%) in controls. Matched pairs hazard ratio was 1.0 (95% CI, 0.06-16.0) for local-regional recurrence free survival. Estimated event-free survival at 10 years was 81% (95% CI, 69-97%) in cases and 76% (95% CI, 64-92%) in controls. Matched pairs hazard ratio was 0.38 (95% CI, 0.10-1.41) for event-free survival. The majority (77%) of case patients experienced satisfactory relief of hot flashes from MPA injection.
Conclusion
In this retrospective case-control study we were unable to identify a detrimental effect of MPA therapy for HF in survivors of ER+BC. MPA may be acceptable for management of HF in this population.
Citation Format: Ertz-Archambault N, Rogoff L, Kosiorek H, Ernst B, Anderson K, Pockaj B, Gray R, Northfelt D. Depomedroxyprogesterone therapy for hot flashes in survivors of ER-expressing breast cancer: Impact on recurrence and survival [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-13.
Collapse
Affiliation(s)
| | - L Rogoff
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - H Kosiorek
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - B Ernst
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - K Anderson
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - B Pockaj
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - R Gray
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| | - D Northfelt
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Florida, Jacksonville, FL
| |
Collapse
|
3
|
Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. Abstract P2-14-01: The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In women with breast cancer receiving neoadjuvant chemotherapy, residual cancer burden (RCB) predicts distant recurrence and survival. In those with high risk tumors, locoregional recurrence (LRR) remains a concern, and has been associated with type of local therapy received. We evaluated the impact of local therapy on LRR in the ISPY-2 TRIAL.
Methods: Data were analyzed in Stata 14.2, using Chi2 test, log rank test, and a Cox proportional hazards model. RCB was considered a categorical variable (0/1 versus 2/3), as described in prior publications. Breast surgery categories were lumpectomy +/- radiotherapy, or mastectomy +/- radiotherapy. Axillary surgery was defined as sentinel lymph node (SLN) surgery (≤6 nodes removed) or axillary dissection (>6 nodes).
Results: Follow up data from the I-SPY2 TRIAL were available for 630 patients (median follow up 2.76 yrs, range 0.4-7.2). Type of local therapy was significantly associated with clinical stage at presentation, with stage III patients most frequently undergoing mastectomy + radiation (p<0.001). Women with higher RCB were more likely to undergo mastectomy than those with lower RCB (61.3% vs 48.8% mastectomy rate, p=0.002), and more likely to receive adjuvant radiotherapy (62.0% vs 53.9%, p=0.048). There was no association between clinical stage, type of surgery, or radiotherapy and LRR (Table). Higher RCB was significantly associated with LRR, with 3 year locoregional recurrence free rate of 95.1% in RCB 0/1 versus 89.9% in RCB 2/3 (p=0.003).
In a Cox model adjusting for clinical stage, tumor subtype, surgical therapy, RCB status, nodal radiation, and age, significant predictors for LRR were tumor subtype and RCB status. Hazard ratio (HR) for LRR in those with RCB 0/1 was 0.39 compared to those with RCB 2/3 (95% CI 0.17-0.87, p=0.021). There was no difference in LRR between breast conservation and mastectomy; within the breast conservation group, those who had lumpectomy alone had higher hazard of LRR compared to those having lumpectomy + radiation (HR 3.1, 95% CI 1.1-9.2, p=0.043).
Conclusions: Extent of surgical therapy was not associated with local tumor control, regardless of advanced tumor stage at presentation. Rather, tumor biology and response to therapy were the best predictors of LRR. These data highlight the opportunity to minimize the morbidity of extensive surgical therapy for patients with excellent response to systemic therapy.
LRR rates by clinical features and treatment status FrequencyLRR RateP valueClinical Stage 0.5I240 (47.5%)5.8% II185 (36.6%)8.7% III80 (15.8%)6.3% Tumor Subtype 0.014ER+PR+Her2-161 (26.4%)3.1% ER+PR-Her2-56 (9.2%)3.6% Her2+176 (28.9%)6.3% Triple negative216 (35.5%)11.1% Local therapy 0.169Lumpectomy85 (13.5%)11.8% Lumpectomy with radiation198 (31.4%)5.6% Mastectomy173 (27.5%)5.2% Mastectomy with radiation174 (27.6%)8.6% Axillary surgery 0.23None5 (0.8%)20% SLN329 (52.2%)5.8% ALND296 (47%)8.5% Axillary radiation 0.535Yes42 (6.7%)9.5% No588 (93.3%)7.0% Axillary management 0.2No surgery or radiation5 (0.8%)20.0% SLN312 (50%)5.3% SLN+Axillary radiation17 (2.7%)8.3% ALND271 (43%)10.3% ALND+Axillary radiation25 (4%)5.4% RCB 0.0020/1293 (50.1%)3.8% 2/3292 (49.9%)10.3%
Citation Format: Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, I-SPY 2 TRIAL Consortium, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-01.
Collapse
Affiliation(s)
- J Silverstein
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Suleiman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Yau
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ER Price
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Singhrao
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Yee
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A DeMichele
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Isaacs
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KS Albain
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AJ Chien
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A Forero-Torres
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AM Wallace
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Pusztai
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ED Ellis
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AD Elias
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JE Lang
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - J Lu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Han
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AS Clark
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Korde
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Nanda
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DW Northfelt
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - QJ Khan
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RK Viscusi
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DM Euhus
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KK Edmiston
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SY Chui
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - K Kemmer
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - WC Wood
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JW Park
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - MC Liu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - O Olopade
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - B Leyland-Jones
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Tripathy
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SL Moulder
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Rugo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Schwab
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - S Lo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - T Helsten
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - H Beckwith
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DA Berry
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SM Asare
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - LJ Esserman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JC Boughey
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RA Mukhtar
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | | |
Collapse
|
4
|
Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen YY, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Abstract P2-07-03: Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients achieving a pathologic complete response (pCR) following neoadjuvant therapy have significantly improved event-free survival relative to those who do not; and pCR is an FDA-accepted endpoint to support accelerated approval of novel agents/combinations in the neoadjuvant treatment of high risk early stage breast cancer. Previous studies have shown that recurrence risk increased with increasing burden of residual disease (as assessed by the RCB index). As well, these studies suggest that patients with minimum residual disease (RCB-I class) also have favorable outcomes (comparable to those achieving a pCR) within high risk tumor subtypes. In this study, we assess whether integrating RCB with MRI functional tumor volume (FTV), which in itself is prognostic, can improve prediction of distant recurrence free survival (DRFS); and identify a subset of patients with minimal residual disease with comparable DRFS as those who achieved a pCR. Imaging tools can then be used to identify the subset that will do well early and guide the timing of surgical therapy.
Method: We performed a pooled analysis of 596 patients from the I-SPY2 TRIAL with RCB, pre-surgical MRI FTV data and known follow-up (median 2.5 years). We first assessed whether FTV predicts residual disease (pCR or pCR/RCB-I) using ROC analysis. We applied a power transformation to normalize the pre-surgical FTV distribution; and assessed its association with DRFS using a bi-variate Cox proportional hazard model adjusting for HR/HER2 subtype. We also fitted a bivariate Cox model of RCB index adjusting for subtype; and assessed whether adding pre-surgical FTV to this model further improves association with DRFS using a likelihood ratio (LR) test. For the Cox modeling, penalized splines approximation of the transformed FTV and RCB index with 2 degrees of freedom was used to allow for non-linear effects of FTV and RCB on DRFS.
Result: Pre-surgical MRI FTV is significantly associated with DRFS (Wald p<0.00001), and more effective at predicting pCR/RCB-I than predicting pCR alone (AUC: 0.72 vs. 0.65). Larger pre-surgical FTV remains associated with worse DRFS adjusting for subtype (Wald p <0.00001). The RCB index is also significantly associated with DRFS adjusting for subtype (Wald p<0.00001). Adding FTV to a model containing RCB and subtype further improves association with DRFS (LR p=0.0007). RCB-I patients have excellent DRFS (94% at 3 years compared to 95% in the pCR group). Efforts are underway to identify an optimal threshold for dichotomizing pre-surgical FTV and FTV change measures for use in combination with pCR/RCB-I class to generate integrated RCB (iRCB) groups as a composite predictor of DRFS.
Conclusion: Pre-surgical MRI FTV is effective at predicting minimal residual disease (RCB0/I) in the I-SPY 2 TRIAL. Despite the association between FTV and RCB, FTV appears to provide independent added prognostic value (to RCB and subtype), suggesting that integrating MRI volume measures and RCB into a composite predictor may improve DRFS prediction.
Citation Format: Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen Y-Y, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, I-SPY 2 TRIAL Consortium, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-03.
Collapse
Affiliation(s)
- NM Hylton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WF Symmans
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Yau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Li
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Hatzis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Isaacs
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KS Albain
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - Y-Y Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Krings
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Wei
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Harada
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Datnow
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Fadare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Klein
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Pambuccian
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Adamson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - P Mhawech-Fauceglia
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Magliocco
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Feldman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Rendi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Sattar
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Zeck
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - I Ocal
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Tawfik
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Grasso LeBeau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sahoo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Vinh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Adams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AJ Chien
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Ferero-Torres
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - E Stringer-Reasor
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wallace
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JC Boughey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ED Ellis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AD Elias
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JE Lang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Lu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Han
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AS Clark
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Korde
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Nanda
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DW Northfelt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - QJ Khan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - RK Viscusi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DM Euhus
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KK Edmiston
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SY Chui
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Kemmer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WC Wood
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JW Park
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MC Liu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Olopade
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Tripathy
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SL Moulder
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Rugo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Schwab
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Lo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Helsten
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Beckwith
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PK Haugen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ van't Veer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Perlmutter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ME Melisko
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wilson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Peterson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AL Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MB Buxton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Paoloni
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JL Clennell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - GL Hirst
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Singhrao
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Steeg
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JB Matthews
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Sanil
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Abe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Wolverton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - EP Crane
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KA Ward
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Nelson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - BL Niell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Oh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KR Brandt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DH Bang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Ojeda-Fournier
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Eghtedari
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PA Sheth
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WK Bernreuter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Umphrey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MA Rosen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Dogan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Joe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Yee
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Pusztai
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A DeMichele
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DA Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ Esserman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | | |
Collapse
|
5
|
McDonald BR, Contente-Cuomo T, Sammut SJ, Ernst B, Odenheimer-Bergman A, Perdigones N, Chin SF, Farooq M, Cronin PA, Anderson KS, Kosiorek H, Northfelt D, McCullough A, Patel B, Caldas C, Pockaj B, Murtaza M. Abstract P4-01-21: Multiplexed targeted digital sequencing of circulating tumor DNA to detect minimal residual disease in early and locally advanced breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-21] [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:
Circulating tumor DNA (ctDNA) analysis holds potential for minimal residual disease (MRD) detection in early stage breast cancer. However, sensitivity for MRD is limited due to low ctDNA levels in early stage patients and limited blood volumes. Loss of input DNA during library preparation, limited multiplexing or low sensitivity of current molecular methods further limit accuracy. To address this gap, we have developed TARgeted DIgital Sequencing (TARDIS), a novel method for simultaneous analysis of multiple patient-specific mutations in plasma DNA.
Methods:
Using tumor exome sequencing, we identify and prioritize somatic founder mutations, design nested primers and evaluate them for multiplex performance. Using 5-10 ng input plasma DNA, we perform 1) targeted linear pre-amplification to improve downstream molecular conversion, 2) single-stranded adapter ligation to incorporate unique molecular identifiers (UMIs) and 3) targeted PCR to prepare sequencing-ready libraries. The resulting sequencing reads have fixed target-specific ends and variable ligation ends. We utilize fragment size and UMIs to group sequencing reads into read families. To ensure specificity, we require targeted mutations are supported by 2 or more read families.
Results:
To assess analytical performance, we targeted 8 mutations in cell-free DNA reference samples with 0.25%-2% mutation allele fractions (AFs). Precision across 7-16 replicates at each AF level agreed with expectations of Poisson distribution, demonstrating effective analysis of ˜70% of input DNA. At 2%, 1%, 0.5% and 0.25% AFs, variant-level sensitivity was 96.4%, 96.4%, 91.1% and 65.8%, approaching the theoretical limit given input DNA. At 0.25% AF, 3-7 mutations were detected per sample, achieving 100% sample-level sensitivity. In 16 wild-type replicates, no targeted mutations were called (100% specificity). Averaging multiple mutations improved precision in sample-level AF estimates. Mean AFs from 8 mutations for the 2% sample were 2.34%-2.80% (5.8% CV).
In 6 patients with breast cancer treated with neoadjuvant therapy (NAT), we analyzed 8-18 patient-specific mutations (mean 11.8). Before treatment, ctDNA was detected in 5/6 patients at mean AFs of 0.02%-1.19% (mean 0.40%), supported by 2-10 mutations (mean 5.6). Of these 5 patients, 4 had residual disease after NAT and ctDNA was detected pre-operatively or during NAT in 3/4 patients. 1 patient achieved pathological Complete Response and ctDNA was undetectable after NAT.
Conclusions:
Preliminary results suggest TARDIS enables accurate MRD detection after neoadjuvant therapy in patients with early stage breast cancer. On-going work is expanding this analysis to include additional patients and investigate the clinical validity of peri-operative ctDNA monitoring.
Summary of clinical resultsPatientPre-NAT Stage (TNM)SubtypeNo. of Mutations TargetedBaseline ctDNA (AF%, No. of Mutations)ctDNA after or during NAT (AF%, No. of Mutations)Residual Tumor (TNM)1T3 N1ER+ PR+ HER2-8+ (0.02%, 2)-T2 N12T3 N0TNBC12+ (0.29%, 6)+ (0.01%, 1)T1a N03T2 N1TNBC18+ (1.19%, 10)+ (0.01%, 1)T1mi N04T3 N1TNBC10+ (0.02%, 3)+ (0.05%, 3)T3 N15T2 N0TNBC9+ (0.46%, 7)-pathCR6T1c N1TNBC14--pathCR
Citation Format: McDonald BR, Contente-Cuomo T, Sammut S-J, Ernst B, Odenheimer-Bergman A, Perdigones N, Chin S-F, Farooq M, Cronin PA, Anderson KS, Kosiorek H, Northfelt D, McCullough A, Patel B, Caldas C, Pockaj B, Murtaza M. Multiplexed targeted digital sequencing of circulating tumor DNA to detect minimal residual disease in early and locally advanced breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-21.
Collapse
Affiliation(s)
- BR McDonald
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - T Contente-Cuomo
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - S-J Sammut
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - B Ernst
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - A Odenheimer-Bergman
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - N Perdigones
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - S-F Chin
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - M Farooq
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - PA Cronin
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - KS Anderson
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - H Kosiorek
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - D Northfelt
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - A McCullough
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - B Patel
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - C Caldas
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - B Pockaj
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - M Murtaza
- Translational Genomics Research Institute, Phoenix, AZ; Mayo Clinic, Scottsdale, AZ; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| |
Collapse
|
6
|
Schwab R, Clark A, Yau C, Wolf D, Chien AJ, Majure M, Ewing C, Wallace A, Roesch E, Helsten T, Forero A, Stringer-Reasor E, Vaklavas C, Nanda R, Jaskowiak N, Boughey J, Haddad T, Han H, Lee C, Albain K, Isaacs C, Elias A, Ellis E, Shah P, Lang J, Lu J, Tripathy D, Kemmer K, Yee D, Haley B, Korde L, Edmiston K, Northfelt D, Viscusi R, Khan Q, Symmans WF, Perlmutter J, Hylton N, Rugo H, Melisko M, Wilson A, Singhrao R, Asare S, van't Veer L, DeMichele A, Berry D, Esserman L. Abstract P1-15-02: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-15-02] [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
This abstract was withdrawn by the authors.
Citation Format: Schwab R, Clark A, Yau C, Wolf D, Chien AJ, Majure M, Ewing C, Wallace A, Roesch E, Helsten T, Forero A, Stringer-Reasor E, Vaklavas C, Nanda R, Jaskowiak N, Boughey J, Haddad T, Han H, Lee C, Albain K, Isaacs C, Elias A, Ellis E, Shah P, Lang J, Lu J, Tripathy D, Kemmer K, Yee D, Haley B, Korde L, Edmiston K, Northfelt D, Viscusi R, Khan Q, I-SPY 2 Consortium, Symmans WF, Perlmutter J, Hylton N, Rugo H, Melisko M, Wilson A, Singhrao R, Asare S, van't Veer L, DeMichele A, Berry D, Esserman L. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-02.
Collapse
Affiliation(s)
- R Schwab
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A Clark
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - C Yau
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - D Wolf
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - AJ Chien
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - M Majure
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - C Ewing
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A Wallace
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - E Roesch
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - T Helsten
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A Forero
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - E Stringer-Reasor
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - C Vaklavas
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - R Nanda
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - N Jaskowiak
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - J Boughey
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - T Haddad
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - H Han
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - C Lee
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - K Albain
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - C Isaacs
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A Elias
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - E Ellis
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - P Shah
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - J Lang
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - J Lu
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - D Tripathy
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - K Kemmer
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - D Yee
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - B Haley
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - L Korde
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - K Edmiston
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - D Northfelt
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - R Viscusi
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - Q Khan
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - WF Symmans
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - J Perlmutter
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - N Hylton
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - H Rugo
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - M Melisko
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A Wilson
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - R Singhrao
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - S Asare
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - L van't Veer
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - A DeMichele
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - D Berry
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | - L Esserman
- University of California San Diego, La Jolla, CA; University of Pennsylvania, Philadelphia, PA; University of California San Francisco, San Francisco, CA; Quantum Leap Health Care Collaborative, San Francisco, CA; University of Alabama Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Mayo Rochester, Rochester, MN; Moffitt Cancer Center, Tampa, FL; Loyola University, Chicago, IL; Georgetown University, Washington, DC; University of Colorado Denver, Denver, CO; Swedish Cancer Institute, Seattle, WA; University of Southern California, Los Angeles, CA; MD Anderson Cancer Center, Houston, TX; Oregon Health and Sciences University, Portland, OR; University of Minnesota, Minneapolis, MN; University of Texas Southwestern, Dallas, TX; CTEP, National Cancer Institute, Bethesda, Washington DC; Mayo Scottsdale, Scottsdale, AZ; University of Arizona, Tuscon, AZ; University of Kansas, Lawrence, KS; Berry Consultants, LLC, Houston, TX; Gemini Group, Ann Arbor; Inova Health System, Fairfax, VA
| | | |
Collapse
|
7
|
Moreno V, Gil-Martin M, Johnson M, Aljumaily R, Lopez-Criado M, Northfelt D, Crittenden M, Jabbour S, Rosen L, Calvo E, Papadopoulos K, Garrido P, Hervás Morón A, Rietschel P, Mohan K, Li J, Stankevich E, Feng M, Lowy I, Fury M. MA04.01 Cemiplimab, a Human Monoclonal Anti-PD-1, Alone or in Combination with Radiotherapy: Phase 1 NSCLC Expansion Cohorts. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Hilal T, Covington M, Pockaj B, Northfelt D, Wu T, Zwart C, Li J, Patel BK. Abstract P4-02-03: Pre-neoadjuavnt therapy MRI phenotype can predict response to neoadjuvant endocrine therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
OBJECTIVE: Neoadjuvant endocrine therapy (NET) is increasingly used for the treatment of low and intermediate grade, hormone receptor positive, HER2 negative breast cancer. Several MRI phenotypes that may predict response to neoadjuvant chemotherapy (NAC) have been identified, but little data exists for phenotypes associated with response to NET. This study analyzed imaging phenotypes for all patients treated with NET with the aim to identify specific features that can be predictive of response to therapy.
MATERIALS AND METHODS: The study was retrospective and included 21 patients with clinical stage I, II, and III breast cancer. The tumors were grade 1 or 2, estrogen receptor (ER) positive in >20% of cells, and HER2 non-amplified. MRI examinations were performed in all women before NET. MRI interpretation included mass shape, non-mass enhancement (NME) pattern, background parenchymal enhancement, and MRI phenotype (I well-defined unicentric mass; II well defined multilobulated mass; III area enhancement with nodularity; IV area enhancement without nodularity; V septal spreading). Type of neoadjuvant endocrine therapy included: tamoxifien alone, an aromatase inhibitor (AI) alone, AI + ovarian suppression, and AI + a non-chemotherapeutic agent. Patients received NET for a total duration ranging between 3 - 6 months, with one patient receiving therapy for 18 months. Clinically meaningful response was defined as stable or decreased tumor size by clinical exam and confirmed at resection by comparing final pathologic T stage with clinical T stage.
RESULTS: Twenty-one patients were identified. Median age was 62 (range 36-84) years. Most were post-menopausal 17 (81%). Pre-neoadjuvant meadian tumor size on MRI was 3.9 (range 1.0-7.5) cm and comprised T1 3 (14.3%), T2 8 (38.1%), T3/4 10 (47.6%). Pre-treatment N stage was N0 14 (66.7%), N1 7 (33.3%) and pre-NET stage was I in 3 (14.3%), II in 8 (38.1%), and III in 10 (47.6%) patients. The majority 17 (81%) had some tumor reduction, and 4 (19%) had no response. No one achieved a complete response. Of the 17 responders, 7 (41%) had a good response defined as >25% decrease in tumor size. Median tumor size after NET was 3.1 (range 0.6-11) cm and the distribution of T stage was T1 7 (33.3%), T2 9 (42.9%), and T3/4 5 (23.8%). Eleven of 12 (92%) patients with well-defined phenotypes had a response as compared to 6 of 9 (67%) patients with non-well defined phenotypes. Phenotype was not predictive of a good response to therapy, 4 were in the well-defined phenotype and 3 were in the non-well defined phenotype groups. All 4 non-responders had moderate or marked background enhancement as compared to 5 of 17 responders (p = 0.02).
CONCLUSION: A well-defined pre treatment MRI phenotype was significantly predictive of a positive response to NET, while a non well-defined MRI phenotype and higher degree of background enhancement was significantly predictive of negative response to NET. This warrants further prospective evaluation, especially in association with Ki-67 levels. If validated, pre treatment MRI phenotype can be applied in the clinical decision to either initiate NET or referral for upfront surgical resection.
Citation Format: Hilal T, Covington M, Pockaj B, Northfelt D, Wu T, Zwart C, Li J, Patel BK. Pre-neoadjuavnt therapy MRI phenotype can predict response to neoadjuvant endocrine therapy [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 P4-02-03.
Collapse
|
9
|
Hilal T, Covington M, Sugi M, Zhang N, Pockaj B, Northfelt D, Ocal IT, Patel BK. Abstract PD2-11: Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-11] [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
OBJECTIVE: Currently, no study has assessed the performance of contrast-enhanced spectral mammography (CESM) in evaluating tumor response in breast cancer patients undergoing neoadjuvant systemic therapy (NST). This study aims to evaluate whether the accuracy of CESM is comparable to MRI in detection of residual breast cancer following NST.
MATERIALS AND METHODS: Retrospective review of CESM cases at our institution between September 2014 and June 2016 identified patients who had both CESM and MRI pre- and post-NST with pathologic assessment after surgical management. Size of residual malignancy (if any) on post-neoadjuvant CESM and MRI was compared to surgical pathology (reference standard). Pathologic complete response (pCR) was documented and compared to Residual Cancer Burden (RCB) score for confirmation. Bland-Altman plots were used to visualize the differences between CESM/MRI and pathologic tumor size.
RESULTS: Forty female patients met inclusion criteria. Mean age was 52.3 years (range 35-73). Type of NST included: 34 (85%) chemotherapy and 6 (15%) endocrine therapy. Histological analysis showed invasive ductal carcinoma in 38 (95%), the remaining cases consisted of one invasive lobular carcinoma, and one mixed invasive carcinoma. Mean tumor size after NST was 10.3 mm (range 0-75 mm) for CESM and 9.7 mm (range 0-60 mm) for MRI compared to 15.7 mm (range 0-100 mm) on final surgical pathology. Equivalence tests demonstrated that the mean tumor size measured by CESM or by MRI is equivalent to the mean tumor size measured by pathology within -1 and 1 cm range (p=0.0132 for CESM and p=0.0194 for MRI).
Difference in Measurement Post-NST Compared to Pathology Path Tumor Size (mm)CESM Tumor Size (mm)MRI Tumor Size (mm)Mean (SD)15.7 (24.5)10.3 (18.9)9.7 (16.3)Difference Compared with Path (SD); P value -5.4 (12.6); 0.0132-6.0 (11.7); 0.0194
A complete radiologic response was seen in 25 CESM and 22 MRI cases which was confirmed by pathology in 17 and 14, respectively. Alternatively, CESM and MRI demonstrated residual disease in 15 patients and 18 patients respectively and this was confirmed on pathology in 15 and 15, respectively.
Accuracy of CESM vs. MRIModalityResidual Disease by Pathology (N=23)Complete Response by Pathology (N=17)SensitivitySpecificityPPVNPVResidual Disease by CESM (N=15)150Complete Response by CESM (N=25)81765.2%100%100%68%Residual Disease by MRI (N=18)153Complete Response by MRI (N=22)81465.2%82.4%83.3%63.6%
All patients who achieved a pCR had an RCB score of 0 indicating no residual cancer in lymph nodes. Among patients with residual disease, their mean RCB score was 2.6 (range 0.8-4.18).
CONCLUSION: In this study, CESM was comparable to MRI in assessing residual malignancy after completion of NST, thereby offering a potentially faster and less expensive alternative to MRI for monitoring treatment response in the neoadjuvant setting.
Citation Format: Hilal T, Covington M, Sugi M, Zhang N, Pockaj B, Northfelt D, Ocal IT, Patel BK. Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy [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 PD2-11.
Collapse
|
10
|
Wolf J, Lourenco A, Alpers J, Rohatgi N, Constantini C, Hollingsworth A, Grobmyer S, Pederson H, Haythem A, Polen W, Northfelt D, Morris M, Baker K, Ghosh K, Kass F, Arterbery E, Yang R, Tran Q, Letsios E, Mulpuri R, Reese DE. Abstract P1-02-08: Provista-002: A prospective, multi-center study to determine the effectiveness of a biomarker assay to distinguish benign from invasive breast cancer in women with BI-RADS 3, 4 and 5 imaging reports. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-02-08] [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
This abstract was not presented at the symposium.
Collapse
Affiliation(s)
- J Wolf
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - A Lourenco
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - J Alpers
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - N Rohatgi
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - C Constantini
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - A Hollingsworth
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - S Grobmyer
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - H Pederson
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - A Haythem
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - W Polen
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - D Northfelt
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - M Morris
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - K Baker
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - K Ghosh
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - F Kass
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - E Arterbery
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - R Yang
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - Q Tran
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - E Letsios
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - R Mulpuri
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| | - DE Reese
- Rhode Island Hospital; Avera Cancer Institute; Sutter Institute; Scripps; Provista Diagnostics; Mercy Women's Hospital; Cleveland Clinic; Henry Ford Health System; Summit Medical Group New Jersey; Mayo Clinic; Banner Research Institute; St. Joseph's Hospital; Sansum Clinic; St. Mary's of Michigan; Lahey Clinic
| |
Collapse
|
11
|
Gawryletz CD, Anderson KS, Northfelt DW, Kosiorek HE, Linnaus ME, Ocal IT, McCullough AE, Pockaj BA, Barrett MT. Abstract P1-05-19: Homologous recombination deficiency in PD-L1, PD-L2, Jak2 (PDJ) amplified triple negative breast carcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-19] [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
Introduction: Homologous recombination (HR) is essential for repairing double-stranded DNA breaks. Tumors deficient in DNA HR display high levels of copy number aberrations including amplifications, deletions, and breakpoints. Studies in BRCAmut cancers have shown that HR deficiency (HRD) renders triple negative breast carcinoma (TNBC) sensitive to carboplatin or Poly(ADP-ribose) polymerase (PARP) inhibitors via a synthetic lethal interaction, as previously described. Clinical observations in breast and other solid tumors suggest that the HRD phenotype may arise independently of BRCA1/2 mutation. The implications of HRD enrichment in PD-L1, PD-L2, Jak2 (PDJ) 9p24.1 amplified TNBC are not known. Our goal was to determine the HRD status in PDJ enriched tumors, and the potential association of the PDJ amplicon with a BRCA like HRD phenotype.
Methods: Archival fresh frozen and formalin-fixed paraffin embedded (FFPE) tumor samples from 41 patients with TNBC were obtained from 1998-2015. Tumor populations (diploid, tetraploid, and aneuploidy) were sorted using DNA content flow cytometry and interrogated with oligonucleotide array comparative genomic hybridization (aCGH). Tumor homologous recombination deficiency (HRD) scores were calculated by number of interstitial aberrations (IA) in their genomes (HRD-IA). A cut-off of < 40 (low), > 40 (high) or > 50 (very high) was assigned based on our studies of known BRCAmut tumors. Data were compared between HRD groups using chi-square, ANOVA F-test or log-rank test.
Results: 14/41 (34%) TNBC patients had high HRD-IA score and 6/41 (14.6%) had very high HRD-IA score. The median age was 61.8 years (SD = 12.8), the average tumor size was 3.1cm (SD = 2.6), 42% were node positive, 24% were pre-menopausal, 19% were Black, Hispanic, or Asian/Pacific Islander. Genetic testing was negative for BRCA1/2 mutations in 9/41 patients, including 3 high and very high HRD-IA score patients. There was no difference in the OS at 5-years [74% versus 59% (p = 0.907)] in the high HRD-AI group. 12/41 (29%) patients were PDJ+. In the PDJ+ patients, 4/12 (33.3%) had HRD > 40 and 1/12 (8.3%) had HRD > 50 compared to the PDJ- patients where 10/29 (34%) had high HRD-IA score and 5/29 (17%) had a very high HRD-IA score, p=0.463. Patients with inflammatory TNBC were significantly more likely to have high HRD-IA score 4/6 (66%) compared to non-inflammatory TNBC 8/31 (26%), p=0.05.
Conclusions: We describe a unique group of TNBC patients with similar patient characteristics, tumor size, nodal status, and stage when compared by low, high and very high HRD-IA score. For inflammatory TNBC, there was statistically significant percentage of patients with a high HRD-IA score. We did not see a statistically significant correlation with 9p24.1 amplification based on HRD-IA score which has been suggested in other data sets. The HRD-IA score did not statistically impact OS but there was a suggestion that those with a higher score may have an improved OS potentially due to chemotherapy sensitivity. Further study with a greater number of patients to adequately power the study is needed to determine whether our initial findings can be confirmed and whether the HRD-IA score can be used to define a specific subset of TNBC patients.
Citation Format: Gawryletz CD, Anderson KS, Northfelt DW, Kosiorek HE, Linnaus ME, Ocal IT, McCullough AE, Pockaj BA, Barrett MT. Homologous recombination deficiency in PD-L1, PD-L2, Jak2 (PDJ) amplified triple negative breast carcinoma [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-19.
Collapse
Affiliation(s)
- CD Gawryletz
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - KS Anderson
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - HE Kosiorek
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - ME Linnaus
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - IT Ocal
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - AE McCullough
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - BA Pockaj
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| | - MT Barrett
- Mayo Clinic, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ; Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
12
|
Pierobon M, Wong S, Reeded A, Anthony S, Robert N, Northfelt DW, Jahanzeb M, Vocila L, Wulfkuhle J, Dunetz B, Aldrich J, Byron S, Craig D, Liotta L, Carpten J, Petricoin EF. Abstract P1-07-09: A multi-OMIC analysis to explore the impact of “actionable” genomic alterations on protein pathway activation: Clinical implication for precision medicine in metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-07-09] [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: While genomic alterations are central players in tumor progression, proteins are the targets for precision therapy. The degree by which “actionable” genomic alterations translate into activated/altered proteins and pathway is still under investigation. Using a multi-OMIC approach from the SideOut 2 metastatic breast cancer (MBC) trial, this study explored the concordance between selected “actionable” genomic alterations and protein expression/activation.
Methods: Snap frozen biopsies from 29 MBC patients enrolled in a prospective phase II trial were used for this analysis. Exome WES and RNASeq data was processed using an in-house developed pipeline and identified amplification of CCND1 (6/29), FGFR1 (4/29), and FGF 3, 4, 5, and 19 (4/29) as some of most frequent “actionable” genomic alterations in our MBC cohort. Signaling analysis of the 29 cases was performed using Reverse Phase Protein Microarray coupled with Laser Capture Microdissection. Protein expression/phosphorylation was measured in a continuous scale and classified based on quartile distribution. Concordance between CCND1 amplification and Cyclin D1 expression, along with the activation of FOXM1 T600 and Rb S780, was explored. Amplification of the FGFR1 locus or its ligands was correlated with the level of activation/phosphorylation of FGFR1 Y653/654.
Results: While Cyclin D1 protein expression was greater than the population mean for 4/6 (67%) patients with CCND1 amplification, only 2/6 (33%) patients with CCND1 amplification had Cyclin D1 level within the top quartile of the population (n=29). FOXM1 T600 activation was independent from CCND1 amplification, with high levels of FOXM1 T600 predominantly in the CCND1 wild-type population. Only 1/6 (17%) patients with CCND1 amplification had FOXM1 T600 level similar to the top quartile of the population while a second patient was above the population median. Activation of Rb S780 was above the population median, but below the top quartile, in 2/6 (33%) CCND1 amplified patients. Similarly, none of the patients with activation of FGFR Y653/654 equal to the top quartile harbored an FGFR1 amplification. Only 1/4 (25%) patients carrying an FGFR1 amplification had an activation of FGFR Y653/654 above the population median. Similarly, 1/4 (25%) patients with FGF ligand amplification showed FGFR Y653/654 level within the top quartile while three patients had FGFR Y653/654 activation below the population median. No significant results were found between proteomic (below/above the median) and genomic characteristics by Fisher test (p>0.05).
Conclusion: Molecular genotyping of “actionable” cancer targets alone may be insufficient in predicting whether the actual drug target protein is expressed and/or activated in any given patient's tumor. Although these results need further validation, the combination of genomic and proteomic data may represent a more informative approach for identifying real molecular drivers of individual lesions as well as “actionable” protein/phosphoprotein targets in the absence of genomic events. Multi-OMIC approaches may lead to more effective stratification in precision medicine trials.
Citation Format: Pierobon M, Wong S, Reeded A, Anthony S, Robert N, Northfelt DW, Jahanzeb M, Vocila L, Wulfkuhle J, Dunetz B, Aldrich J, Byron S, Craig D, Liotta L, Carpten J, Petricoin EF. A multi-OMIC analysis to explore the impact of “actionable” genomic alterations on protein pathway activation: Clinical implication for precision medicine in metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-09.
Collapse
Affiliation(s)
- M Pierobon
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - S Wong
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - A Reeded
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - S Anthony
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - N Robert
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - DW Northfelt
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - M Jahanzeb
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - L Vocila
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - J Wulfkuhle
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - B Dunetz
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - J Aldrich
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - S Byron
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - D Craig
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - L Liotta
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - J Carpten
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| | - EF Petricoin
- George Mason University, Manassas, VA; Translational Genomics Research Institut, Pheonix, AZ; Virginia Cancer Specialists/US Oncology, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; The Side Out Foundation, Fairfax, VA; Keck School of Medicine, Los Angeles, CA; Arizona Oncology, Sedona, AZ
| |
Collapse
|
13
|
Pierobon M, Wong S, Reeder A, Anthony SP, Robert NJ, Northfelt DW, Jahanzeb M, Vocila L, Wulfkuhle J, Dunetz B, Aldrich J, Byron S, Craig D, Liotta L, Petricoin EF, Carpten J. Abstract P2-05-21: The AKT-mTOR pathway as a potential organ-specific drug target signature of hepatic metastases from breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-05-21] [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: The identification of organ-specific targetable signatures may help design more effective treatment for patients with metastatic breast cancer (MBC). We took a multi-OMIC approach to assess whether the AKT-mTOR pathway is globally activated during metastatic progression or whether it represents an organ-specific target.
Methods: Snap frozen biopsies from 25 MBC patients enrolled in a prospective phase II trial were used. Sites of metastasis were classified as liver (n=8) and others (n=17), the latter including cutaneous, lung, lymph nodes, and intra-abdominal lesions. Signaling analysis of the 25 cases was performed using Reverse Phase Protein Microarray (RPPA) coupled with Laser Capture Microdissection. Activation of the AKT-mTOR pathway was quantified as phosphorylation of AKT (S473) and the mTOR target p70S6 (T389). Matched exome (WES) and RNASeq data were available for 17 of 25 patients, five with liver metastases. Sequencing data was processed using an in-house developed pipeline to identify somatic events including coding mutations, copy number alterations, gene fusions, and differential expression. Activation of the AKT-mTOR pathway and sequencing data were compared between hepatic and non-hepatic lesions using an integrated RPPA and genomic approach.
Results: Among liver metastases, AKT was activated in 4 of the 8 (50.0%) patients, while 6 of the 8 cases (75.0%) showed activation of p70S6. Sequencing data revealed mutation of PIK3CA in 4 of the 5 liver metastases (80.0%). Three of the PIK3CA mutated specimens with catalytic domain mutations (codons 1023 and 147) demonstrated co-activation of AKT and p70S6, while the fourth case, containing a helical domain mutation (E542K), had activation of p70S6 only. The PIK3CA wild-type liver metastasis demonstrated low activation of AKT and p70S6. For non-hepatic metastases AKT was activated in 2 of the 17 cases (11.8%) and p70S6 in 5 of the 17 patients (29.4%).
Discussion: Although these results need further validation, activation of the AKT-mTOR pathway appears to be a hepatic specific signature in MBC and could be used for the selection of targeted agents for hepatic lesions.
Citation Format: Pierobon M, Wong S, Reeder A, Anthony SP, Robert NJ, Northfelt DW, Jahanzeb M, Vocila L, Wulfkuhle J, Dunetz B, Aldrich J, Byron S, Craig D, Liotta L, Petricoin EF, Carpten J. The AKT-mTOR pathway as a potential organ-specific drug target signature of hepatic metastases from breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-05-21.
Collapse
Affiliation(s)
- M Pierobon
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - S Wong
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - A Reeder
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - SP Anthony
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - NJ Robert
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - DW Northfelt
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - M Jahanzeb
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - L Vocila
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - J Wulfkuhle
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - B Dunetz
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - J Aldrich
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - S Byron
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - D Craig
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - L Liotta
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - EF Petricoin
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| | - J Carpten
- George Mason University, Manassas, VA; Translational Genomics Research Institute, Phoenix, AZ; Evergreen Hematology & On, Spokane, WA; Virginia Cancer Specialists, Fairfax, VA; Mayo Clinic Arizona, Scottsdale, AZ; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Campus, Deerfield Beach, FL; TD2 Translational Drug Development, Scottsdale, AZ; Side Out Foundation, Fairfax, VA
| |
Collapse
|
14
|
Ma CX, Gao F, Northfelt D, Goetz M, Forero A, Naughton M, Ademuyiwa F, Suresh R, Anderson KS, Margenthaler J, Aft R, Hobday T, Moynihan T, Gillanders W, Cyr A, Eberlein TJ, Hieken T, Krontiras H, Hoog J, Han J, Guo Z, Vij K, Mardis E, Al-Kateb H, Sanati S, Ellis MJ. Abstract S6-05: A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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
ER+ BC is associated with activated CDK4/6. The CDK4/6 inhibitor palbociclib (P) markedly improves time to progression in advanced ER+HER2- BC. We conducted a neoadjuvant phase II trial to determine the activity of P in primary breast cancer as a prelude to adjuvant studies.
Methods
To assess molecular changes induced by anastrozole (A) or P+A, patients (pts) were treated initially with A alone (1mg PO daily) for 28 days in cycle 0 (C0) before the addition of P (125mg PO daily on D1-21 each cycle) on C1D1. P+A was administered for 4 28-day cycles followed by C5 with A alone for 2-4 weeks (wks) before surgery. P was added in C5 for 10-12 days immediately prior to surgery in the last 20 pts enrolled to assess molecular changes induced by A, either alone or in combination with P immediately prior to surgery, in resected tumor. Goserelin was added in premenopausal pts.
Research tumor biopsies were obtained at baseline, C1D1, and C1D15. Central Ki67 analysis was performed at all timepoints, those with Ki67 >10% at C1D15 went off study treatment.
The primary endpoint was complete cell cycle arrest (CCA), defined as Ki67 <2.7%, at C1D15. Patient stratification was based on PIK3CA mutation status with an initial focus on PIK3CA wild type (WT) disease. Pts with PIK3CA mutant (Mut) tumors enrolled to a separate cohort. A sample size of 33 pts in the PIK3CA WT cohort was chosen based on the Fleming's single-stage phase II design to test the hypothesis that P+A leads to > 50% improvement over A in CCA rate on C1D15 biopsy (44% with A alone based on historical data, vs 66% with P+A, power = 0.8, alpha=0.05). The primary endpoint is met if >20 pts achieved CCA in this cohort.
Correlative endpoints included assessment of markers of proliferation, apoptosis, senescence, Rb, gene expression microarray, intrinsic subtype, and next generation sequencing of 83-gene panels, which will be reported at the meeting.
Results
Between 4/23/2013 and 4/24/2015, 50 pts (33 PIK3CA WT, 11 PIK3CA Mut, 2 pending, 4 tissue quantity or quality not sufficient for sequencing (QNS)) were enrolled to the study. Median age was 57.5 (range: 34.1–79.6) years. Four pts, all with WT PIK3CA, went off study due to Ki67 >10% on C1D15 biopsy, 26 pts completed treatment and surgery, 1 refused surgery, 3 withdrew study treatment in C1, and 16 continued to receive study drug (2 in C0, 3 in C1, 4 in C2, 5 in C3, 1 in C4, and 1 in C5). Among the 40 pts currently evaluable for the primary endpoint (C1D15 Ki67), CCA occurred in 34 (85%) pts, including 9 of 9 (100%) PIK3CA Mut, 22 of 28 (78.5%) WT, and 3 of 3 QNS pts. Preliminary analysis of available data indicated a significantly lower Ki67 value after 2 wks of P+A (C1D15) compared to that on A alone (C1D1) (p=0.034, n=18).
Conclusion
This study met the primary endpoint demonstrating that P+A is a highly effective anti-proliferative combination. The sequential biopsy design clearly demonstrated that P+A increased cell cycle control over A alone. P+A was effective regardless of PIK3CA mutation status and these results support the evaluation of this combination in the adjuvant setting for ER+HER2- BC.
Citation Format: Ma CX, Gao F, Northfelt D, Goetz M, Forero A, Naughton M, Ademuyiwa F, Suresh R, Anderson KS, Margenthaler J, Aft R, Hobday T, Moynihan T, Gillanders W, Cyr A, Eberlein TJ, Hieken T, Krontiras H, Hoog J, Han J, Guo Z, Vij K, Mardis E, Al-Kateb H, Sanati S, Ellis MJ. A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-05.
Collapse
Affiliation(s)
- CX Ma
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - F Gao
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - D Northfelt
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - M Goetz
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - A Forero
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - M Naughton
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - F Ademuyiwa
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - R Suresh
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - KS Anderson
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Margenthaler
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - R Aft
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Hobday
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Moynihan
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - W Gillanders
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - A Cyr
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - TJ Eberlein
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Hieken
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - H Krontiras
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Hoog
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Han
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - Z Guo
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - K Vij
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - E Mardis
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - H Al-Kateb
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - S Sanati
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| |
Collapse
|
15
|
Moyer AM, Boughey JC, Kalari KR, Suman VJ, McLaughlin SA, Moreno-Aspitia A, Northfelt DW, Gray RJ, Sinnwell JP, Carlson EE, Dockter TJ, Jones KN, Felten SJ, Conners AL, Wieben ED, Ingle JN, Wang L, Weinshilboum RM, Visscher DW, Goetz MP. Abstract P4-04-05: Differential mRNA expression patterns in breast tumors with high vs. low quantity of stromal tumor–Infiltrating lymphocytes. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-04-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor-infiltrating lymphocytes (TIL) have prognostic and potentially predictive significance in the (neo)adjuvant treatment of high-risk breast cancer. However, quantitative TIL measurement is not routinely performed. It is unclear why some tumors attract large quantities of TIL while others do not. We sought to confirm the association between TIL and pathologic complete response rate (pCR) and to further use next generation sequencing (NGS) to identify genes and gene pathways associated with the presence/absence of TIL.
Methods: We studied 140 women with high risk stage I-III breast cancer, enrolled in the Breast Cancer Genome Guided Therapy Study (BEAUTY), obtaining serial biopsies for DNA/RNA sequencing and MRI imaging to assess response to neoadjuvant chemotherapy (NAC) with taxane (+/- trastuzumab+/-pertuzumab for HER2+ disease) followed by AC or (F)EC. Diagnostic pre-NAC core needle biopsies and surgical resection specimens post-NAC were available from 110 patients. Stromal TIL were semi-quantitated on a scale of 1-4 (with 1: ≤10/hpf, 2: subtle infiltrate >10/hpf, 3: moderate infiltrate readily visible at low power magnification, 4: dense infiltrate with innumerable lymphocytes). For this analysis, low TIL was defined as scores of 1-2 vs. high defined as 3-4. Using pre-NAC biopsies, RNAseq was performed using the Illumina HiSeq2000 and the Mayo Analysis Pipeline for RNAseq (MAP-Rseq) for quality control, sequence alignment, and gene counts. The quantity of TIL was associated with transcripts across the transcriptome after conditional quantile normalization. Differentially expressed genes were obtained using EdgeR analysis, using a false discovery rate of 0.05, and pathways were evaluated using GAGE methods.
Results: The pCR and residual cancer burden (RCB)-0/I rates by stromal TIL status within each molecular subtype are presented in the table. A diverse spectrum of 1344 genes with differential expression between tumors with high vs. low stromal TIL was identified. The genes with >2.0-fold change (FC) and p<1e-09 included S100A7 (4.49 FC), LCN2 (2.48 FC), and ART3 (2.82 FC) (genes known to be involved in immune regulation), as well as TDRD1 (2.71 FC) (a gene related to ERG [ETS-related gene] expression). In addition, the "regulation of actin cytoskeleton" pathway was upregulated in tumors with high TIL, while the "Hedgehog signaling" and "Wnt signaling" pathways were downregulated.
Molecular SubtypeStromal TILspCR rate n (%)RCB-0/I rateLuminal AHigh------Luminal ALow0/9 (0%)0/9 (0%)Luminal BHigh1/9 (11.1%)1/8 (12.5%)Luminal BLow3/24 (12.5%)6/23 (26.1%)ER+/HER2+High3/9 (33.3%)4/9 (44.4%)ER+/HER2+Low1/6 (16.7%)1/6 (16.7%)ER-/HER2+High8/9 (88.9%)7/7 (100%)ER-/HER2+Low4/8 (50.0%)6/8 (75.0%)Triple NegativeHigh10/19 (52.6%)13/19 (68.4%)Triple NegativeLow7/14 (50.0%)9/13 (69.2%)
Conclusions: We identified genes and gene pathways associated with high TIL expression in breast tumors prior to NAC that provide insight into the interactions between TIL and tumors. TIL can be easily semi-quantitated on H&E and along with these novel biomarkers, may contribute to the personalization of breast cancer therapy.
Citation Format: Moyer AM, Boughey JC, Kalari KR, Suman VJ, McLaughlin SA, Moreno-Aspitia A, Northfelt DW, Gray RJ, Sinnwell JP, Carlson EE, Dockter TJ, Jones KN, Felten SJ, Conners AL, Wieben ED, Ingle JN, Wang L, Weinshilboum RM, Visscher DW, Goetz MP. Differential mRNA expression patterns in breast tumors with high vs. low quantity of stromal tumor–Infiltrating lymphocytes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-05.
Collapse
Affiliation(s)
- AM Moyer
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JC Boughey
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KR Kalari
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - VJ Suman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SA McLaughlin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - A Moreno-Aspitia
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - RJ Gray
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JP Sinnwell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - EE Carlson
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - TJ Dockter
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KN Jones
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SJ Felten
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - AL Conners
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - ED Wieben
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JN Ingle
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - L Wang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - RM Weinshilboum
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Visscher
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - MP Goetz
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
16
|
Boughey JC, Kalari KR, Suman VJ, McLaughlin SA, Moreno Aspitia A, Moyer AM, Northfelt DW, Gray RJ, Vedell PT, Tang X, Dockter TJ, Jones KN, Felten SJ, Conners AL, Hart SN, Visscher DW, Wieben ED, Ingle JN, Hartman AR, Timms K, Elkin E, Jones J, Wang L, Weinshilboum RW, Goetz MP. Abstract P3-07-29: Role of germline BRCA status and tumor homologous recombination (HR) deficiency in response to neoadjuvant weekly paclitaxel followed by anthracycline-based chemotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-29] [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: Both HR deficiency and BRCA mutation status predict response to platinum-based therapy and BRCA mutation status predicts docetaxel resistance. However, the association of either biomarker with response to the individual elements of either AC or taxanes (T) is unknown since T is commonly given concomitantly with or after anthracyclines (A). We evaluated the association of HRD and BRCA mutation status with response to neoadjuvant weekly T followed by AC or (F)EC in high-risk breast cancer.
Methods: We studied 140 high risk Stage I-III breast cancer patients (pts), enrolled in the breast cancer genome guided therapy study (BEAUTY), obtaining biopsies for DNA/RNA sequencing and MRI imaging to assess response to neoadjuvant weekly T (+trastuzumab+/-pertuzumab for HER2+ disease) followed by AC or (F)EC. Germline BRCA status and HR status of tumor samples (Myriad laboratories) were obtained. HR deficient tumor was defined as HRD score ≥42 or BRCA mutation. MRI response by changes in tumor size after 12 weeks of T was classified by WHO criteria. pCR was defined as ypT0/Tis ypN0. Both MRI response after T and pCR (after T and AC) were examined in terms of germline BRCA mutation (gBRCAmut vs. gBRCAwt) and tumor HR deficiency.
Results: Of 140 pts enrolled, 8 withdrew consent and 2 carboplatin treated pts were excluded. Germline data were available for 124/130 pts. 12 patients had BRCA deleterious germline mutations (4 BRCA1, 8 BRCA2). MRI partial (PR)/complete response (CR) rate to T was 47.3% (95% CI: 37.8-57.0%) in the BRCAwt group and 66.7% (95% CI: 34.9-90.1%) in the BRCAmut group. No MRI CR's were observed in BRCA1 mut pts. In contrast, pCR rate was 50% in the 12 gBRCAmut pts (95% CI: 21.1-78.9%) and 31.3% in the 112 gBRCAwt pts (95% CI: 22.8-40.7%). HR deficiency status has thus far been determined for 74 pts: 26 pts have HD deficient tumors: 18 TNBC, 5 Luminal B, 2 ER-/HER2+; and 1 ER+/HER2+. Determination of HR deficiency is ongoing and will be reported for the full cohort in terms of 12 week MRI response to T and pCR to T+AC.
HR deficientMolecular Subtypeyes (%)no (%)TBD (%)Luminal A0/112/11 (18.2)9/11 (81.8)Luminal B5/37 (13.5)13/37 (35.1)19/37 (51.3)Luminal NOS0/21/2 (50)1/2 (50)ER+/Her2+1/17 (5.8)14/17 (82.4)2/17 (11.8)ER-/Her2+2/20 (10)11/20 (55)7/20 (35)Triple Negative18/43 (41.9)6/43 (18.6)17/43 (39.5)germline BRCA statusMRI partial response after T (%)MRI complete response after T (%)pCR after T&AC (%)BRCA11/4 (25)0/42/4 (50)BRCA25/8 (62.5)2/8 (25)4/8 (50)BRCAwt35/112 (31.3)18/112 (16.1)35/112 (31.3)
Conclusion: In the setting of neoadjuvant weekly T followed by AC, pCR rates were non-significantly higher in pts with BRCA1 mutations. While we observed no overall association between BRCA mutation status and response rates to taxanes; nearly all MRI responses to taxanes (partial and complete) were observed in the BRCA2 group. Prospective studies are needed to validate these findings and to determine whether BRCA status can be used to select therapy. HR deficiency is uncommon in luminal A and HER2+, frequent in TNBC, and the association of HRD with both MRI response to taxanes and pCR will be reported at the meeting.
Citation Format: Boughey JC, Kalari KR, Suman VJ, McLaughlin SA, Moreno Aspitia A, Moyer AM, Northfelt DW, Gray RJ, Vedell PT, Tang X, Dockter TJ, Jones KN, Felten SJ, Conners AL, Hart SN, Visscher DW, Wieben ED, Ingle JN, Hartman A-R, Timms K, Elkin E, Jones J, Wang L, Weinshilboum RW, Goetz MP. Role of germline BRCA status and tumor homologous recombination (HR) deficiency in response to neoadjuvant weekly paclitaxel followed by anthracycline-based chemotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-29.
Collapse
Affiliation(s)
- JC Boughey
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - KR Kalari
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - VJ Suman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - SA McLaughlin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - A Moreno Aspitia
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - AM Moyer
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - RJ Gray
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - PT Vedell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - X Tang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - TJ Dockter
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - KN Jones
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - SJ Felten
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - AL Conners
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - SN Hart
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - DW Visscher
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - ED Wieben
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - JN Ingle
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - A-R Hartman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - K Timms
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - E Elkin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - J Jones
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - L Wang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - RW Weinshilboum
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| | - MP Goetz
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AR; Mayo Clinic, Jacksonville, FL; Myriad Genetic Laboratories, Salt Lake City, UT
| |
Collapse
|
17
|
Yu J, Qin B, Boughey JC, Moyer AM, Visscher DW, Sinnwell JP, Yin P, Thompson KJ, Docter TJ, Kalari KR, Suman VJ, Wieben ED, Felten SJ, Conners AL, Jones KN, McLaughlin SA, Copland JA III, Moreno Aspitia A, Northfelt DW, Gray RJ, Ingle JN, Lou Z, Weinshilboum R, Goetz MP, Wang L. Abstract P3-07-51: Regulation of DNA methyltransferases via TRAF6 determines breast cancer response to decitabine. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-51] [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: 11/16/2022]
Abstract
Abstract
Background: Tumorigenesis involves both genetic and epigenetic changes. Epigenetic alterations are reversible and are promising cancer therapeutic targets. Decitabine (5-aza-2'-deoxycytidine), a DNA methyltransferase inhibitor, is FDA approved for hematological malignancies. However, the effect of decitabine in breast cancer is not completely understood. Previous reports indicated that one decitabine mechanism involves regulation of protein levels for DNMT1, the major DNA methyltransferase that methylates hemimethylated CpG di-nucleotides in DNA. However, the E3 ligase involved in this process has not been identified. Whether decitabine also regulates DNMT3A and 3B in a similar fashion remains unclear. Therefore, our goals were to 1) understand mechanisms underlying decitabine action, 2) test the antitumor activity of decitabine in breast cancer models and 3) identify biomarkers associated with response to decitabine.
Methods and Results: Western blots of breast cancer cell lines showed that DNMT1, DNMT3A, and DNMT3B protein levels decreased following decitabine treatment without a reduction in mRNA levels. Bioinformatic analysis of DNA methyltransferase sequences revealed a potential TRAF6 binding motif, and the interaction with TRAF6 (TNF receptor-associated factor 6) was confirmed by IP. TRAF6 functions as an E3 ligase. To determine whether TRAF6 might be the E3 ligase responsible for the degradation of DNMTs after decitabine treatment, we knocked down TRAF6 by RNA interference or knocked out the TRAF6 gene by CRISPR/Cas9. Down regulation of TRAF6 attenuated DNMT ubiquitination and increased DNMT protein levels, suggesting that TRAF6 might mediate proteasome-dependent degradation of all three DNMTs. This was further confirmed by reconstituting the knockout cells with WT and a TRAF6-C70A mutant, followed by assessing DNMT protein levels. Global DNA methylation was also increased after TRAF6 depletion and was confirmed in TRAF6 knock out cells in which DNMT levels were unaffected by decitabine. Cell cytotoxicity and colony forming assays showed that TRAF6 knockout cells were resistant to decitabine, suggesting that a major decitabine mechanism of action is through the regulation of TRAF6 which, in turn, degrades DNMTs, leading to decreased global methylation. Finally, decitabine significantly induced TRAF6 at both mRNA and protein levels, a process that might create positive feedback leading to increased degradation of DNMT proteins upon decitabine treatment. Based on these results, we further hypothesized that levels of the three DNMTs might influence decitabine response. Using 18 breast cancer patient derived xenograft (PDX) models, we found a wide range of DNMT protein levels regardless of ER/HER2 status. DNMT levels in the PDX models were directly associated with sensitivity to decitabine treatment, confirming our hypothesis.
Conclusion: Our data showed that decitabine might be an effective agent for treating breast cancer and revealed a novel mechanism underlying decitabine treatment. Baseline DNMT protein levels may serve as a biomarker for predicting decitabine drug response.
Citation Format: Yu J, Qin B, Boughey JC, Moyer AM, Visscher DW, Sinnwell JP, Yin P, Thompson KJ, Docter TJ, Kalari KR, Suman VJ, Wieben ED, Felten SJ, Conners AL, Jones KN, McLaughlin SA, Copland JA III, Moreno Aspitia A, Northfelt DW, Gray RJ, Ingle JN, Lou Z, Weinshilboum R, Goetz MP, Wang L. Regulation of DNA methyltransferases via TRAF6 determines breast cancer response to decitabine. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-51.
Collapse
Affiliation(s)
- J Yu
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - B Qin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JC Boughey
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - AM Moyer
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Visscher
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JP Sinnwell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - P Yin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KJ Thompson
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - TJ Docter
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KR Kalari
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - VJ Suman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - ED Wieben
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SJ Felten
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - AL Conners
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KN Jones
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SA McLaughlin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - III Copland JA
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - A Moreno Aspitia
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - RJ Gray
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JN Ingle
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - Z Lou
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - R Weinshilboum
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - MP Goetz
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - L Wang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
18
|
Goetz MP, Suman VJ, Reid JM, Northfelt DW, Mahr MA, Dockter T, Kuffel M, Buhrow SA, Safgren SL, McGovern RM, Collins JM, Streicher H, Hawse JR, Haddad TC, Erlichman C, Ames MM, Ingle JN. Abstract PD2-03: Final results of a first-in-human phase I study of the tamoxifen (TAM) metabolite, Z-Endoxifen hydrochloride (Z-Endx) in women with aromatase inhibitor (AI) refractory metastatic breast cancer (MBC) (NCT01327781). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd2-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AI's are more effective than TAM in ER+ breast cancer. In AI refractory MBC, the response rate to TAM is 0% (Osborne 2011). Z-Endx is an active metabolite of TAM and among TAM treated women in the adjuvant and metastatic settings, reduced CYP2D6 metabolism and low Endx concentrations (Css <20 nM) have been associated with increased likelihood of disease recurrence. Preclinical studies have demonstrated greater Z-Endx exposure and anti-tumor activity with oral Z-Endx compared to equivalent doses of oral TAM (Reid 2014)
Methods: We conducted a phase I trial to determine the maximum-tolerated dose (MTD) and evaluate the toxicities, clinical activity, and pharmacokinetics (PK) of Z-Endx in patients (pts) with ER+, AI refractory MBC. Unlimited prior endocrine regimens were allowed. An accelerated titration schedule was applied (2 pts/dose level) until moderate toxicity or DLT, followed by a 3+3 design and then to expansion cohorts (40, 80, and 100 mg/day). Z-Endx was administered orally once daily (28 day cycle). Eye exams were performed at baseline, and end of cycles 2 and 6. PK was performed during cycle 1 and prior to subsequent cycles. For pts in the expansion cohorts, tumor biopsies were obtained at baseline for DNA sequencing (Foundation Medicine). Plasma cholesterol levels were obtained at baseline and after 1 cycle.
Results: From March 2011 to Dec 2014, 41 pts (38 evaluable), median age 60, received Z-Endx once daily encompassing 7 dose levels (20-160 mg/daily). The median number of prior hormonal regimens was 2 and 3 for the dose escalation and expansion cohorts, respectively. Dose escalation was stopped at 160 mg/day given MTD not reached and attainment of mean Endx Css of 3.6 uM. Cycle 1 DLT (PE) was observed in one patient (60 mg). No eye toxicity was observed. PK demonstrated mean Endx Css of > 1 uM at all dose levels ≥ 40 mg/day. Antitumor activity was observed at multiple dose levels including 3 confirmed partial responses and an additional 7 with stable disease for ≥6 cycles. Of these 10 pts, 9 had prior progression on both AI and fulvestrant and 3 additionally on TAM. After 1 cycle, total and LDL cholesterol decreased > 20 points in 54% and 40% of pts, respectively. Tumor sequencing in the expansion cohorts (n=14) did not identify ESR1 mutations; however, ESR1 amplification was identified in 1 pt with prolonged stable disease (>200 days). Of 6 pts with rapid progression (≤2 cycles), 4/6 had either CCND1 amplification (n=1) or at least one of the following activating mutations: ERBB2 L755S (n=1), AKT1 E17K (n=1), MTOR E1799K (n=1).
Conclusions: The direct administration of Z-END provides substantial drug exposure, acceptable toxicity, and "proof of principle" antitumor activity in endocrine resistant MBC. While the MTD was not determined, the goal of achieving Endx Css concentrations of > 1 uM was achieved. Tumor sequencing identified pts with predicted and confirmed endocrine resistance. A randomized phase II comparing endoxifen (80 mg/day) with TAM in AI refractory MBC was recently activated (NCT02311933). Supported in part by CA 133049, CA186686, CA15083, CA116201, and CA15083.
Citation Format: Goetz MP, Suman VJ, Reid JM, Northfelt DW, Mahr MA, Dockter T, Kuffel M, Buhrow SA, Safgren SL, McGovern RM, Collins JM, Streicher H, Hawse JR, Haddad TC, Erlichman C, Ames MM, Ingle JN. Final results of a first-in-human phase I study of the tamoxifen (TAM) metabolite, Z-Endoxifen hydrochloride (Z-Endx) in women with aromatase inhibitor (AI) refractory metastatic breast cancer (MBC) (NCT01327781). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD2-03.
Collapse
Affiliation(s)
- MP Goetz
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - VJ Suman
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JM Reid
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - MA Mahr
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - T Dockter
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - M Kuffel
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - SA Buhrow
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - SL Safgren
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - RM McGovern
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JM Collins
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - H Streicher
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JR Hawse
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - TC Haddad
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - C Erlichman
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - MM Ames
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JN Ingle
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
19
|
Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. Abstract OT3-02-14: A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-14] [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: Nal-IRI (MM-398, nanoliposomal irinotecan) is designed for extended circulation relative to free irinotecan and to exploit leaky tumor vasculature for enhanced drug delivery to tumors. Tumor deposition of nal-IRI and subsequent conversion to SN-38 in both neoplastic cells and tumor associated macrophages (TAM) may positively correlate with response to therapy. In phase I studies of nal-IRI, activity has been shown in metastatic breast cancer (MBC), pancreatic and colorectal cancer. Ferumoxytol (FMX) is an iron-oxide superparamagnetic nanoparticle that has been used off-label for its MRI contrast properties. FMX has long-circulating pharmacokinetics and is taken up by TAMs with similar distribution patterns to nal-IRI in preclinical models. A single site pilot study established the feasibility of performing quantitative FMX MRI. Thirteen patients with advanced cancer (3 with ER/PR+ MBC) were imaged with FMX MRI and treated with nal-IRI. Median tumor lesion FMX uptake in the pilot study was 32.6 and 34.5 μg/mL at 1 h and 24 h, respectively. Lesions with FMX uptake above the median were associated with greater reductions in tumor size following treatment with nal-IRI as determined by CT lesion measurements. The relationship between FMX levels in tumor lesions and nal-IRI activity may serve as a potential biomarker for nal-IRI deposition and response in solid tumors. This study has been expanded to include additional MBC patients to further evaluate the technical feasibility of FMX MRI at multiple study sites, and to evaluate activity of nal-IRI in patients with MBC.
Trial Design: Three cohorts of 10 patients with MBC in the following categories will be enrolled: ER and/or PR positive/HER2-negative, triple negative (TNBC) and MBC with brain metastases. An imaging phase will be followed by a treatment phase. The imaging phase consists of a baseline MRI scan, FMX infusion, and follow-up MRI scans at 1-4 and 24 h after infusion. The treatment phase begins 1-6 days after imaging and consists of nal-IRI 80 mg/m2 q2w. A pretreatment biopsy is required for correlative studies.
Study Objectives: The primary objective of this multisite expansion is to investigate the feasibility of FMX quantitation in tumor lesions at multiple lesion sites in breast cancer. The secondary objective is to characterize the efficacy of nal-IRI in patients with metastatic breast cancer.
Eligibility Criteria: The key inclusion criteria include patients with MBC, ECOG 0 or 1 with adequate bone marrow reserve and no prior topoisomerase 1 inhibitor or anti-VEGF treatment. ER and/or PR positive/HER2-negative and TNBC patients must have had 1-3 prior lines of chemotherapy in the metastatic setting and have at least 2 measurable lesions. Patients with brain metastasis must be neurologically stable and have new or progressive brain metastases after prior radiation therapy with at least one lesion measuring ≥ 1 cm in longest diameter on gadolinium-enhanced MRI.
Status: This trial is currently recruiting patients.
Citation Format: Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-14.
Collapse
Affiliation(s)
- JC Sachdev
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RK Ramanathan
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - N Raghunand
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - C Anders
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - P Munster
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Minton
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - D Northfelt
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Blanchette
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - K Campbell
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - H Lee
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - SG Klinz
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - BS Hendriks
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - V Moyo
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - JB Fitzgerald
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RL Korn
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| |
Collapse
|
20
|
Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. Abstract P5-13-04: A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-13-04] [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: 11/16/2022]
Abstract
Abstract
Background
Activating mutations in PIK3CA occur in approximately 40% ER+BC. MK-2206 (M), a pan-AKT inhibitor, induced apoptosis of ER+ BC under estrogen deprivation in preclinical studies. We conducted this neoadjuvant trial to determine the pathologic complete response (pCR) rate of M plus anastrozole (A) for PIK3CA mutant (Mut) ER+ BC.
Methods
This single arm open label study of M+A used a 2-stage Simon phase II design (stage 1, n=16; stage 2, n=13, alpha=0.10, power=0.90) to test whether pCR rate <1% (based on historical data with A alone), against the alternative that pCR rate ≥15% in PIK3CA Mut ER+ BC. At least 1 pCR in stage 1 was required to proceed to stage 2.
Eligible patients (pts) with clinical stage II or III ER+HER2- BC were pre-registered and proceeded to a research tumor biopsy for PIK3CA sequencing, followed by treatment with daily A monotherapy for 28 days (cycle 0). Pts with PIK3CA Mut BC were subsequently registered, underwent a second biopsy, and started M (150mg PO weekly) with daily A on cycle 1 day 1 (C1D1) for a maximum of four 28-day cycles followed by surgery. Goserelin was added for premenopausal pts. A tumor biopsy on C1D17, 17 days post the start of M, was performed. Those with C1D17 Ki67 >10% discontinued study treatment. pCR was defined as no invasive cancer in the breast and the lymph nodes. Tumor specimens collected at all timepoints are being analyzed for markers of proliferation, apoptosis, and PI3K pathway activity, gene expression microarray, intrinsic subtypes, and next generation sequencing of 83 genes.
Results
Of the 51 pts pre-registered, 35 pts did not register due to no PIK3CA mutation (n=22), inadequate specimen for testing (n=6), physician/pt decision (n=7). The remaining 16 pts (median age: 58, range: 40-77 years) received combination therapy. Three pts did not complete 4 cycles due to C1D17 Ki67 >10% (n=2) and intolerability (grade (Gr) 4 transaminase elevation in C1, n=1). Other severe toxicities possibly related to M included Gr 3 rash (25%) and pruritus (12.5%). Of the 13 pts completed study therapy and underwent surgery, all had residual disease in the breast and 7 also had positive nodes. Table 1 summarized changes in Ki67 during treatment.
ComparisonsnAbsolute changes in Ki67 median (range)Wilcoxon signed rank p-valueC1D1 relative to pre-registration11-17.0% (-49.8 to 4.1%)0.0020C1D17 relative to pre-registration14-16.4% (-51.4 to 4.1%)0.0004C1D17 relative to C1D112-1.5% (-18.6 to 15.8%)0.9697C1D1, biopsy post 28 days of A alone; C1D17 biopsy post 17 days on combination therapy
Although Ki67 levels post A monotherapy (C1D1) or M+A (C1D17) were significantly lower than that of pre-registration samples, Ki67 did not differ between C1D17 and C1D1 samples. Other correlative studies are ongoing and results will be presented.
Conclusion
Despite the small sample size, biomarker analysis on serial biopsy specimens demonstrated that M+A is unlikely to be more effective than A alone in PIK3CA Mut ER+ BC. This trial demonstrated the feasibility of genomic sequencing for pt selection and the value of a small, well-designed proof-of-principle neoadjuvant trial for the evaluation of targeted agents.
Citation Format: Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-04.
Collapse
Affiliation(s)
- CX Ma
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - VJ Suman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Goetz
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - D Northfelt
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Burkard
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - F Ademuyiwa
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Naughton
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Margenthaler
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Aft
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Gray
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - A Tavaarwerk
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Wilke
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Haddad
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Moynihan
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Loprinzi
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Hieken
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Hoog
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - Z Guo
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Han
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - K Vij
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - E Mardis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - S Sanati
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - H Al-Kateb
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Doyle
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Erlichman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| |
Collapse
|
21
|
Vaz Luis I, O'Neill A, Sepucha K, Miller KD, Baker E, Dang CT, Northfelt DW, Winer EP, Sledge GW, Schneider BP, Partridge A. Abstract P5-11-02: Survival benefit needed to undergo chemotherapy: Patients and physicians preferences. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-11-02] [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: Data regarding patients (pts) and physicians' preferences for modern adjuvant chemotherapy (CT) are limited. Prior studies suggested that most pts with early stage breast cancer were willing to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) for modest survival benefits (e.g. most women would have accepted 3-6 months extension of life).
Methods: E5103 was a phase III trial which randomized node positive or high risk node negative breast cancer pts to receive adjuvant CT (doxorubicin, cyclophosphamide and paclitaxel) with either placebo or bevacizumab. Telephone based surveys were administered to all pts enrolled on E5103 between 01/Jan/10 and 08/Jun/10, as part of a Decision-Making/Quality of Life component. Results presented here are part of the 18 months post-enrollment follow-up. Pts were asked to rate the survival benefit needed to justify 6 months of CT. A complementary survey was sent to all physicians who registered at least one pt on E5103.
Results: 465 out of 519 eligible pts (90%) responded to this survey at 18 months. Main reasons for non response were: inability to reach the patient (6%) or patient refusal (2%). Median pts age was 51 (25-76); 42% of pts had at least a college degree. The majority had at least Stage II cancer.
179 (16%) physicians participated, among whom median age was 50 (35-70). The median years in practice was 17 (3-38); 78% of physicians worked on large size practices, 72% saw at least 5 new breast cancer pts/month, and 77% enroll between 1-4 pts on trials/month.
We found considerable variation in pts preferences particularly for modest survival benefits: a substantial minority of pts (24%) would consider 6 months of CT definitely worthwhile for 1 month survival benefit, 18% would possibly consider it and 56% would not. The percentage considering CT definitely worthwhile increased with greater benefit, but did not reach 100%, even with 24 months survival benefit. About half of pts considered 6 months of CT definitely worthwhile for 9 months benefit, 70% for 12 months and 84% for 24 months.
Physicians were less likely to accept CT for a small chance of benefit (34% of pts vs. 5% of physicians would definitely consider CT worthwhile for 2 months of benefit). For longer benefit, pts and physicians choices were similar (84% of pts vs. 92% of physicians would definitely consider CT worthwhile for 24 months benefit).
Table Yes, definitely worthwhileYes, maybeNo, not worthwhileNo answerConsider 6 months of CT to live:PtsPhysiciansPtsPhysiciansPtsPhysiciansPts/Physicians*1 month longer24%3%18%15%56%80%2%2 months longer34%5%23%32%41%60%2%6 months longer44%32%35%54%19%12%2%9 months longer53%51%34%42%11%5%2%12 months longer70%75%23%22%5%1%2%24 months longer84%92%12%5%2%1%2%n Pts= 465; n Physicians= 179; * equal results in both groups
Conclusions: This subgroup of pts who had undergone modern adjuvant CT in a large multicenter randomized controlled trial and these physicians who registered pts on the same trial had different cutoffs for acceptable levels of benefits and risks when considering adjuvant chemotherapy. It is important to engage pts in determining whether CT is or is not a "reasonable" option for treatment.
Citation Format: Vaz Luis I, O'Neill A, Sepucha K, Miller KD, Baker E, Dang CT, Northfelt DW, Winer EP, Sledge GW, Schneider BP, Partridge A. Survival benefit needed to undergo chemotherapy: Patients and physicians preferences. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-11-02.
Collapse
Affiliation(s)
- I Vaz Luis
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - A O'Neill
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - K Sepucha
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - KD Miller
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - E Baker
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - CT Dang
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - DW Northfelt
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - EP Winer
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - GW Sledge
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - BP Schneider
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| | - A Partridge
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Indiana University Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, NY, NY; Mayo Clinic, Scottsdale, AR; Stanford University, Stanford, CA
| |
Collapse
|
22
|
Shiran A, Aly MFA, Hinojar R, Moustafa S, Mounir Agha HALA, Sanchis Ruiz L, Pilichowska E, Sarvari SI, Blondheim DS, Shimoni S, Jabaren M, Rosenmann D, Sagie A, Leibowitz D, Leitman M, Feinberg M, Liel-Cohen N, Kleijn SAK, Van Lenthe JHV, Menken-Negroiu RFM, Robbers LFR, Beek AMB, Kamp OK, Fernandez-Golfin C, Gonzalez-Gomez A, Casas Rojo E, Megias A, Esteban A, Segura De La Cal T, Rincon LM, Moya-Mur JL, Zamorano JL, Murphy K, Nelluri BK, Northfelt D, Shah P, Lee H, Wilansky S, Naqvi T, Meyer S, Mookadam F, Shalaby LOBNA, Attia WAEL, Abd El Mohsen GASER, Abd El Aziz OSSAMA, Abd El Rahman MOH, Andrea R, Falces C, Lopez-Sobrino T, Bijnens B, Sitges M, Baran J, Stec S, Kulakowski P, Zaborska B, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, Smiseth OA, Edvardsen T. Rapid Fire Abstract session: clinical applications of speckle tracking and tissue Doppler imaging881Two-dimensional strain for diagnosing chest pain in the emergency room (2DSPER): A multicenter prospective study882Comparison between three-dimensional speckle tracking echocardiography and cardiac magnetic resonance for the prediction of prognosis in heart failure patients883Global myocardial mechanics with 2 Dimensional cardiovascular magnetic resonance feature tracking. Relations to hypertrophy and fibrosis in hypertrophic cardiomyopathy884Temporal trends of ventricular function with trastuzumab in human epidermal growth factor receptor II positive breast cancer patients885Early right ventricular dysfunction after Anthracycline chemotherapy in children; tissue Doppler imaging and 2-D speckle tracking echocardiography study886Prognostic value of left atrial strain in ambulatory patients with heart failure onset887Left atrial function and wall properties are better than volume in predicting the outcome after catheter ablation for atrial fibrillation888Prediction of atrial fibrillation recurrence by strain echocardiographic assessment of left atrial function. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Schneider BP, Li L, Shen F, Miller KD, Radovich M, O'Neill A, Gray RJ, Lane D, Flockhart DA, Jiang G, Wang Z, Lai D, Koller D, Pratt JH, Dang CT, Northfelt D, Perez EA, Shenkier T, Cobleigh M, Smith ML, Railey E, Partridge A, Gralow J, Sparano J, Davidson NE, Foroud T, Sledge GW. Genetic variant predicts bevacizumab-induced hypertension in ECOG-5103 and ECOG-2100. Br J Cancer 2014; 111:1241-8. [PMID: 25117820 PMCID: PMC4453857 DOI: 10.1038/bjc.2014.430] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bevacizumab has broad anti-tumour activity, but substantial risk of hypertension. No reliable markers are available for predicting bevacizumab-induced hypertension. METHODS A genome-wide association study (GWAS) was performed in the phase III bevacizumab-based adjuvant breast cancer trial, ECOG-5103, to evaluate for an association between genotypes and hypertension. GWAS was conducted in those who had experienced systolic blood pressure (SBP) >160 mm Hg during therapy using binary analysis and a cumulative dose model for the total exposure of bevacizumab. Common toxicity criteria (CTC) grade 3-5 hypertension was also assessed. Candidate SNP validation was performed in the randomised phase III trial, ECOG-2100. RESULTS When using the phenotype of SBP>160 mm Hg, the most significant association in SV2C (rs6453204) approached and met genome-wide significance in the binary model (P=6.0 × 10(-8); OR=3.3) and in the cumulative dose model (P=4.7 × 10(-8); HR=2.2), respectively. Similar associations with rs6453204 were seen for CTC grade 3-5 hypertension but did not meet genome-wide significance. Validation study from ECOG-2100 demonstrated a statistically significant association between this SNP and grade 3/4 hypertension using the binary model (P-value=0.037; OR=2.4). CONCLUSIONS A genetic variant in SV2C predicted clinically relevant bevacizumab-induced hypertension in two independent, randomised phase III trials.
Collapse
Affiliation(s)
- B P Schneider
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - L Li
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - F Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - K D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M Radovich
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - A O'Neill
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - R J Gray
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - D Lane
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - D A Flockhart
- Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - G Jiang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Z Wang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Lai
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Koller
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - J H Pratt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - C T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - D Northfelt
- Department of Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - E A Perez
- Mayo Clinic, Jacksonville, FL 32224, USA
| | - T Shenkier
- BCCA – Vancouver Cancer Center, Vancouver, BC, V5Z 4E6, USA
| | - M Cobleigh
- Department of Internal Medicine , Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
| | - M L Smith
- Research Advocacy Network, Plano, TX 75093, USA
| | - E Railey
- Research Advocacy Network, Plano, TX 75093, USA
| | - A Partridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - J Gralow
- University of Washington, Seattle, WA 98195, USA
| | - J Sparano
- Department of Oncology, Montefiore Hospital and Medical Center, Bronx, NY 10467, USA
| | - N E Davidson
- Cancer Institute and University of Pittsburgh Cancer Center, Pittsburgh, PA 15232, USA
| | - T Foroud
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - G W Sledge
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
24
|
Goetz MP, Boughey JC, Kalari KR, Eckel-Passow J, Suman VJ, Sicotte H, Hart SN, Moyer AM, Visscher DW, Yu J, Gao B, Sinnwell JP, Mahoney DW, Barman P, Vedell P, Tang X, Thompson K, Dockter TJ, Jones KN, Conners AL, McLaughlin SA, Moreno-Aspitia A, Northfelt DW, Gray RJ, Wieben ED, Farrugia G, Schultz C, Ingle JN, Wang L, Weinshilboum RW. Abstract P1-08-10: Integration of next generation sequencing (NGS) and patient derived xenografts (PDX) to identify novel markers of paclitaxel (T) response in the breast cancer genome guided therapy study (BEAUTY). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-10] [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:
Based upon the association between pathologic response and disease free survival, the neoadjuvant setting is increasingly being used for drug development. NGS has identified unique and recurrent genetic alterations in breast cancer (BC) that are potentially targetable; however, the clinical implications are mostly unknown. We developed a prospective neoadjuvant study (BEAUTY) in high risk BC patients (pts) using weekly T followed by anthracycline-based chemo wherein percutaneous tumor biopsies (PTB) are obtained before/during/after chemo for NGS and PDX. Our goal is to identify novel biomarkers/pathways and develop PDX to test new therapeutic approaches.
Methods: Pts underwent PTB at baseline and after 12 wks of T. Response to T was defined based upon 12 week Ki-67: responder (<15%) vs non-responder (≥15%). Pts with histologic response and absence of invasive BC at 12 wks were classified as responders. NGS was performed using PTB/blood DNA (exome) and PTB (RNA seq). MRI response was classified using RECIST criteria. NGS data were used to identify somatic copy number variants (cnvs) and expressed single nucleotide variants (eSNVs). Non-SCID mice (estrogen supplemented) were implanted ≤ 30 minutes with PTB samples.
Results: Of the first 78 pts, 44 have completed T. Here we focus on 18 pts with either triple negative or luminal B BC. Clinical characteristics according to Ki-67 response are shown in Table 1. Comparison of genomic alterations in BEAUTY pts with TCGA identified a greater overlap with copy number gains (73%) compared to deletions (40%), along with similar observations of mutations in TP53, PTEN, RYR2, and AKT1 genes. Association analysis of CNVs and eSNVs between responders/non-responders identified 33 genes (predominantly located in chromosomes 1, 8, 13) and 580 eSNVs (corresponding to 497 genes) with a p < 0.05. Differential gene expression (DGE) analysis of responders/non-responders identified 198 genes with a p-value < 0.05. Integrated analysis of 539 genes (CNVs, eSNVs and DGE) identified pathways such as TGF-beta, Jak-Stat, WNT and NOTCH signalling. PDX take rate was 44% [triple negative (6/10); Luminal B (2/8)]. PDX growth rate was significantly associated with clinical baseline Ki-67 (p = 0.00014).
Conclusion: This is the first prospective study to demonstrate the feasibility of using PTB to obtain both NGS data and PDX in the neoadjuvant setting. PDX take rate is associated with BC subtype and baseline Ki-67. Studies are ongoing to 1) validate genes/pathways associated with treatment response in subsequent BEAUTY pts; 2) genomically characterize and assess PDX in vivo response to T and 3) Use NGS data to prioritize new drugs/drug combinations in PDX.
Funded by Mayo Clinic Center for Individualized Medicine and MC Cancer Center.
Clinical CharacteristicsOverallResponders: 12 week Ki-67 < 15% (n = 9)Non-Responders: 12 week Ki-67 ≥ 15% (n = 9)Median Age495345T stage T2/T314 (78%)7 (78%)7 (78%)Node Positive8 (44%)4 (44%)4 (44%)Triple negative10 (56%)6 (67%)4 (44%)Luminal B8 (44%)3 (33%)5 (56%)Ki-67 after 12 Weeks of T Median 5% (0-11%)Median 35% (17-60%)Complete/Partial MRI Response after T 6 (67%)2 (22%)
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-10.
Collapse
Affiliation(s)
- MP Goetz
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JC Boughey
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KR Kalari
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - J Eckel-Passow
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - VJ Suman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - H Sicotte
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SN Hart
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - AM Moyer
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Visscher
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - J Yu
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - B Gao
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JP Sinnwell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Mahoney
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - P Barman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - P Vedell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - X Tang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - K Thompson
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - TJ Dockter
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - KN Jones
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - AL Conners
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - SA McLaughlin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - A Moreno-Aspitia
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - RJ Gray
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - ED Wieben
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - G Farrugia
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - C Schultz
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - JN Ingle
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - L Wang
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| | - RW Weinshilboum
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
25
|
Tan WW, Dueck AC, Flynn P, Steen P, Anderson D, Rowland K, Northfelt D, Perez EA. N0539 phase II trial of fulvestrant and bevacizumab in patients with metastatic breast cancer previously treated with an aromatase inhibitor: a North Central Cancer Treatment Group (now Alliance) trial. Ann Oncol 2013; 24:2548-2554. [PMID: 23798616 PMCID: PMC3784332 DOI: 10.1093/annonc/mdt213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Based on preclinical studies, the vascular endothelial pathway is an important mechanism for estrogen receptor resistance. We conducted a phase II study of fulvestrant and bevacizumab in patients with aromatase inhibitor pretreated metastatic breast cancer. PATIENTS AND METHODS A single-stage phase II study was conducted with these objectives: 6-month progression-free survival (PFS), tumor response, toxic effect, and overall survival. Regimen: 250 mg fulvestrant days 1 and 15 (cycle 1) then day 1 (cycle 2 and beyond) and 10 mg/kg bevacizumab days 1 and 15 of each 4-week cycle. RESULTS At interim analysis, 20 eligible patients initiated treatment, 11 were progression free and on treatment at 3 months, not meeting the protocol-specified efficacy requirements (at least 12 of 20). Accrual remained open during interim analysis with 36 patients enrolling before final study closure. Among the 33 eligible patients, the median PFS was 6.2 months [95% confidence interval (CI) 3.6-10.1 months]. Of the 18 with measurable disease, 4 (22%) patients (95% CI 6% to 48%) had a confirmed tumor response (1 complete, 3 partial). The most common grade 3/4 adverse events were hypertension 3 (9%) and headache 3 (9%). CONCLUSIONS The fulvestrant/bevacizumab combination is safe and tolerable; however, it did not meet its statistical end point.
Collapse
Affiliation(s)
- W W Tan
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville
| | - A C Dueck
- Section of Biostatistics, Mayo Clinic, Scottsdale
| | - P Flynn
- Metro Minnesota CCOP, St Louis Park
| | - P Steen
- Sanford Medical Center, Fargo
| | | | | | - D Northfelt
- Divison of Hematology/Oncology, Mayo Clinic, Scottsdale, USA
| | - E A Perez
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville.
| |
Collapse
|
26
|
Miller KD, O'Neill A, Dang C, Northfelt D, Gradishar W, Sledge GW. Abstract P5-17-01: Bevacizumab (B) in the adjuvant treatment of breast cancer - first toxicity results from Eastern Cooperative Oncology Group trial E5103. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A previous feasibility trial (E2104 – Ann Oncol 23(2):331–7,2012) suggested incorporation of B into anthracycline-containing adjuvant therapy was feasible but ongoing cardiac monitoring was required to define the true impact of B on cardiac function.
Methods: Patients (pts) were assigned 1:2:2 to one of three treatment arms. In addition to doxorubicin and cyclophosphamide followed by weekly paclitaxel, patients received either placebo (Arm A – AC>T) or B during chemotherapy (Arm B - BAC>BT), or B during chemotherapy followed by B monotherapy (15 mg/kg q3wk) for an additional 10 cycles (Arm C – BAC>BT>B). Randomization was stratified and B dose adjusted for choice of AC schedule (classical q3wk − 15 mg/kg; dose dense(dd) q2 wk − 10 mg/kg). When indicated, radiation and hormonal therapy were administered concurrently with B (for Arm C pts). The primary cardiac endpoint was the incidence of clinically apparent cardiac dysfunction (CHF)defined as symptomatic decline in left ventricular ejection fraction (LVEF) to below the lower limit of normal (LLN) or symptomatic diastolic dysfunction as assessed by independent review. Cumulative toxicity data as of Jan 23, 2012 are presented.
Results: From 11.07 to 2.11, 4994 pts were enrolled. Median age was 52; 80% received ddAC. Chemotherapy associated toxicities including myelosuppression (Grade 4 neutropenia 16/20/19%) and neuropathy (Grade ≥ 3 8/8/8%) were similar across all arms. Grade ≥ 3 hypertension/thrombosis/proteinuria/hemorrhage was reported by 7/3/<1/<1% of B-treated pts. 99 pts developed CHF, most commonly reported at the post-AC or post-T evaluation. After a median follow-up of 26 months, the cumulative incidence of clinical CHF at 15 months from randomization in Arm A/B/C was 1.0/1.7/2.9% respectively. Median age of CHF pts was 57; median baseline LVEF of CHF pts was 60.
Conclusion: Incorporation of B into anthracycline and taxane containing adjuvant therapy results in a significant but small increase in clinical CHF. The rate of clinical CHF is similar to that predicted by E2104 (2.5–2.9%) and reported In the FDA label for anthracycline pre-treated pts(3.8%). No unexpected toxicities were encountered.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-17-01.
Collapse
Affiliation(s)
- KD Miller
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| | - A O'Neill
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| | - C Dang
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| | - D Northfelt
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| | - W Gradishar
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| | - GW Sledge
- Indiana University Melvin and Bren Simon Cancer Center; Dana Farber Cancer Institute; Memorial Sloan Kettering Cancer Center; Mayo Clinic; Northwestern University
| |
Collapse
|
27
|
Tan WW, Hillman DW, Salim M, Northfelt DW, Anderson DM, Stella PJ, Niedringhaus R, Bernath AM, Gamini SS, Palmieri F, Perez EA. N0332 phase 2 trial of weekly irinotecan hydrochloride and docetaxel in refractory metastatic breast cancer: a North Central Cancer Treatment Group (NCCTG) Trial. Ann Oncol 2009; 21:493-497. [PMID: 19625343 DOI: 10.1093/annonc/mdp328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because of the single-agent activity of irinotecan hydrochloride, combination of irinotecan and docetaxel treatment against metastatic breast cancer (MBC) should be evaluated. PATIENTS AND METHODS Single-stage phase 2 study of irinotecan and docetaxel to evaluate tumor response, toxicity, time to progression, and overall survival was carried out. Regimen of docetaxel (25 mg/m(2)) and irinotecan (70 mg/m(2)) was administered on days 1 and 8 of each 3-week cycle. Patients had histologically confirmed breast adenocarcinoma and metastatic cancer measurable with RECIST. RESULTS Of 70 patients enrolled, 64 were assessable. Prior treatment with an anthracycline and a taxane was required. Eighteen (28%) patients [95% confidence interval (CI) 15% to 31%] had tumor response, plus four patients had stable disease (less than 30% decrease in sum of longest diameter and less than 20% increase) for >6 months. The clinical benefit rate was 34% overall. Median duration of tumor response was 6.7 months (95% CI 4.2-37.7 months); median follow-up was 18.6 months (range 8.5-37.7 months). The most common severe adverse events included fatigue [n = 16 (25%)] and neutropenia [n = 13 (20%)]. CONCLUSIONS Weekly dosing of combination of irinotecan and docetaxel is active against MBC. However, the response rate to our regimen was not significantly better than single-agent docetaxel. Other schedules of irinotecan plus docetaxel should be considered for future studies.
Collapse
Affiliation(s)
- W W Tan
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL.
| | - D W Hillman
- Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - M Salim
- Division of Hematology and Oncology, Allan Blair Cancer Center, Regina, Saskatchewan, Canada
| | - D W Northfelt
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - D M Anderson
- Division of Hematology and Oncology, Abbott Northwestern Hospital, Minneapolis, MN
| | - P J Stella
- Department of Hematology and Oncology, Michigan Cancer Research Consortium, Ann Arbor, MI
| | - R Niedringhaus
- Department of Hematology and Oncology, Duluth CCOP, Duluth, MN
| | - A M Bernath
- Department of Hematology and Oncology, Geisinger Clinic and Medical Center, Danville, PA
| | - S S Gamini
- Department of Hematology and Oncology, Missouri Valley Cancer Consortium, Omaha, NE, USA
| | - F Palmieri
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - E A Perez
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
28
|
Apsey H, Roy V, Pockaj B, Northfelt D, Sticca R, Nikcevich DA, Mattar B, Fitch T, Perez EA. Surgical practice patterns following NCCTG N0338 “Phase II trial of docetaxel and darboplatin administered every two weeks as induction therapy for stage II and stage III breast cancer.”. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.623] [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
623 Background: Neoadjuvant therapy plays an important role in breast cancer treatment. Unlike patients who undergo surgery followed by adjuvant therapy,there are no established guidelines for surgical management following neoadjuvant therapy. Methods: Surgical practice patterns from 50 patients in N0338 “Phase II trial of Docetaxel and Carboplatin administered every two weeks as induction therapy for Stage II and Stage III breast cancer” were reviewed. The protocol did not mandate surgical therapy leaving the decision to the treating surgeon and patient. Results: 66% of patients underwent mastectomy (M) and 33% underwent breast conservation therapy (BCT). Three (9%) had immediate reconstruction. Eight (24%) underwent contralateral prophylactic M. Residual tumor size did not always impact primary surgical therapy. In the M group 4 (12%) had no residual disease, 15 (45%) < 2cm and 14 (42%) > 2cm; whereas, in the BCT group 1 (6%) had no residual disease, 12 (70%) < 2cm and 4 (24%) > 2cm. Axillary lymph node (ALN) staging varied tremendously. Three (6%) patients presented with palpable lymphadenopathy and proceeded to complete axillary lymph node dissection (ALND) after chemotherapy (CT). Fine needle aspiration (8) or core needle biopsy (7) of the axilla was performed in 15 (30%) patients before CT; 1 was negative and went on to have sentinel lymph node biopsy (SLNB) after CT; 14 (94%) were positive with 13 (86%) going on to ALND and 1 SLNB after CT. Five (10%) underwent SLNB prior to CT. One (20%) was positive and went on to have ALND after CT; 4 (8%) were negative and had no further ALN staging. A total of 19 (39%) had SLNB after neoadjuvant therapy; 13 (68%) were positive and underwent ALND; 1 SLNB failed; 2 of 5 that were negative underwent ALND with 1 having a positive lymph node. Ten (20%) underwent ALND with no pre-operative staging with 8 being positive for ALN metastases. Conclusions: Review of study data from multiple institutions revealed no consistent criteria in selection of surgical intervention for the breast tumor or ALN staging. There remains a need for further research in this area to establish standard practice guidelines. Support from NIH, sanofi-aventis, Amgen, Breast Cancer Research Foundation. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- H. Apsey
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - V. Roy
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - B. Pockaj
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - D. Northfelt
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - R. Sticca
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - D. A. Nikcevich
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - B. Mattar
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - T. Fitch
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| | - E. A. Perez
- Mayo Clinic Arizona, Phoenix, AZ; Mayo Clinic Minnesota, Rochester, MN; Mayo Clinic Arizona, Scottsdale, AZ; University of North Dakota, Grand Forks, ND; Duluth Clinic, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Mayo Clinic Florida, Jacksonville, FL
| |
Collapse
|
29
|
Chiappori A, Williams C, Northfelt D, Adams J, Malik S, Edelman M, Rosen P, Van Echo D, Berger M, Haura E. 592 POSTER Obatoclax (GX17–070), a small molecule pan-bcl-2 inhibitor, in combination with docetaxel in a phase I/II trial enrolling patients with relapsed non-small cell lung cancer (NSCLC). EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
30
|
Chong G, Bhatnagar A, Cunningham D, Cosgriff TM, Harper PG, Steward W, Bridgewater J, Moore M, Cassidy J, Coleman R, Coxon F, Redfern CH, Jones JJ, Hawkins R, Northfelt D, Sreedharan S, Valone F, Carmichael J. Phase III trial of 5-fluorouracil and leucovorin plus either 3H1 anti-idiotype monoclonal antibody or placebo in patients with advanced colorectal cancer. Ann Oncol 2005; 17:437-42. [PMID: 16311275 DOI: 10.1093/annonc/mdj090] [Citation(s) in RCA: 27] [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: 12/15/2022] Open
Abstract
BACKGROUND The monoclonal antibody 3H1 mimics the external structure of the carcinoembryonic antigen (CEA). It therefore has the potential, via the anti-idiotypic network, to stimulate immune responses to CEA that may benefit colorectal cancer patients. PATIENTS AND METHODS A total of 630 patients with previously untreated metastatic colorectal cancer were randomised in a 2:1 fashion to receive bolus 5-fluorouracil (5-FU) and leucovorin (LV) plus either 3H1 (n = 422) or placebo (n = 208). RESULTS The addition of 3H1 to 5-FU and LV did not result in increased toxicity. Survival for the full intent-to-treat population was 14.7 months for the 3H1 arm and 15.2 months for the placebo arm (P = 0.80). Anti-CEA antibody responses were observed in 70% of patients treated with 3H1. Patients with a negative CEA response had a median survival of 8.3 months (95% CI 7.5-11.0) compared with patients with a strong response: median survival not reached (P <0.001). CONCLUSION 3H1 is safe and effectively induces immune responses to CEA. Addition of 3H1 to 5-FU and LV was not shown to improve overall patient outcomes. However, improved survival in patients developing anti-CEA responses to 3H1 are provocative and should be studied in further clinical trials.
Collapse
Affiliation(s)
- G Chong
- Royal Marsden Hospital, Sutton, Surrey, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Schild S, Wong W, Vora S, Halyard M, Northfelt D, Kogut H, Wheeler R. P-225 The long-term results of a pilot study of three times a dayradiotherapy and escalating doses of daily cisplatin for locally advanced non-small cell lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
32
|
Slamon D, Yeon CH, Pienkowski T, Northfelt D, Eiermann W, Patel R, Crown J, Riva A, Blitz S, Pegram M. Survival analysis from two open-label non-randomized phase II trials of trastuzumab (H) combined with docetaxel (T) and platinums (C, cisplatin or carboplatin) (TCH) in women with HER2+ advanced breast cancer (ABC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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)
- D. Slamon
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - C. H. Yeon
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - T. Pienkowski
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - D. Northfelt
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - W. Eiermann
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - R. Patel
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - J. Crown
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - A. Riva
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - S. Blitz
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| | - M. Pegram
- UCLA Geffen School of Medicine, Los Angeles, CA; Curie Institute of Oncology, Warsaw, Poland; UCLA Oncology Research Network, Los Angeles, CA; Cancer International Research Group Investigators, Paris, France
| |
Collapse
|
33
|
Smith RE, Tchekmedyian NS, Chan D, Meza LA, Northfelt DW, Patel R, Austin M, Colowick AB, Rossi G, Glaspy J. A dose- and schedule-finding study of darbepoetin alpha for the treatment of chronic anaemia of cancer. Br J Cancer 2003; 88:1851-8. [PMID: 12799626 PMCID: PMC2741110 DOI: 10.1038/sj.bjc.6600994] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A multicentre study evaluated the efficacy and safety of darbepoetin alpha administered weekly (QW), every 3 weeks (Q3W), and every 4 weeks (Q4W) to anaemic patients with cancer not concurrently receiving chemotherapy or radiotherapy. The QW portion (n=102) was an open-label, sequential, dose-escalation design; cohorts received darbepoetin alpha QW by subcutaneous (s.c.) injection at 0.5, 1.0, 2.25, or 4.5 micro g kg(-1) week(-1) for 12 weeks. The 12-week placebo-controlled, double-blind Q3W (6.75 micro g kg(-1)) and Q4W (6.75 or 10.0 micro g kg(-1)) schedules (n=86), which enrolled different patients, took place after the QW schedule and were followed by a 12-week, open-label phase. Patients were evaluated for change in haemoglobin end points and red blood cell transfusions, serum darbepoetin alpha concentration, and safety. Selected domains of health-related quality of life (HRQOL) were measured. With QW dosing, at least 70% of each cohort had a haemoglobin increase from baseline of > or =2 g dl(-1) or a concentration > or =12 g dl(-1) (haematopoietic response). In the 4.5 micro g kg(-1) QW cohort, all patients achieved a haematopoietic response (100%; 95% confidence interval (CI)=100, 100). In the Q3W and Q4W schedules, all cohorts had at least 60% of patients who achieved a haematopoietic response. Darbepoetin alpha effectively increases haemoglobin concentration when given QW, Q3W, or Q4W. Less-frequent administration may benefit patients with chronic anaemia of cancer and their caregivers alike.
Collapse
Affiliation(s)
- R E Smith
- South Carolina Oncology Associates, 1301 Taylor, Suite 1A, Columbia, SC 29201, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Osoba D, Northfelt DW, Budd DW, Himmelberger D. Effect of treatment on health-related quality of life in acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma: a randomized trial of pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine. Cancer Invest 2001; 19:573-80. [PMID: 11486699 DOI: 10.1081/cnv-100104284] [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: 11/03/2022]
Abstract
The purpose of this study was to determine whether health-related quality of life (HRQL) would be improved in patients with acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma treated by pegylated-liposomal doxorubicin (PLD) as compared to those treated by a conventional combination of doxorubicin, bleomycin, and vincristine (ABV). One hundred thirty-three patients received PLD and 125 patients received ABV every 2 weeks with a planned total of 6 cycles. Patients completed a 30-item AIDS-related HRQL questionnaire before beginning treatment (baseline), every 2 weeks while on treatment, and about 21 days after the end of treatment. Twenty-two items, involving nine domains, were analyzable. While on treatment, PLD-treated patients with partial clinical responses achieved statistically significant greater improvement (compared to baseline) in general health than did ABV-treated patients with partial clinical responses (rho = 0.008). By the end of treatment, the overall group of patients receiving PLD showed statistically significant greater improvement in pain and energy/fatigue than did the group receiving ABV (rho = 0.01-0.002). In addition, duration of clinically significant improvement in global QL was longer in the PLD arm.
Collapse
Affiliation(s)
- D Osoba
- Quality of Life Consulting, 4939 Edendale Court, West Vancouver, BC V7W 3H7, Canada.
| | | | | | | |
Collapse
|
35
|
Walmsley S, Northfelt DW, Melosky B, Conant M, Friedman-Kien AE, Wagner B. Treatment of AIDS-related cutaneous Kaposi's sarcoma with topical alitretinoin (9-cis-retinoic acid) gel. Panretin Gel North American Study Group. J Acquir Immune Defic Syndr 1999; 22:235-46. [PMID: 10770343 DOI: 10.1097/00126334-199911010-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [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: 11/25/2022]
Abstract
BACKGROUND Kaposi's sarcoma (KS) is the most frequent malignancy in patients with HIV. Given the promise that retinoids show in the treatment of various hyperproliferative skin disorders and in vitro evidence of inhibition of proliferation of KS cells, a randomized, controlled clinical trial was conducted. METHODS AND RESULTS A 12-week, multicenter, randomized, double-blind, vehicle-controlled safety and efficacy evaluation of topical alitretinoin 0.1% gel applied to cutaneous KS lesions was conducted in HIV-infected patients. The primary efficacy endpoint was the patient's response rate, as determined by evaluating six index lesions representative of the patient's overall KS cutaneous disease using AIDS Clinical Trials Group (ACTG) response criteria applied to topical therapy. Of 268 patients entered in the blinded treatment phase of the study (alitretinoin group, n = 134; vehicle group, n = 134), 47 patients (35%) treated with alitretinoin 0.1% gel had a positive response, compared with 24 patients (18%) treated with vehicle gel. Of 184 patients receiving open-label alitretinoin treatment following the blinded phase of the trial, 90 patients (49%) met criteria for a positive response. This superior efficacy of alitretinoin gel over vehicle gel was maintained when the data were adjusted or analyzed for age, race, Kamofsky scores, baseline CD4+ lymphocyte counts, number of raised lesions at baseline, and aggregate area of index lesions. Alitretinoin 0.1% gel was superior to vehicle gel regardless of the number of concurrent antiretroviral therapies. Most adverse events were mild to moderate in severity, limited to the application site, and reversible on reduction in frequency or suspension of application. Relatively few patients (7%) discontinued alitretinoin therapy because of to related adverse events. CONCLUSIONS The results show that alitretinoin gel application is safe and generally well tolerated, and they indicate the superiority of alitretinoin 0.1% gel over vehicle gel in the treatment of cutaneous AIDS-related KS lesions.
Collapse
Affiliation(s)
- S Walmsley
- Division of Infectious Diseases, Toronto Hospital, University of Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Northfelt DW, Dezube BJ, Thommes JA, Miller BJ, Fischl MA, Friedman-Kien A, Kaplan LD, Du Mond C, Mamelok RD, Henry DH. Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi's sarcoma: results of a randomized phase III clinical trial. J Clin Oncol 1998; 16:2445-51. [PMID: 9667262 DOI: 10.1200/jco.1998.16.7.2445] [Citation(s) in RCA: 486] [Impact Index Per Article: 18.7] [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] Open
Abstract
PURPOSE Kaposi's sarcoma (KS), the most common neoplasm in patients with AIDS, is a significant clinical problem for which current therapies are frequently unsatisfactory. We conducted a randomized phase III clinical trial to compare the efficacy and toxicities of a new form of therapy, pegylated-liposomal doxorubicin, with standard combination chemotherapy in patients with advanced AIDS-related KS (AIDS-KS). PATIENTS AND METHODS Two hundred fifty-eight patients with advanced AIDS-KS were randomly assigned to receive either pegylated-liposomal doxorubicin (20 mg/m2) or the combination of doxorubicin (20 mg/m2), bleomycin (10 mg/m2) and vincristine (1 mg) (ABV) every 14 days for six cycles. Standard response criteria, toxicity criteria, and predefined indicators of clinical benefit were examined to evaluate outcomes. RESULTS Among 133 patients randomized to receive pegylated-liposomal doxorubicin, one achieved a complete clinical response and 60 achieved a partial response for an overall response rate of 45.9% (95% confidence interval [CI], 37% to 54%). Among 125 patients randomized to receive ABV, 31 achieved a partial response (24.8%; 95% confidence interval [CI], 17% to 32%). This difference was statistically significant (P < .001). In addition to objective responses, prospectively defined clinical benefits and toxicity outcomes also favored pegylated-liposomal doxorubicin. CONCLUSION Pegylated-liposomal doxorubicin is more effective and less toxic than the standard combination chemotherapy regimen ABV for treatment of AIDS-KS.
Collapse
|
37
|
Lalezari JP, Holland GN, Kramer F, McKinley GF, Kemper CA, Ives DV, Nelson R, Hardy WD, Kuppermann BD, Northfelt DW, Youle M, Johnson M, Lewis RA, Weinberg DV, Simon GL, Wolitz RA, Ruby AE, Stagg RJ, Jaffe HS. Randomized, controlled study of the safety and efficacy of intravenous cidofovir for the treatment of relapsing cytomegalovirus retinitis in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17:339-44. [PMID: 9525435 DOI: 10.1097/00042560-199804010-00008] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To assess the effect of intravenous cidofovir on delaying progression of previously treated, relapsing cytomegalovirus (CMV) retinitis, we conducted a randomized, controlled comparison of two maintenance dose levels of cidofovir. One hundred and fifty patients with AIDS and CMV retinitis that had progressed or was persistently active despite treatment with ganciclovir, foscarnet, or both were randomized to receive induction cidofovir, 5 mg/kg once weekly for 2 weeks, then maintenance therapy with either 5 mg/kg or 3 mg/kg once every other week. Concomitant probenecid and intravenous hydration were administered with each cidofovir dose. Retinitis progression was assessed in the first 100 patients by bilateral, full-field retinal photographs read at a central reading center by an ophthalmologist masked to treatment assignment. Incidence of side effects, changes in visual acuity, and mortality were also assessed. Median time to retinitis progression as assessed by retinal photography was not reached (95% confidence interval [CI], 115 days-upper limit not reached) in the 5-mg/kg group, and was 49 days (95% CI, 35-52 days) in the 3-mg/kg group (p = .0006). Dose-dependent asymptomatic proteinuria (39%) and serum creatinine elevation (24%) were the most common adverse events thought to be related to cidofovir. Reversible probenecid reactions including constitutional symptoms and nausea occurred in 65 of 150 (43%) patients. Cidofovir therapy is effective in delaying progression of CMV retinitis that had previously progressed using other anti-CMV therapies.
Collapse
Affiliation(s)
- J P Lalezari
- University of California, San Francisco-Mt. Zion Medical Center, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kaplan LD, Straus DJ, Testa MA, Von Roenn J, Dezube BJ, Cooley TP, Herndier B, Northfelt DW, Huang J, Tulpule A, Levine AM. Low-dose compared with standard-dose m-BACOD chemotherapy for non-Hodgkin's lymphoma associated with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med 1997; 336:1641-8. [PMID: 9171066 DOI: 10.1056/nejm199706053362304] [Citation(s) in RCA: 238] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reduced doses of cytotoxic chemotherapy or standard-dose therapy plus a myeloid colony-stimulating factor decreases hematologic toxicity and its complications in patients with non-Hodgkin's lymphoma associated with infection with the human immunodeficiency virus (HIV). However, the effect of reducing the doses of cytotoxic chemotherapeutic agents on clinical outcome is not known. METHODS We randomly assigned 198 HIV-seropositive patients with previously untreated, aggressive non-Hodgkin's lymphoma to receive standard-dose therapy with methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) along with granulocyte-macrophage colony-stimulating factor (GM-CSF; n=94) or reduced-dose m-BACOD with GM-CSF administered only as indicated (n=98). RESULTS A complete response was achieved in 39 of the 94 assessable patients assigned to low-dose therapy (41 percent) and in 42 of the 81 assessable patients assigned to standard-dose therapy (52 percent, P= 0.56). There were no significant differences in overall or disease-free survival; median survival times were 35 weeks for patients receiving low-dose therapy and 31 weeks for those receiving standard-dose therapy (risk ratio for death in the standard-dose group=1.17; 95 percent confidence interval, 0.84 to 1.63; P=0.25). Toxic effects of chemotherapy rated grade 3 or higher occurred in 66 of 94 patients assigned to standard-dose therapy (70 percent) and 50 of 98 patients assigned to low-dose treatment (51 percent, P=0.008). Hematologic toxicity accounted for the difference. CONCLUSIONS As compared with treatment with standard doses of cytotoxic chemotherapy (m-BACOD), reduced doses caused significantly fewer hematologic toxic effects yet had similar efficacy in patients with HIV-related lymphoma. Dose-modified chemotherapy should be considered for most HIV-infected patients with lymphoma.
Collapse
Affiliation(s)
- L D Kaplan
- Department of Medicine, San Francisco General Hospital, CA 94110, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Levine AM, Tulpule A, Tessman D, Kaplan L, Giles F, Luskey BD, Scadden DT, Northfelt DW, Silverberg I, Wernz J, Espina B, Von Hoff D. Mitoguazone therapy in patients with refractory or relapsed AIDS-related lymphoma: results from a multicenter phase II trial. J Clin Oncol 1997; 15:1094-103. [PMID: 9060550 DOI: 10.1200/jco.1997.15.3.1094] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [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: 02/03/2023] Open
Abstract
PURPOSE Patients with AIDS-related lymphoma usually have extensive lymphomatous disease, with relatively frequent involvement of the CNS. Approximately half may achieve complete remission after chemotherapy. Mitoguazone, an inhibitor of polyamine biosynthesis, has demonstrated efficacy in patients with de novo recurrent lymphoma. The drug is relatively nonmyelotoxic and may cross the blood-brain barrier. The current study was designed to assess the safety and potential efficacy of mitoguazone in patients with relapsed or refractory AIDS-lymphoma. PATIENTS AND METHODS Thirty-five patients were accrued, all of whom had failed one (51%) or multiple (two to six) prior regimens. Mitoguazone (600 mg/m2) was given intravenously on days 1 and 8, and then every 2 weeks, until best response, progression, or toxicity. RESULTS The median age was 39 years. High-grade lymphoma was diagnosed in 29 patients (83%). Extranodal disease was present in 30 patients (86%), with multiple extranodal sites (two to seven) in 18 (51%). The median CD4 cell count at study entry was 66/dL (range, zero to 549). Twenty-six patients were assessable for response. The objective response rate was 23% (95% confidence interval [CI], 6.9 to 39.3), with complete remission in three patients (11.5%), and partial remission (PR) in three patients (11.5%). Six patients experienced stable disease. Median survival from study entry was 2.6 months for the group as a whole; 21.5 months (range, 3.8 to 29.1) in complete responders, 5.6 months (range, 3.8 to 34.8) in partial responders. The most common toxicities occurred solely during drug infusion and included vasodilation (63%), paresthesia (86%), and somnolence (17%). Fourteen patients (40%) experienced nausea and 16 (46%) vomiting (grade 3 in one). Ten patients (29%) developed stomatitis, including grade 3 in two and grade 4 in one. Seven patients (20%) developed neutropenia, with grade 4 in one. Thrombocytopenia occurred in nine patients (26%). While on study, three patients developed sepsis, four had pneumonia, and two developed opportunistic infections. CONCLUSION Mitoguazone is an effective agent in patients with multiply relapsed or refractory AIDS-related lymphoma, with acceptable toxicity. Further study in patients with newly diagnosed disease is warranted.
Collapse
Affiliation(s)
- A M Levine
- University of Southern California School of Medicine, Los Angeles 90033, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Amantea MA, Forrest A, Northfelt DW, Mamelok R. Population pharmacokinetics and pharmacodynamics of pegylated-liposomal doxorubicin in patients with AIDS-related Kaposi's sarcoma. Clin Pharmacol Ther 1997; 61:301-11. [PMID: 9084455 DOI: 10.1016/s0009-9236(97)90162-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [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: 02/04/2023]
Abstract
OBJECTIVE To characterize the population pharmacokinetics of pegylated-liposomal doxorubicin in patients with acquired immunodeficiency disease (AIDS)-related Kaposi's sarcoma and to explore the relationship between response of the cutaneous Kaposi's sarcoma lesions to treatment and measures of drug exposure. METHODS Forty-three male patients (median age, 40 years; age range, 28 to 50 years), body surface area, 1.89 m2; range, 1.5 to 2.3 m2) with AIDS and at least five biopsy-proven cutaneous Kaposi's sarcoma lesions were randomized to receive either a 10 or 20 mg/m2 dose of study drug for their first cycle and the alternate dose 3 weeks later. Patients continued to receive the study drug at a dose of 20 mg/m2 every 3 weeks. Serial blood samples were obtained after the first two doses and analyzed by HPLC for determination of total plasma doxorubicin concentration. Kaposi's sarcoma lesion response was categorized as either progressive disease, stable disease, partial response, or complete response. Classification and regression tree (CART) analysis was used to determine the relationship between drug exposure and categorical lesion response. Iterative two-stage analysis was used to characterize both the pharmacokinetics of pegylated-liposomal doxorubicin and to model the probabilities of achieving a specific lesion response. RESULTS The pharmacokinetics of pegylated-liposomal doxorubicin were best described by a two-compartment linear structural model. Lesion response was significantly related to both the average daily maximum doxorubicin concentration (Cmax,avg) and dose intensity. CONCLUSIONS The pharmacokinetics of pegylated-liposomal doxorubicin are strikingly different from conventional doxorubicin. Identification of both Cmax,avg and dose intensity as predictors of lesion response will provide guidelines for future dosing regimen designs.
Collapse
Affiliation(s)
- M A Amantea
- SEQUUS Pharmaceuticals, Inc., Menlo Park, CA 94025, USA
| | | | | | | |
Collapse
|
41
|
Northfelt DW, Dezube BJ, Thommes JA, Levine R, Von Roenn JH, Dosik GM, Rios A, Krown SE, DuMond C, Mamelok RD. Efficacy of pegylated-liposomal doxorubicin in the treatment of AIDS-related Kaposi's sarcoma after failure of standard chemotherapy. J Clin Oncol 1997; 15:653-9. [PMID: 9053490 DOI: 10.1200/jco.1997.15.2.653] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.8] [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: 02/03/2023] Open
Abstract
PURPOSE To determine the efficacy and safety of pegylated-liposomal doxorubicin in patients with AIDS and Kaposi's sarcoma (AIDS-KS) who experienced failure of standard chemotherapy. METHODS Fifty-three patients with advanced AIDS-KS who experienced disease progression or intolerable toxicities while receiving standard doxorubicin/bleomycin/vincristine (ABV) or bleomycin/vincristine (BV) chemotherapy were identified from a cohort of patients who were then treated with pegylated-liposomal doxorubicin. Patients received 20 mg/m2 pegylated-liposomal doxorubicin (Doxil; Sequus Pharmaceuticals, Inc, Menlo Park, CA) every 3 weeks. RESULTS Nineteen patients (36%) had a partial response (PR) and one patient had a clinical complete response (CCR). The median duration of response and time (from study entry) to treatment failure were 128 and 134 days, respectively. Of 28 patients who experienced disease progression while receiving combination regimens that contained standard doxorubicin, the PR rate was 32%, which suggests that the pegylated-liposomal encapsulation increases the therapeutic effect of doxorubicin. Patients obtained clinical benefits such as flattening of lesions (48%), improved lesion color (56%), relief of pain (45%), and loss of edema (83%). Forty-nine percent of patients had more than one clinical benefit. The most common adverse effect was leukopenia, which occurred in 40% of patients. Only 15% of patients had nausea and/or vomiting, none of which was severe; 9% experienced alopecia, also generally mild. CONCLUSION Pegylated-liposomal doxorubicin offers a new alternative for treatment of patients who have experienced failure of standard chemotherapy for AIDS-KS.
Collapse
|
42
|
Abstract
Prolonged, severe immunodeficiency provides the necessary milieu for the emergence of anogenital neoplasia caused by human papillomaviruses. Anal neoplasia is likely to become a more common manifestation of HIV disease as patients with profound immunodeficiency, who would have succumbed to opportunistic infections earlier in the epidemic, are now surviving for extended periods of time because of increasingly effective antiretroviral, prophylactic, and antimicrobial therapies. The screening and treatment strategies described for use in HIV-infected patients with anal neoplasia are currently being investigated and refined.
Collapse
Affiliation(s)
- D W Northfelt
- Pacific Oaks Medical Group, Palm Springs, California, USA
| | | | | |
Collapse
|
43
|
Northfelt DW. Anal neoplasia in persons with HIV infection. AIDS Clin Care 1996; 8:63-6. [PMID: 11363714] [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] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- D W Northfelt
- Pacific Oaks Medical Group, Beverly Hills, California, USA
| |
Collapse
|
44
|
Northfelt DW, Martin FJ, Working P, Volberding PA, Russell J, Newman M, Amantea MA, Kaplan LD. Doxorubicin encapsulated in liposomes containing surface-bound polyethylene glycol: pharmacokinetics, tumor localization, and safety in patients with AIDS-related Kaposi's sarcoma. J Clin Pharmacol 1996; 36:55-63. [PMID: 8932544 DOI: 10.1002/j.1552-4604.1996.tb04152.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A study of the plasma pharmacokinetics, tumor localization, and safety of a single dose of doxorubicin encapsulated in liposomes containing surface-bound polyethylene glycol (PEG-liposomal doxorubicin) was conducted in patients with Kaposi's sarcoma (KS) as a manifestation of acquired immune deficiency syndrome (AIDS). Eighteen patients with AIDS-KS diagnosed by examination of biopsy specimens were randomly assigned to receive either standard doxorubicin or PEG-liposomal doxorubicin. Consecutive participants were entered at three dose levels (10, 20, and 40 mg/m2) in ascending fashion. Clearance of PEG-liposomal doxorubicin was 0.034 L/h/m2 to 0.108 L/h/m2, volume of distribution (Vd) was 2.2 L/m2 to 4.4 L/m2, and half-lives (t1/2) of the initial decline in the plasma concentration-time curve and of the terminal decline were 3.77 hours and 41.3 hours, respectively. Seventy-two hours after administration, doxorubicin levels observed in lesions of patients receiving PEG-liposomal doxorubicin were 5.2 to 11.4 times greater than those found in patients given comparable doses of standard doxorubicin. PEG-liposomal doxorubicin and standard doxorubicin were roughly equipotent in producing toxicity. Encapsulation in liposomes containing surface-bound PEG significantly limits the distribution and elimination of doxorubicin, results in greater accumulation of the drug in KS lesions 72 hours after dosing than does standard doxorubicin, and may improve drug efficacy and therapeutic index in the treatment of AIDS-KS.
Collapse
Affiliation(s)
- D W Northfelt
- AIDS/Oncology Division, University of California, San Francisco, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Timmerman JM, Northfelt DW, Small EJ. Malignant germ cell tumors in men infected with the human immunodeficiency virus: natural history and results of therapy. J Clin Oncol 1995; 13:1391-7. [PMID: 7538557 DOI: 10.1200/jco.1995.13.6.1391] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To determine how men infected with the human immunodeficiency virus (HIV) tolerate and respond to treatment for malignant germ cell tumors (GCTs), and how GCT histology and stage compare among HIV-infected versus non-HIV-infected men. PATIENTS AND METHODS Two hundred ninety-four cases of GCT diagnosed or treated from 1980 to 1993 were reviewed. Nine new cases among HIV-infected men were identified; these were analyzed together with six cases previously reported from our institution. RESULTS Low-stage tumors (stages I and IIA) comprised 67% of HIV-infected and 63% of non-HIV-infected cases. Sixty-seven percent of HIV-infected cases were seminomas versus 51% of non-HIV-infected cases. Ten patients had AIDS at the time of GCT diagnosis. Five patients underwent radiation therapy and one patient underwent retroperitoneal lymphadenectomy without complications. Seven patients received chemotherapy with four cycles of cisplatin, etoposide, and bleomycin (PEB) or cisplatin, vinblastine, and bleomycin (PVB) without excess cytopenias or new opportunistic infections. Of seven patients treated for advanced disease, there were five complete and two partial responses. Six patients have died of AIDS at a median of 20 months after diagnosis of GCT. The median follow-up time for surviving patients has been 42 months (range, 8 to 87) and all but one remain without evidence of active disease. In no case was a patient's HIV disease classification altered by antitumor therapy. CONCLUSION The natural history of GCTs is comparable in HIV-infected and non-HIV-infected men and standard therapy including orchiectomy, retroperitoneal lymph node dissection, radiation therapy, and chemotherapy is well tolerated.
Collapse
Affiliation(s)
- J M Timmerman
- Division of Hematology/Oncology, University of California, San Francisco, USA
| | | | | |
Collapse
|
47
|
Hambleton J, Aragón T, Modin G, Northfelt DW, Sande MA. Outcome for hospitalized patients with fever and neutropenia who are infected with the human immunodeficiency virus. Clin Infect Dis 1995; 20:363-71. [PMID: 7742443 DOI: 10.1093/clinids/20.2.363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We conducted a retrospective cohort study to evaluate the occurrence of bacteremia and associated mortality among hospitalized patients who were seropositive for the human immunodeficiency virus (HIV) and who developed fever and neutropenia following antineoplastic chemotherapy or for other reasons. Review of medical records revealed 224 episodes in 142 patients. Of these episodes, 57% occurred following antineoplastic chemotherapy, and 43% occurred under other circumstances. Members of the chemotherapy group had significantly less-advanced HIV disease, a lower mean absolute-neutrophil-count nadir, and a shorter duration of hospitalization. There was no difference between the two groups in the frequency of bacteremia or mortality due to all causes when they were compared by multivariate analysis. Statistically significant univariate and multivariate predictors of bacteremia included sepsis syndrome and concurrent infection. Predictors of mortality included sepsis syndrome, concurrent infection, bacteremia, and antimicrobial therapy. This study suggests that the cause of neutropenia in HIV-seropositive patients is not a predictor of the outcome of fever and neutropenic episodes. Instead, clinical presentation and concomitant illnesses have a greater impact on outcome for a patient.
Collapse
Affiliation(s)
- J Hambleton
- Department of Medicine, University of California, San Francisco 94143, USA
| | | | | | | | | |
Collapse
|
48
|
Gowdey G, Lipsey LR, Lee R, Jacques C, Northfelt DW. Gingival mass lesions in a patient with HIV infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79:7-9. [PMID: 7614166] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G Gowdey
- HIV CARE Program, University of the Pacific School of Dentistry, San Francisco, Calif., USA
| | | | | | | | | |
Collapse
|
49
|
Northfelt DW, Charlebois ED, Mirda MI, Child C, Kaplan LD, Abrams DI. Continuous low-dose interferon-alpha therapy for HIV-related immune thrombocytopenic purpura. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 8:45-50. [PMID: 8548345] [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: 01/31/2023]
Abstract
Our objective was to examine the efficacy and toxicity of continuous, low-dose interferon-alpha therapy for human immunodeficiency virus-related immune thrombocytopenic purpura (HIV-ITP) in a Phase II clinical trial overseen by a community-based consortium of physicians conducting clinical trials in HIV-related diseases. Sixteen patients with HIV-ITP defined by prospective clinical criteria were enrolled; the majority had failed other therapies for HIV-ITP. Baseline and serial measurements were made of platelet counts, complete blood counts, serum chemistries, platelet-associated immunoglobulin, and CD4+ T-lymphocyte counts; subjective symptoms and bleeding were recorded. Three million units of interferon-alpha 2b were self-administered by subcutaneous injection every Monday, Wednesday, and Friday for 16 weeks. Thirteen participants were evaluable for response. One obtained a complete response, eight had partial responses, and four had no response to interferon-alpha therapy. The mean absolute platelet count of the group rose from 15.5 x 10(9)/L at baseline to 47.3 x 10(9)/L at 2 weeks and remained in this range for the duration of the study. CD4+ T-lymphocyte counts and serum chemistries did not change significantly during therapy. Ability to detect platelet-associated immunoglobulin did not change in a predictable manner in relation to platelet count response. Hematologic toxicity was limited to one episode of granulocytopenia, which resolved after a lowering of zidovudine dosage. Subjective toxicities were mild and tolerable, and minor bleeding problems improved in all participants so affected. Low-dose, continuous therapy with interferon-alpha resulted in meaningful increases in the platelet counts of the majority of study participants with HIV-ITP. Interferon-alpha was safe and tolerable for most participants with HIV-ITP at the dosage and schedule employed in this study. Interferon-alpha for clinically significant thrombocytopenia and who have failed to respond to zidovudine.
Collapse
Affiliation(s)
- D W Northfelt
- Department of Medicine, University of California, San Francisco 94143-1270, USA
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Kaposi's sarcoma is the most common malignancy associated with HIV infection, and the morbidity and mortality attributable to AIDS-related Kaposi's sarcoma (AIDS-KS) may be increasing. No curative therapy is available for AIDS-KS, but palliative therapy can eliminate or reduce cosmetically unacceptable lesions, reduce painful or unsightly oedema or lymphadenopathy, shrink symptomatic oral lesions and relieve symptoms caused by visceral involvement. Strategies currently employed to treat the various clinical problems encountered in AIDS-KS include single- and multi-agent cytotoxic chemotherapy, treatment with interferon-alpha, radiotherapy, and other local therapies. Current clinical research is focusing on use of liposome-encapsulated cytotoxic agents and treatment with substances that inhibit angiogenesis. Any treatment plan for AIDS-KS must be flexible and must be based on the patient's overall clinical and immunological status as well as therapeutic goals. Limited local disease is usually amenable to treatment with local measures. Extensive, symptomatic AIDS-KS warrants systemic treatment. The response of mucocutaneous lesions to low dose systemic cytotoxic chemotherapy is typically excellent. Treatment with interferon-alpha may also be beneficial in this setting. Multi-agent chemotherapeutic regimens are usually reserved for treatment of patients most severely affected by AIDS-KS. It is hoped that liposome-encapsulated cytotoxic chemotherapy and antiangiogenic therapies will prove more effective and less toxic than the treatment strategies currently in use.
Collapse
Affiliation(s)
- D W Northfelt
- Department of Medicine, University of California, San Francisco
| |
Collapse
|