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Ganz PA, Bandos H, Španić T, Friedman S, Müller V, Kuemmel S, Delaloge S, Brain E, Toi M, Yamauchi H, de Dueñas EM, Armstrong A, Im SA, Song CG, Zheng H, Sarosiek T, Sharma P, Geng C, Fu P, Rhiem K, Frauchiger-Heuer H, Wimberger P, t'Kint de Roodenbeke D, Liao N, Goodwin A, Chakiba-Brugère C, Friedlander M, Lee KS, Giacchetti S, Takano T, Henao-Carrasco F, Virani S, Valdes-Albini F, Domchek SM, Bane C, McCarron EC, Mita M, Rossi G, Rastogi P, Fielding A, Gelber RD, Scheepers ED, Cameron D, Garber J, Geyer CE, Tutt ANJ. Patient-Reported Outcomes in OlympiA: A Phase III, Randomized, Placebo-Controlled Trial of Adjuvant Olaparib in g BRCA1/2 Mutations and High-Risk Human Epidermal Growth Factor Receptor 2-Negative Early Breast Cancer. J Clin Oncol 2024; 42:1288-1300. [PMID: 38301187 DOI: 10.1200/jco.23.01214] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE The OlympiA randomized phase III trial compared 1 year of olaparib (OL) or placebo (PL) as adjuvant therapy in patients with germline BRCA1/2, high-risk human epidermal growth factor receptor 2-negative early breast cancer after completing (neo)adjuvant chemotherapy ([N]ACT), surgery, and radiotherapy. The patient-reported outcome primary hypothesis was that OL-treated patients may experience greater fatigue during treatment. METHODS Data were collected before random assignment, and at 6, 12, 18, and 24 months. The primary end point was fatigue, measured with the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary end points, assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30 item, included nausea and vomiting (NV), diarrhea, and multiple functional domains. Scores were compared between treatment groups using mixed model for repeated measures. Two-sided P values <.05 were statistically significant for the primary end point. All secondary end points were descriptive. RESULTS One thousand five hundred and thirty-eight patients (NACT: 746, ACT: 792) contributed to the analysis. Fatigue severity was statistically significantly greater for OL versus PL, but not clinically meaningfully different by prespecified criteria (≥3 points) at 6 months (diff OL v PL: NACT: -1.3 [95% CI, -2.4 to -0.2]; P = .022; ACT: -1.3 [95% CI, -2.3 to -0.2]; P = .017) and 12 months (NACT: -1.6 [95% CI, -2.8 to -0.3]; P = .017; ACT: -1.3 [95% CI, -2.4 to -0.2]; P = .025). There were no significant differences in fatigue severity between treatment groups at 18 and 24 months. NV severity was worse in patients treated with OL compared with PL at 6 months (NACT: 6.0 [95% CI, 4.1 to 8.0]; ACT: 5.3 [95% CI, 3.4 to 7.2]) and 12 months (NACT: 6.4 [95% CI, 4.4 to 8.3]; ACT: 4.5 [95% CI, 2.8 to 6.1]). During treatment, there were some clinically meaningful differences between groups for other symptoms but not for function subscales or global health status. CONCLUSION Treatment-emergent symptoms from OL were limited, generally resolving after treatment ended. OL- and PL-treated patients had similar functional scores, slowly improving during the 24 months after (N)ACT and there was no clinically meaningful persistence of fatigue severity in OL-treated patients.
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Affiliation(s)
- Patricia A Ganz
- University of California, Los Angeles, Los Angeles, CA
- Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hanna Bandos
- NRG Oncology SDMC, The University of Pittsburgh, Pittsburgh, PA
| | - Tanja Španić
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
- Europa Donna Slovenia, Ljubljana, Slovenia
| | | | - Volkmar Müller
- Depatment of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Masakazu Toi
- Kyoto University Hospital, Kyoto, Japan
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | | | - Eduardo-M de Dueñas
- Consorcio Hospitalario Provincial de Castellón, Castellón, Spain
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Anne Armstrong
- Department of Medical Oncology, Division of Cancer Sciences, The University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chuan-Gui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zheng
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Cuizhi Geng
- The Fourth Hospital of Hebei Medical University, Shiijazhuang, China
| | - Peifen Fu
- Breast Surgery Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Cologne, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | | | - Ning Liao
- Guangdong People's Hospital, Guangzhou, China
| | - Annabel Goodwin
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of NSW and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sylvie Giacchetti
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, Paris, France
| | - Toshimi Takano
- Breast Medical Oncology Department, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | | | | | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA
| | | | - Edward C McCarron
- MedStar Franklin Square Medical Center-Harry and Jeanette Weinberg Cancer Institute, Baltimore, MD
| | - Monica Mita
- Cedars Sinai Medical Center, SOCCI, Los Angeles, CA
| | | | - Priya Rastogi
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Magee Women's Hospital, Pittsburgh, PA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA
- Frontier Science Foundation, Boston, MA
| | | | | | - Judy Garber
- Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Charles E Geyer
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Andrew N J Tutt
- The Institute of Cancer Research London, London, United Kingdom
- Kings College London, London, United Kingdom
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Mamounas EP, Bandos H, Rastogi P, Lembersky BC, Jeong JH, Geyer CE, Fehrenbacher L, Chia SK, Brufsky AM, Walshe JM, Soori GS, Dakhil SR, Wade JL, McCarron EC, Swain SM, Wolmark N. Ten-year update: NRG Oncology/National Surgical Adjuvant Breast and Bowel Project B-42 randomized trial: extended letrozole therapy in early-stage breast cancer. J Natl Cancer Inst 2023; 115:1302-1309. [PMID: 37184928 PMCID: PMC10637036 DOI: 10.1093/jnci/djad078] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The National Surgical Adjuvant Breast and Bowel Project B-42 trial evaluated extended letrozole therapy (ELT) in postmenopausal breast cancer patients who were disease free after 5 years of aromatase inhibitor (AI)-based therapy. Seven-year results demonstrated a nonstatistically significant trend in disease-free survival (DFS) in favor of ELT. We present 10-year outcome results. METHODS In this double-blind, phase III trial, patients with stage I-IIIA hormone receptor-positive breast cancer, disease free after 5 years of an AI or tamoxifen followed by an AI, were randomly assigned to 5 years of letrozole or placebo. Primary endpoint was DFS, defined as time from random assignment to breast cancer recurrence, second primary malignancy, or death. All statistical tests are 2-sided. RESULTS Between September 2006 and January 2010, 3966 patients were randomly assigned (letrozole: 1983; placebo: 1983). Median follow-up time for 3923 patients included in efficacy analyses was 10.3 years. There was statistically significant improvement in DFS in favor of letrozole compared with placebo (hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.74 to 0.96; P = .01; 10-year DFS: placebo = 72.6%, letrozole = 75.9%, absolute difference = 3.3%). There was no difference in the effect of letrozole on overall survival (HR = 0.97, 95% CI = 0.82 to 1.15; P = .74). Letrozole statistically significantly reduced breast cancer-free interval events (HR = 0.75, 95% CI = 0.62 to 0.91; P = .003; absolute difference in cumulative incidence = 2.7%) and distant recurrences (HR = 0.72, 95% CI = 0.55 to 0.92; P = .01; absolute difference = 1.8%). The rates of osteoporotic fractures and arterial thrombotic events did not differ between treatment groups. CONCLUSIONS The beneficial effect of ELT on DFS persisted at 10 years. Letrozole also improved breast cancer-free interval and distant recurrences without improving overall survival. Careful assessment of potential risks and benefits is necessary for selecting appropriate candidates for ELT.
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Affiliation(s)
| | - Hanna Bandos
- NRG Oncology SDMC, and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Priya Rastogi
- University of Pittsburgh Medical Center Hillman Cancer Center, Department of Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Oncology, University of Pittsburgh Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Barry C Lembersky
- University of Pittsburgh Medical Center Hillman Cancer Center, Department of Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jong-Hyeon Jeong
- NRG Oncology SDMC, and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles E Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center, Department of Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Louis Fehrenbacher
- Department of Medical Oncology, Kaiser Permanente Oncology Clinical Trials Northern California, Novato, CA, USA
| | - Stephen K Chia
- Department of Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Adam M Brufsky
- Department of Oncology, University of Pittsburgh Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Janice M Walshe
- Department of Oncology, Cancer Trials Ireland (formerly known as Irish Clinical Oncology Research Group—ICORG), Dublin, Ireland
| | - Gamini S Soori
- Department of Oncology, Florida Cancer Specialists, Fort Myers, FL, USA
| | - Shaker R Dakhil
- Department of Oncology, Community Clinical Oncology Program, Wichita via Christi Regional Medical Center, Wichita, KS, USA
| | - James L Wade
- Department of Oncology, Decatur Memorial Hospital, Cancer Care Specialists of Illinois, Heartland National Cancer Institute Community Oncology Research Program, Decatur, IL, USA
| | - Edward C McCarron
- Department of Surgical Oncology, MedStar Franklin Square Medical Center at Weinberg Cancer Institute, Baltimore, MD, USA
| | - Sandra M Swain
- Department of Surgical Oncology, Georgetown Lombardi Comprehensive Cancer Center, MedStar Health, Washington, DC, USA
| | - Norman Wolmark
- NRG Oncology SDMC, and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
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Slingluff CL, Lewis KD, Andtbacka R, Hyngstrom J, Milhem M, Markovic SN, Bowles T, Hamid O, Hernandez-Aya L, Claveau J, Jang S, Philips P, Holtan SG, Shaheen MF, Curti B, Schmidt W, Butler MO, Paramo J, Lutzky J, Padmanabhan A, Thomas S, Milton D, Pecora A, Sato T, Hsueh E, Badarinath S, Keech J, Kalmadi S, Kumar P, Weber R, Levine E, Berger A, Bar A, Beck JT, Travers JB, Mihalcioiu C, Gastman B, Beitsch P, Rapisuwon S, Glaspy J, McCarron EC, Gupta V, Behl D, Blumenstein B, Peterkin JJ. Multicenter, double-blind, placebo-controlled trial of seviprotimut-L polyvalent melanoma vaccine in patients with post-resection melanoma at high risk of recurrence. J Immunother Cancer 2021; 9:jitc-2021-003272. [PMID: 34599031 PMCID: PMC8488725 DOI: 10.1136/jitc-2021-003272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Most patients with advanced melanomas relapse after checkpoint blockade therapy. Thus, immunotherapies are needed that can be applied safely early, in the adjuvant setting. Seviprotimut-L is a vaccine containing human melanoma antigens, plus alum. To assess the efficacy of seviprotimut-L, the Melanoma Antigen Vaccine Immunotherapy Study (MAVIS) was initiated as a three-part multicenter, double-blind, placebo-controlled phase III trial. Results from part B1 are reported here. METHODS Patients with AJCC V.7 stage IIB-III cutaneous melanoma after resection were randomized 2:1, with stage stratification (IIB/C, IIIA, IIIB/C), to seviprotimut-L 40 mcg or placebo. Recurrence-free survival (RFS) was the primary endpoint. For an hypothesized HR of 0.625, one-sided alpha of 0.10, and power 80%, target enrollment was 325 patients. RESULTS For randomized patients (n=347), arms were well-balanced, and treatment-emergent adverse events were similar for seviprotimut-L and placebo. For the primary intent-to-treat endpoint of RFS, the estimated HR was 0.881 (95% CI: 0.629 to 1.233), with stratified logrank p=0.46. However, estimated HRs were not uniform over the stage randomized strata, with HRs (95% CIs) for stages IIB/IIC, IIIA, IIIB/IIIC of 0.67 (95% CI: 0.37 to 1.19), 0.72 (95% CI: 0.35 to 1.50), and 1.19 (95% CI: 0.72 to 1.97), respectively. In the stage IIB/IIC stratum, the effect on RFS was greatest for patients <60 years old (HR=0.324 (95% CI: 0.121 to 0.864)) and those with ulcerated primary melanomas (HR=0.493 (95% CI: 0.255 to 0.952)). CONCLUSIONS Seviprotimut-L is very well tolerated. Exploratory efficacy model estimation supports further study in stage IIB/IIC patients, especially younger patients and those with ulcerated melanomas. TRIAL REGISTRATION NUMBER NCT01546571.
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Affiliation(s)
- Craig L Slingluff
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Karl D Lewis
- University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert Andtbacka
- Huntsman Cancer Institute Cancer Hospital, Salt Lake City, Utah, USA
| | - John Hyngstrom
- Huntsman Cancer Institute Cancer Hospital, Salt Lake City, Utah, USA
| | - Mohammed Milhem
- The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Omid Hamid
- Cedars-Sinai Medical Center Angeles Clinic and Research Institute, Santa Monica, California, USA
| | - Leonel Hernandez-Aya
- Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Joel Claveau
- CHU de Quebec-Universite Laval, Quebec, Québec, Canada
| | - Sekwon Jang
- Department of Medical Oncology, Inova Health System, Falls Church, Virginia, USA
| | | | - Shernan G Holtan
- University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA
| | - Montaser F Shaheen
- University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Brendan Curti
- Earle A Chiles Research Institute, Providence Portland Medical Center, Portland, Oregon, USA
| | | | - Marcus O Butler
- Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Juan Paramo
- Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Jose Lutzky
- Department of Oncology, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | | | - Sajeve Thomas
- MD Anderson Cancer Center Orlando, Orlando, Florida, USA
| | - Daniel Milton
- Investigative Clinical Research of Indiana, Indianapolis, Indiana, USA
| | - Andrew Pecora
- Department of Oncology, John Theurer Cancer Center, Hackensack, New Jersey, USA
| | - Takami Sato
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eddy Hsueh
- St. Louis University Hospital, St. Louis, Missouri, USA
| | | | - John Keech
- Multicare Institute for Research and Innovation, Tacoma, Washington, USA
| | - Sujith Kalmadi
- Ironwood Cancer and Research Centers, Chandler, Arizona, USA
| | - Pallavi Kumar
- Harry and Jeanette Weinberg Cancer Institute at Franklin Square, Baltimore, Maryland, USA
| | - Robert Weber
- St. Mary's Hospital and Medical Center, San Francisco, California, USA
| | - Edward Levine
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Berger
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Anna Bar
- Oregon Health & Science University, Portland, Oregon, USA
| | - J Thaddeus Beck
- Department of Medical Oncology, Highlands Oncology Group, Fayetteville, Arkansas, USA
| | | | | | - Brian Gastman
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Suthee Rapisuwon
- Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia, USA,Department of Hematology/Oncology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - John Glaspy
- University of California Los Angeles, Los Angeles, California, USA
| | | | - Vinay Gupta
- MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| | - Deepti Behl
- Sutter Institute for Medical Research, Sacramento, California, USA
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Shoucair S, Blitzer D, Kumar Gupta V, McCarron EC. Hospital Readmissions and Infectious Complications Post Pancreaticoduodenectomy: An Analysis of 3,935 Patients from the American College of Surgeons NSQIP Database. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.521] [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]
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Mamounas EP, Bandos H, Lembersky BC, Jeong JH, Geyer CE, Rastogi P, Fehrenbacher L, Graham ML, Chia SK, Brufsky AM, Walshe JM, Soori GS, Dakhil SR, Seay TE, Wade JL, McCarron EC, Paik S, Swain SM, Wickerham DL, Wolmark N. Use of letrozole after aromatase inhibitor-based therapy in postmenopausal breast cancer (NRG Oncology/NSABP B-42): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2018; 20:88-99. [PMID: 30509771 DOI: 10.1016/s1470-2045(18)30621-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The optimal duration of extended therapy with aromatase inhibitors in patients with postmenopausal breast cancer is unknown. In the NSABP B-42 study, we aimed to determine whether extended letrozole treatment improves disease-free survival after 5 years of aromatase inhibitor-based therapy in women with postmenopausal breast cancer. METHODS This randomised, double-blind, placebo-controlled, phase 3 trial was done in 158 centres in the USA, Canada, and Ireland. Postmenopausal women with stage I-IIIA hormone receptor-positive breast cancer, who were disease-free after about 5 years of treatment with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor, were randomly assigned (1:1) to receive 5 years of letrozole (2·5 mg orally per day) or placebo. Randomisation was stratified by pathological node status, previous tamoxifen use, and lowest bone mineral density T score in the lumbosacral spine, total hip, or femoral neck. The primary endpoint was disease-free survival, defined as time from randomisation to breast cancer recurrence, second primary malignancy, or death, and was analysed by intention to treat. To adjust for previous interim analyses, the two-sided statistical significance level for disease-free survival was set at 0·0418. This study is registered with ClinicalTrials.gov, number NCT00382070, is active, and is no longer enrolling patients. FINDINGS Between Sept 28, 2006, and Jan 6, 2010, 3966 patients were randomly assigned to receive letrozole (n=1983) or placebo (n=1983). Follow-up information was available for 3903 patients for the analyses of disease-free survival. Median follow-up was 6·9 years (IQR 6·1-7·5). Letrozole treatment did not significantly improve disease-free survival (339 disease-free survival events were reported in the placebo group and 292 disease-free survival events were reported in the letrozole group; hazard ratio 0·85, 95% CI 0·73-0·999; p=0·048). 7-year disease-free survival estimate was 81·3% (95% CI 79·3-83·1) in the placebo group and 84·7% (82·9-86·4) in the letrozole group. The most common grade 3 adverse events were arthralgia (47 [2%] of 1933 patients in the placebo group vs 50 [3%] of 1941 patients in the letrozole group) and back pain (44 [2%] vs 38 [2%]). The most common grade 4 adverse event in the placebo group was thromboembolic event (eight [<1%]) and the most common grade 4 adverse events in the letrozole group were urinary tract infection, hypokalaemia, and left ventricular systolic dysfunction (four [<1%] each). INTERPRETATION After 5 years of aromatase inhibitor-based therapy, 5 years of letrozole therapy did not significantly prolong disease-free survival compared with placebo. Careful assessment of potential risks and benefits is required before recommending extended letrozole therapy to patients with early-stage breast cancer. FUNDING National Cancer Institute, Korea Health Technology R&D Project, Novartis.
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Affiliation(s)
- Eleftherios P Mamounas
- NRG Oncology/NSABP, Pittsburgh, PA, USA; UF Health Cancer Center at Orlando Health, Orlando, FL, USA.
| | - Hanna Bandos
- NRG Oncology/NSABP, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Barry C Lembersky
- NRG Oncology/NSABP, Pittsburgh, PA, USA; The University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jong-Hyeon Jeong
- NRG Oncology/NSABP, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles E Geyer
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Priya Rastogi
- NRG Oncology/NSABP, Pittsburgh, PA, USA; The University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Louis Fehrenbacher
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA, USA
| | - Mark L Graham
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Southeast Cancer Control Consortium, Goldsboro, NC, USA
| | - Stephen K Chia
- NRG Oncology/NSABP, Pittsburgh, PA, USA; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Adam M Brufsky
- NRG Oncology/NSABP, Pittsburgh, PA, USA; The University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Janice M Walshe
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Cancer Trials Ireland (formerly known as Irish Clinical Oncology Research Group-ICORG), Dublin, Ireland
| | - Gamini S Soori
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Cancer Alliance of Nebraska(Missouri Valley Cancer Consortium), Omaha, NE, USA
| | - Shaker R Dakhil
- NRG Oncology/NSABP, Pittsburgh, PA, USA; CCCOP, Wichita Cancer Center of Kansas, Wichita, KS, USA
| | - Thomas E Seay
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Georgia NCI Community Oncology Research Program, Atlanta, GA, USA
| | - James L Wade
- NRG Oncology/NSABP, Pittsburgh, PA, USA; CCOP, Central Illinois, Decatur, IL, USA
| | - Edward C McCarron
- NRG Oncology/NSABP, Pittsburgh, PA, USA; MedStar Franklin Square Medical Center/Weinberg Cancer Institute, Baltimore, MD, USA
| | - Soonmyung Paik
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Yonsei University College of Medicine, Seoul, South Korea
| | - Sandra M Swain
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - D Lawrence Wickerham
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Norman Wolmark
- NRG Oncology/NSABP, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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6
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Bandos H, Melnikow J, Rivera DR, Swain SM, Sturtz K, Fehrenbacher L, Wade JL, Brufsky AM, Julian TB, Margolese RG, McCarron EC, Ganz PA. Long-term Peripheral Neuropathy in Breast Cancer Patients Treated With Adjuvant Chemotherapy: NRG Oncology/NSABP B-30. J Natl Cancer Inst 2018; 110:4093779. [PMID: 28954297 PMCID: PMC5825682 DOI: 10.1093/jnci/djx162] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/02/2017] [Accepted: 07/07/2017] [Indexed: 01/10/2023] Open
Abstract
Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (AC→T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The AC→T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with AC→T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95% CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (Ptrend < .001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.
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Affiliation(s)
- Hanna Bandos
- NRG Oncology and The University of Pittsburgh, Pittsburgh, PA
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California
Davis, Sacramento, CA
| | - Donna R. Rivera
- Division of Cancer Control and Population Sciences, National Cancer
Institute, Rockville, MD
| | - Sandra M. Swain
- NRG Oncology and The Washington Cancer Institute at Washington Hospital
Center, Washington, DC and current: Georgetown University, Washington, DC
| | - Keren Sturtz
- NRG Oncology and The Colorado Cancer Research Program, Denver, CO
| | | | - James L. Wade
- NRG Oncology and The Central Illinois CCOP Heartland NCORP, Decatur,
IL
| | - Adam M. Brufsky
- NRG Oncology and The University of Pittsburgh/Magee Womens Hospital,
Pittsburgh, PA
| | | | - Richard G. Margolese
- NRG Oncology and The Jewish General Hospital, McGill University,
Montréal, QC, Canada
| | - Edward C. McCarron
- NRG Oncology and The MedStar Franklin Square Medical Center/Harry and
Jeanette Weinberg Cancer Institute, Baltimore, MD
| | - Patricia A. Ganz
- NRG Oncology and The University of California Los Angeles, Schools of
Medicine and Public Health, Los Angeles, CA
- Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA
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7
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AbdusSamad M, Gaur A, Simbulan-Rosenthal CM, McCarron EC, Rosenthal DS. Abstract 2501: Combination therapy with mebendazole, trametinib and metformin eliminates recalcitrant NRASQ61K melanoma cells. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2501] [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
Melanoma is an aggressive and lethal form of cancer with increasing incidence worldwide. In recent years, the FDA approved several promising treatments for malignant melanoma. However, treatment often fails due to the survival and regrowth of drug-resistant cells. Studies by our lab and others suggest that Melanoma Initiating Cells (MIC), a CD133+ population that forms xenograft tumors, may represent an intermediate stage in the acquisition of stable drug resistance. This study aims to determine the effect of CD133-expression and drug resistance in metastatic melanoma cells harboring difficult-to-treat mutation signatures by focusing on the two main downstream cascades of MAPK and PI3K/AKT/mTOR. Our results show that triple combination therapy using mebendazole (repurposed anthelmintic BRAF inhibitor), trametinib (MEK inhibitor) and metformin (repurposed anti-diabetic mTOR inhibitor) synergistically reduces cell viability of NRASQ61K melanoma cells when compared with mebendazole, trametinib or metformin alone. Further, the surviving fraction from each monotherapy is highly enriched for CD133+ cells. Thus, the multi-kinase inhibitor trametinib, along with repurposed anthelmintic and anti-diabetic drugs may inhibit MAPK and PI3K/AKT/mTOR pathways, which could potentially be an effective therapy for the resistant subpopulation of melanoma initiating cells.
Citation Format: Maryam AbdusSamad, Anirudh Gaur, Cynthia M. Simbulan-Rosenthal, Edward C. McCarron, Dean S. Rosenthal. Combination therapy with mebendazole, trametinib and metformin eliminates recalcitrant NRASQ61K melanoma cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2501.
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Affiliation(s)
- Maryam AbdusSamad
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Anirudh Gaur
- 2Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC
| | - Cynthia M. Simbulan-Rosenthal
- 2Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC
| | - Edward C. McCarron
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Dean S. Rosenthal
- 2Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC
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AbdusSamad M, Gaur A, Zhou H, Zapas JL, Simbulan-Rosenthal CM, McCarron EC, Rosenthal DS. Abstract 4224: CD133 knockdown sensitizes melanoma to kinase inhibitors. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4224] [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
Melanoma is an aggressive and lethal form of cancer, responsible for 9,710 deaths in the US every year, as indicated by the Surveillance Epidemiology and End Results (SEER) program. Although early stages are surgically treatable, the advanced or metastatic stages are the most fatal, presumably due to resistance to chemotherapy, radiation or other therapies. Refractoriness of metastatic melanoma is due to self-renewal properties of a subpopulation of resistant cells, which may be the same as what have been termed “melanoma initiating cells” (MIC), many of which have been associated with the expression CD133. CD133 (PROM-1) is a 5-transmembrane-glycoprotein that is a cell surface marker for different cancers including late-stage cutaneous melanoma. By magnetic activated cell sorting, we isolated a CD133-positive population derived from a patient harboring a difficult-to-treat NRASQ61R/BRAFWT profile. The MIC were transfected with CD133-specific small-interfering RNA (siRNAs) to deplete CD133 protein levels in cells. Our results show that knocking down CD133 in NRASQ61R/BRAFWT mutant melanoma renders cells more sensitive to clinically employed-MEK/BRAF inhibitors. Thus, specific gene knockdown or small molecule targeting, along with the multikinase inhibitors, may be a high potency therapeutic of late-stage and recurrent melanoma. Analyses of patient-derived melanomas harboring different mutation signatures are currently in progress to determine if CD133 and MIC play broader roles in melanoma chemoresistance.
Citation Format: Maryam AbdusSamad, Anirudh Gaur, Hengbo Zhou, John L. Zapas, Cynthia M. Simbulan-Rosenthal, Edward C. McCarron, Dean S. Rosenthal. CD133 knockdown sensitizes melanoma to kinase inhibitors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4224. doi:10.1158/1538-7445.AM2015-4224
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Affiliation(s)
- Maryam AbdusSamad
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Anirudh Gaur
- 2Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Hengbo Zhou
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | - John L. Zapas
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | | | - Edward C. McCarron
- 1Division of Surgical Oncology, The Harry and Jeanette Weinberg Cancer Institute, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Dean S. Rosenthal
- 2Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
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9
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Sharma BK, Manglik V, O'Connell M, Weeraratna A, McCarron EC, Broussard JN, Divito KA, Simbulan-Rosenthal CM, Rosenthal DS, Zapas JL. Clonal dominance of CD133+ subset population as risk factor in tumor progression and disease recurrence of human cutaneous melanoma. Int J Oncol 2012; 41:1570-6. [PMID: 22922842 PMCID: PMC3583984 DOI: 10.3892/ijo.2012.1590] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 05/22/2012] [Indexed: 11/06/2022] Open
Abstract
Chemotherapeutic refractoriness of advanced cutaneous melanoma may be linked with melanoma-initiating cells, also known as melanoma stem cells. This study aimed to determine relative risk of clonal dominance of the CD133+ phenotype in tissues from melanoma patients with different clinical outcomes that could be applied to early diagnosis, prognosis or disease monitoring. Significant overexpression of CD133 (p<0.02) was observed by immunohistochemical staining in tissues from patients with recurrent disease versus those without disease recurrence. Relative risk analysis between these two groups suggested that the patients with recurrence or metastatic lesion had a greater than 2-fold overexpression of CD133. In addition, immunodetectable CD133 corroborated with upregulation of CD133 RNA levels (14- to 30-fold) as assessed by quantitative real-time reverse transcription-PCR (qRT-PCR) comparison of melanoma cell lines derived from patients with poor clinical outcomes and short overall survival (<10 months), vs. those derived from patients with good clinical outcomes and longer overall survival (>24 months). Further, cells derived from patients, and MACS-sorted according to their CD133 status retained their CD133-positivity (>95%) or CD133-negativity (>95%) for more than 8 passages in culture. CD133+ cells could repopulate and form tumors (p<0.03) in athymic NCr-nu/nu mice within 8 weeks while no tumors were observed with CD133− phenotype (up to 200,000 cells). Taken together, the study demonstrates, for the first time, that there exists a clonal dominance of a CD133+ population within the hierarchy of cells in cutaneous tissues from patients that have undergone successive progressive stages of melanoma, from primary to metastatic lesions. CD133, thus, provides a predictive marker of disease as well as a potential therapeutic target of high-risk melanoma.
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Affiliation(s)
- Bhuvnesh K Sharma
- Department of Surgical Oncology, The Maryland Melanoma Center, The Harry and Jeanette Weinberg Cancer Institute, Baltimore, MD, USA.
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10
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Elias EG, Zapas JL, McCarron EC, Beam SL, Hasskamp JH, Culpepper WJ. Sequential administration of GM-CSF (Sargramostim) and IL-2 +/- autologous vaccine as adjuvant therapy in cutaneous melanoma: an interim report of a phase II clinical trial. Cancer Biother Radiopharm 2008; 23:285-91. [PMID: 18593361 DOI: 10.1089/cbr.2007.0438] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-2 (IL-2) are 2 cytokines with distinct mechanisms of action that complement one another in the adjuvant management of melanoma. Forty-five patients with high-risk melanoma were enrolled in an open-label, single-arm, phase II clinical trial to examine the safety, tolerability, and effectiveness of this combination. After potentially curative surgery, each patient received 12 months of GM-CSF 125 microg/m2/d subcutaneously (SC) for 14 days followed by IL-2, 9 million IU/m2/d SC for 4 days (given every other cycle from months 7-12), followed by 10 days of no treatment. In addition, patients who had tumors yielding an adequate number of live cells received autologous melanoma vaccines. For months 13-24, patients received only GM-CSF 250 microg/m2 twice weekly. This is an interim analysis based on the 45 enrolled patients with a median of 15.9 months follow-up (range, 1-50 months). Thirty-two patients are alive: 9 of 13 with stage IV resected melanoma, 16 of 25 with stage III disease, and 7 of 7 with stage II disease. Twelve died of the disease, and one due to stroke. Adjuvant use of sequential GM-CSF and IL-2 +/- autologous vaccine was well tolerated with good patient compliance and seemed to benefit high-risk patients with surgically resected melanoma.
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Affiliation(s)
- E George Elias
- The Maryland Melanoma Center at the Weinberg Cancer Institute, Franklin Square Hospital Center, Baltimore, MD 21237, USA.
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11
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Agrawal S, McCarron EC, Gibbs JF, Nava HR, Wilding GE, Rajput A. Surgical management and outcome in primary adenocarcinoma of the small bowel. Ann Surg Oncol 2007; 14:2263-9. [PMID: 17549572 DOI: 10.1245/s10434-007-9428-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 03/27/2007] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary adenocarcinoma of the small bowel is a rare malignancy and is associated with poor survival outcome. Patient, tumor and treatment-related factors were analyzed for their association with recurrence and survival. METHODS Between 1971 and 2005, 64 patients with primary adenocarcinoma of the small bowel were treated at our institution. Clinico-pathologic data, operative details, postoperative treatment, recurrence pattern and survival were reviewed. RESULTS The most common clinical features at presentation included abdominal pain (n = 33; 51.6%) or bowel obstruction (n = 20; 31.3%). The most frequently involved portion of the small bowel was the duodenum (n = 41; 64%). A segmental bowel resection was performed in 30 patients and pancreaticoduodenectomy in 14 patients. Postoperative mortality and morbidity rates were 3.6% (n = 2) and 14.5% (n = 8), respectively. Of the 55 patients who underwent operative intervention, a curative resection was performed in 30 (54.5%). The most common sites of recurrence following a curative resection were the liver and lung. Median survival for all 64 patients was 18 months with a 5-year survival of 21.1%. On multivariate analysis, absence of distant metastatic disease (5-year survival 30.4%), curative resection (5-year survival 44.8%) and pathological T stage 1-3 (5-year survival 39.2%) were identified as independent predictors of survival. CONCLUSIONS A curative resection in the absence of both distant metastases and pathological T4 tumor provides the best survival outcome. Recurrence at distant sites is the predominant pattern of failure following a curative resection, suggesting a role for adjuvant therapy.
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Affiliation(s)
- Shefali Agrawal
- Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Elm and Carlton Streets, Buffalo, New York 14263, USA
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12
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McCarron EC, Fishman EK, Ratner LE. Retroaortic left renal vein. J Am Coll Surg 2000; 191:681. [PMID: 11129819 DOI: 10.1016/s1072-7515(00)00728-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- E C McCarron
- Union Memorial Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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