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Konstantinopoulos PA, Cheng SC, Lee EK, da Costa AABA, Gulhan D, Wahner Hendrickson AE, Kochupurakkal B, Kolin DL, Kohn EC, Liu JF, Penson RT, Stover EH, Curtis J, Sawyer H, Polak M, Chowdhury D, D'Andrea AD, Färkkilä A, Shapiro GI, Matulonis UA. Randomized Phase II Study of Gemcitabine With or Without ATR Inhibitor Berzosertib in Platinum-Resistant Ovarian Cancer: Final Overall Survival and Biomarker Analyses. JCO Precis Oncol 2024; 8:e2300635. [PMID: 38635934 DOI: 10.1200/po.23.00635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/28/2023] [Accepted: 02/29/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE The multicenter, open-label, randomized phase 2 NCI-9944 study (NCT02595892) demonstrated that addition of ATR inhibitor (ATRi) berzosertib to gemcitabine increased progression-free survival (PFS) compared to gemcitabine alone (hazard ratio [HR]=0.57, one-sided log-rank P = .044, which met the one-sided significance level of 0.1 used for sample size calculation). METHODS We report here the final overall survival (OS) analysis and biomarker correlations (ATM expression by immunohistochemistry, mutational signature 3 and a genomic biomarker of replication stress) along with post-hoc exploratory analyses to adjust for crossover from gemcitabine to gemcitabine/berzosertib. RESULTS At the data cutoff of January 27, 2023 (>30 months of additional follow-up from the primary analysis), median OS was 59.4 weeks with gemcitabine/berzosertib versus 43.0 weeks with gemcitabine alone (HR 0.79, 90% CI 0.52 to 1.2, one-sided log-rank P = .18). An OS benefit with addition of berzosertib to gemcitabine was suggested in patients stratified into the platinum-free interval ≤3 months (N = 26) subgroup (HR, 0.48, 90% CI 0.22 to 1.01, one-sided log-rank P =.04) and in patients with ATM-negative/low (N = 24) tumors (HR, 0.50, 90% CI 0.23 to 1.08, one-sided log-rank P = .06). CONCLUSION The results of this follow-up analysis continue to support the promise of combined gemcitabine/ATRi therapy in platinum resistant ovarian cancer, an active area of investigation with several ongoing clinical trials.
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Affiliation(s)
| | - Su-Chun Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alexandre André B A da Costa
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, MA
| | - Doga Gulhan
- Department of Biomedical Informatics and Ludwig Center at Harvard, Harvard Medical School, Boston, MA
| | | | - Bose Kochupurakkal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, MA
| | - David L Kolin
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Joyce F Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Richard T Penson
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Elizabeth H Stover
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer Curtis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hannah Sawyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Madeline Polak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Dipanjan Chowdhury
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alan D D'Andrea
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, MA
| | - Anniina Färkkilä
- Research Program in Systems Oncology, FIMM and HiLife, University of Helsinki, Helsinki, Finland
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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2
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Kamboj M, Bohlke K, Kohn EC. Vaccination of Adults With Cancer: ASCO Guideline Clinical Insights. JCO Oncol Pract 2024:OP2400107. [PMID: 38498798 DOI: 10.1200/op.24.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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3
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Kamboj M, Bohlke K, Baptiste DM, Dunleavy K, Fueger A, Jones L, Kelkar AH, Law LY, LeFebvre KB, Ljungman P, Miller ED, Meyer LA, Moore HN, Soares HP, Taplitz RA, Woldetsadik ES, Kohn EC. Vaccination of Adults With Cancer: ASCO Guideline. J Clin Oncol 2024:JCO2400032. [PMID: 38498792 DOI: 10.1200/jco.24.00032] [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] [Received: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To guide the vaccination of adults with solid tumors or hematologic malignancies. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. RECOMMENDATIONS The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Kieron Dunleavy
- MedStar Georgetown University Hospital, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Abbey Fueger
- The Leukemia and Lymphoma Society, Rye Brook, NY
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | - Amar H Kelkar
- Harvard Medical School, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Per Ljungman
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eric D Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Heloisa P Soares
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | | | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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4
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Lumish MA, Kohn EC, Tew WP. Top advances of the year: Ovarian cancer. Cancer 2024; 130:837-845. [PMID: 38100616 DOI: 10.1002/cncr.35135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Although cure rates remain low and effective screening strategies are elusive, the recent advances in systemic therapies over the past year highlighted in this review have prolonged survival for women with ovarian cancer. In 2022, the first antibody-drug conjugate for platinum-resistant ovarian cancer received accelerated US Food and Drug Administration (FDA) approval. Confirmatory studies examining the efficacy of mirvetuximab and other antibody-drug conjugates are underway. In the upfront setting, the first data establishing an overall survival benefit from poly(ADP-ribose) polymerase inhibitor maintenance was demonstrated after a 7-year follow-up period. In contrast, long-term updates from poly(ADP-ribose) polymerase inhibitor trials in the noncurative setting reported survival detriments, and the FDA withdrew the respective indications. Several trials attempted to improve upon the standard of care for platinum-sensitive ovarian carcinoma and those with rare ovarian cancer histologies (carcinosarcoma, clear cell carcinoma) but failed to demonstrate a clinically or statistically meaningful benefit. This leaves the open question of how to further optimize systemic therapy for advanced ovarian carcinoma to improve long-term survival and cure rates.
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Affiliation(s)
- Melissa A Lumish
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elise C Kohn
- National Cancer Institute, Bethesda, Maryland, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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5
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Singh S, Hope TA, Bergsland EB, Bodei L, Bushnell DL, Chan JA, Chasen BR, Chauhan A, Das S, Dasari A, Del Rivero J, El-Haddad G, Goodman KA, Halperin DM, Lewis MA, Lindwasser OW, Myrehaug S, Raj NP, Reidy-Lagunes DL, Soares HP, Strosberg JR, Kohn EC, Kunz PL. Consensus report of the 2021 National Cancer Institute neuroendocrine tumor clinical trials planning meeting. J Natl Cancer Inst 2023; 115:1001-1010. [PMID: 37255328 PMCID: PMC10483264 DOI: 10.1093/jnci/djad096] [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: 10/24/2022] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023] Open
Abstract
Important progress has been made over the last decade in the classification, imaging, and treatment of neuroendocrine neoplasm (NENs), with several new agents approved for use. Although the treatment options available for patients with well-differentiated neuroendocrine tumors (NETs) have greatly expanded, the rapidly changing landscape has presented several unanswered questions about how best to optimize, sequence, and individualize therapy. Perhaps the most important development over the last decade has been the approval of 177Lu-DOTATATE for treatment of gastroenteropancreatic-NETs, raising questions around optimal sequencing of peptide receptor radionuclide therapy (PRRT) relative to other therapeutic options, the role of re-treatment with PRRT, and whether PRRT can be further optimized through use of dosimetry among other approaches. The NET Task Force of the National Cancer Institute GI Steering Committee convened a clinical trial planning meeting in 2021 with multidisciplinary experts from academia, the federal government, industry, and patient advocates to develop NET clinical trials in the era of PRRT. Key clinical trial recommendations for development included 1) PRRT re-treatment, 2) PRRT and immunotherapy combinations, 3) PRRT and DNA damage repair inhibitor combinations, 4) treatment for liver-dominant disease, 5) treatment for PRRT-resistant disease, and 6) dosimetry-modified PRRT.
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Affiliation(s)
- Simron Singh
- Department of Medicine, Sunnybrook Health Sciences Centre, Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Emily B Bergsland
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Lisa Bodei
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA
| | | | - Jennifer A Chan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Beth R Chasen
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aman Chauhan
- Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Satya Das
- Late-Stage Development, Oncology R&D AstraZeneca, Gaithersburg, MD, USA
| | - Arvind Dasari
- Department of GI Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ghassan El-Haddad
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Daniel M Halperin
- Department of GI Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark A Lewis
- Department of Medicine, Intermountain Health, Salt Lake City, UT, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, Bethesda, MD, USA
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Center, Toronto, ON, Canada
| | - Nitya P Raj
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Heloisa P Soares
- Department of Medicine, Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | | | | | - Pamela L Kunz
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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6
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Chauhan A, Christner SM, Beumer JH, Kunos C, Khurana A, El Khouli R, Weiss H, Yan D, Soares HP, Halfdanarson TR, Li D, Carson WE, Evers MB, Ivy P, Kohn EC, Rubinstein L, Arnold SM, Kolesar J, Anthony LB, Konda B. Pharmacokinetics and RP2D analysis from ETCTN 10388: A phase I trial of triapine and lutetium Lu-177 dotatate in well-differentiated somatostatin receptor–positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.648] [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: 02/25/2023] Open
Abstract
648 Background: Radiation is a potent inducer of DNA double-strand breaks, and ribonucleotide reductase (RNR) is the rate-limiting enzyme for conversion of ribonucleoside diphosphate to deoxyribonucleotide diphosphate, and thus repair of DNA in this setting. ETCTN 10388 evaluated safety of combination Lu-177 DOTATATE, a beta-emitting radionuclide in combination with triapine, a ribonucleotide reductase (RNR) inhibitor. Methods: This investigator initiated, NCI sponsored, multicenter phase 1 trial, enrolled a total of 31 patients in the dose escalation [using the Bayesian optimal interval design (BOIN)] and dose expansion cohorts. Oral triapine was administered on days 1-14 and Lu-177 DOTATATE [200 mCi] intravenously on day 1 of every 56-day cycle. A total of 4 cycles were administered. All enrolled patients had blood samples collected for triapine pharmacokinetic (PK) analysis in EDTA tubes prior to and at 0.5, 1, 1.5, 2, 3, 4, 6, and 8 h after oral administration during cycle 1. Results: Five patients were enrolled in triapine Dose Level 1 (100 mg/day), twenty-five to dose level two (150 mg/day), and one patient to dose level three (200 mg/day). PK data were available for 12 patients enrolled in the dose escalation cohort. The geometric mean (SD) AUC0-inf was 1159 (1.22) µg/L•h for the 100mg dose level and 1862 (1.76) µg/L•h for the 150 mg dose level, suggesting that exposure increased with dose, and inter-patient variability was as expected for an oral agent. Triapine PK parameter values observed in this trial, were comparable to previous reports that used a previous formulation [ 1 ]. While exposure was similar, variability appeared smaller with the current oral formulation. Adverse events (AE) were assessed in all 31 patients per CTCAE 5.0. A total of one DLT in dose level 1, seven DLTs (Transient cytopenia; primarily neutropenia and rarely thrombocytopenia) in dose level 2, and one grade 5 DLT (Death probably from progressive cancer and carcinoid heart disease but possibly from trial drugs) in dose level 3 were observed. Detailed AE profile will be presented at the meeting. Conclusions: The RP2D of triapine is 150 mg QD on days 1-14 in combination with Lu-177 DOTATATE on day 1 of every 56-day cycle. Clinical trial information: 04234568 .
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Affiliation(s)
- Aman Chauhan
- UK Markey Cancer Center, University of Kentucky, Lexington, KY
| | | | | | - Charles Kunos
- University of Kentucky, Radiation Oncology, Lexington, KY
| | - Aman Khurana
- University of Kentucky, Department of Radiology, Lexington, KY
| | | | - Heidi Weiss
- University of Kentucky HealthCare, Lexington, KY
| | | | | | | | - Daneng Li
- City of Hope National Comprehensive Cancer Center, Duarte, CA
| | | | | | | | | | - Larry Rubinstein
- National Cancer Institute Division of Cancer Treatment and Diagnosis, Rockville, MD
| | | | - Jill Kolesar
- University of Kentucky, Department of Pharmacology, Lexington, KY
| | | | - Bhavana Konda
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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7
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Chauhan A, Kolesar J, Yan D, Li D, Khurana A, Carson WE, Arnold SM, Gore S, Rubinstein L, Kohn EC, Ivy P, Xiao Y, Dewaraja Y, Soares HP, Beumer JH, Konda B, Sukrithan V, Anthony LB. ETCTN 10450: A phase I trial of peposertib and lutetium 177 DOTATATE in well-differentiated somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps658] [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: 02/25/2023] Open
Abstract
TPS658 Background: Radiolabeled somatostatin analogues provide a means of delivering targeted radiation with a high therapeutic index to NETs that express somatostatin receptors (SSTRs). Radiolabeled somatostatin analogue Lutetium 177 DOTATATE (Lutathera) is a beta-emitting radionuclide, FDA approved for use in SSTR positive gastroenteropancreatic neuroendocrine tumors (GEPNETS) in the US based on the NETTER-1 Phase III trial. Despite favorable PFS and safety profile, the drug has limited cytoreductive capability with a 17% ORR. Peptide receptor radionuclide therapy (PRRT) also doesn’t seem to be very effective in treating peritoneal disease. We hypothesize that addition of an effective radiation sensitizer could help improve antitumor activity of Lutathera. Radiation is a potent inducer of DNA double-strand break (DSB); targeting signaling networks involved in DSB repair is a promising approach for enhancing cellular radiosensitivity. The primary repair mechanism of radiation-induced DSBs is nonhomologous end-joining (NHEJ) pathway, in which the DNA-PK (Deoxyribonucleic acid protein kinase) complex plays a pivotal role. Upregulation of DNA-PK promotes repair of DSBs leading to tumor radio-resistance preclinically and clinically. Thus, DNA-PK is an important molecular target for inhibiting DSB repair and enhancing the cytotoxicity of radiation. Peposertib is a selective inhibitor of DNA-PK that targets tumor cell DNA damage repair and survival by blocking NHEJ. We previously reported strong anti-tumor activity when Peposertib was used as radiation sensitizer in pre-clinical NET models. Methods: This study is an investigator initiated, NCI sponsored, multicenter phase 1 trial of peposertib and Lutetium Lu 177 DOTATATE in well-differentiated somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumor (GEP-NETs) after the failure of at least one line of prior systemic cancer treatment. A total of 29 patients will be enrolled in the dose escalation with help of Bayesian optimal interval design (BOIN) and dose expansion cohorts. The study will be open through the NCI ETCTN (National Cancer Institute Experimental Therapeutics Clinical Trials Network) program. Patients will be treated with 177 lutetium dotatate in combination with peposertib. Peposertib will be administered orally from D1-21 with each dose of PRRT [200 mCi]. Primary endpoint is to evaluate recommended phase II dose (RP2D). Secondary endpoints are to evaluate safety, pharmacokinetics, and clinical activity (ORR and PFS). We are also evaluating Lu-177 DOTATATE dosimetry in collaboration with NIH IROC and plasma hPG80, a novel blood based diagnostic biomarker. In addition, the study will correlate clinical outcome with somatic tumor mutations and germline mutations. Clinical trial information: 04750954 .
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Affiliation(s)
- Aman Chauhan
- University of Kentucky Department of Medicine, Lexington, KY
| | - Jill Kolesar
- University of Kentucky, Department of Pharmacology, Lexington, KY
| | | | - Daneng Li
- City of Hope National Comprehensive Cancer Center, Duarte, CA
| | - Aman Khurana
- University of Kentucky, Department of Radiology, Lexington, KY
| | | | | | | | - Larry Rubinstein
- National Cancer Institute Division of Cancer Treatment and Diagnosis, Rockville, MD
| | | | | | - Ying Xiao
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | | | | | | | - Bhavana Konda
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Tew WP, Lacchetti C, Kohn EC. Poly(ADP-Ribose) Polymerase Inhibitors in the Management of Ovarian Cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2022; 40:3878-3881. [PMID: 36150092 DOI: 10.1200/jco.22.01934] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options.
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Affiliation(s)
- William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Ethier JL, Fuh KC, Arend R, Konecny GE, Konstantinopoulos PA, Odunsi K, Swisher EM, Kohn EC, Zamarin D. State of the Biomarker Science in Ovarian Cancer: A National Cancer Institute Clinical Trials Planning Meeting Report. JCO Precis Oncol 2022; 6:e2200355. [PMID: 36240472 PMCID: PMC9848534 DOI: 10.1200/po.22.00355] [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: 06/29/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Despite therapeutic advances in the treatment of ovarian cancer (OC), 5-year survival remains low, and patients eventually die from recurrent, chemotherapy-resistant disease. The National Cancer Gynecologic Cancer Steering Committee identified the integration of scientifically defined subgroups as a top strategic priority in clinical trial planning. METHODS A group of experts was convened to review the scientific literature in OC to identify validated predictive biomarkers that could inform patient selection and treatment stratification. Here, we report on these findings and their potential for use in future clinical trial design on the basis of hierarchal evidence grading. RESULTS The biomarkers were classified on the basis of mechanistic targeting, including DNA repair and replication stress, immunotherapy and tumor microenvironment, oncogenic signaling, and angiogenesis. Currently, BRCA mutations and homologous recombination deficiency to predict poly (ADP-ribose) polymerase inhibitor response are supported in OC by the highest level of evidence. Additional biomarkers of response to agents targeting the pathways above have been identified but require prospective validation. CONCLUSION Although a number of biomarkers of response to various agents in OC have been described in the literature, high-level evidence for the majority is lacking. This report highlights the unmet need for identification and validation of predictive biomarkers to guide therapy and future trial design in OC.
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Affiliation(s)
- Josee-Lyne Ethier
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Katherine C. Fuh
- Division of Gynecologic Oncology, Washington University St Louis, St Louis, MO
| | - Rebecca Arend
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingam, AL
| | - Gottfried E. Konecny
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Kunle Odunsi
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | | | - Elise C. Kohn
- Clinical Investigations Branch of The Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, ML
| | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Vergote I, Gonzalez-Martin A, Lorusso D, Gourley C, Mirza MR, Kurtz JE, Okamoto A, Moore K, Kridelka F, McNeish I, Reuss A, Votan B, du Bois A, Mahner S, Ray-Coquard I, Kohn EC, Berek JS, Tan DSP, Colombo N, Zang R, Concin N, O'Donnell D, Rauh-Hain A, Herrington CS, Marth C, Poveda A, Fujiwara K, Stuart GCE, Oza AM, Bookman MA, Mahner S, Reuss A, du Bois A, Grimm C, Marth C, Berger R, Concin N, Chang TC, Ochiai K, Gebski V, Davis A, Beale P, Vergote I, Kridelka F, Denys H, Vandecaveye V, Cancido dos Reis FJ, Del Pilar Estevez Diz M, Stuart G, MacKay H, Carey M, Cibula D, Dundr (path) P, Dorigo O, Berek J, O'Donnell D, Saadeh A, Boere I, Lok C, Coronado P, Ottevanger N, Tan DSP, Ng J, Gonzalez Martin A, Oaknin A, Poveda A, Perez Fidalgo A, Rauh-Hain A, Lu K, López-Zavala C, Gómez-García EM, Ray-Coquard I, Paoletti X, Kurtz JE, Joly F, Votan B, Bookman M, Moore K, Arend R, Fujiwara K, Fujiwara H, Hasegawa K, Bruchim I, Tsoref D, Oda K, Okamoto A, Enomoto T, Michel D, Kim HS, Lee JY, Mukhopadhyay A, Katsaros D, Colombo N, Pignata S, Lorusso D, Scambia G, Kohn E, Lee JM, McNeish I, Nicum S, Farrelly L, Sehouli J, Keller M, Braicu E, Bjørge L, Mirza MR, Auranen A, Welch S, Oza AM, Heinzelmann V, Gourley C, Roxburgh P, Herrington CS, Glasspool R, Zang R, Zhu J. Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup. Lancet Oncol 2022; 23:e374-e384. [PMID: 35901833 PMCID: PMC9465953 DOI: 10.1016/s1470-2045(22)00139-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/13/2022]
Abstract
The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.
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11
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Mishkin GE, Kohn EC. Biomarker development: bedside to bench. Clin Cancer Res 2022; 28:2722-2724. [PMID: 35481871 DOI: 10.1158/1078-0432.ccr-22-0750] [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] [Received: 03/17/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
This commentary complements the report from Nixon and colleagues by addressing the critical definitions, assay and analytical quality control and interpretation, and resources available to advance similar fit-for-purpose biomarker development.
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Affiliation(s)
| | - Elise C Kohn
- National Cancer Institute, Rockville, MD, United States
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12
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Liu JF, Brady MF, Matulonis UA, Miller A, Kohn EC, Swisher EM, Cella D, Tew WP, Cloven NG, Muller CY, Bender DP, Moore RG, Michelin DP, Waggoner SE, Geller MA, Fujiwara K, D'Andre SD, Carney M, Alvarez Secord A, Moxley KM, Bookman MA. Olaparib With or Without Cediranib Versus Platinum-Based Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer (NRG-GY004): A Randomized, Open-Label, Phase III Trial. J Clin Oncol 2022; 40:2138-2147. [PMID: 35290101 DOI: 10.1200/jco.21.02011] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Platinum-based chemotherapy is the standard of care for platinum-sensitive ovarian cancer, but complications from repeated platinum therapy occur. We assessed the activity of two all-oral nonplatinum alternatives, olaparib or olaparib/cediranib, versus platinum-based chemotherapy. PATIENTS AND METHODS NRG-GY004 is an open-label, randomized, phase III trial conducted in the United States and Canada. Eligible patients had high-grade serous or endometrioid platinum-sensitive ovarian cancer. Patients were randomly assigned 1:1:1 to platinum-based chemotherapy, olaparib, or olaparib/cediranib. The primary end point was progression-free survival (PFS) in the intention-to-treat population. Secondary end points included activity within germline BRCA-mutated or wild-type subgroups and patient-reported outcomes (PROs). RESULTS Between February 04, 2016, and November 13, 2017, 565 eligible patients were randomly assigned. Median PFS was 10.3 (95% CI, 8.7 to 11.2), 8.2 (95% CI, 6.6 to 8.7), and 10.4 (95% CI, 8.5 to 12.5) months with chemotherapy, olaparib, and olaparib/cediranib, respectively. Olaparib/cediranib did not improve PFS versus chemotherapy (hazard ratio [HR] 0.86; 95% CI, 0.66 to 1.10; P = .077). In women with germline BRCA mutation, the PFS HR versus chemotherapy was 0.55 (95% CI, 0.32 to 0.94) for olaparib/cediranib and 0.63 (95% CI, 0.37 to 1.07) for olaparib. In women without a germline BRCA mutation, the PFS HR versus chemotherapy was 0.97 (95% CI, 0.73 to 1.30) for olaparib/cediranib and 1.41 (95% CI, 1.07 to 1.86) for olaparib. Hematologic adverse events occurred more commonly with chemotherapy; however, nonhematologic adverse events were higher with olaparib/cediranib. In 489 patients evaluable for PROs, patients receiving olaparib/cediranib scored on average 1.1 points worse on the NFOSI-DRS-P subscale (97.5% CI, -2.0 to -0.2, P = .0063) versus chemotherapy; no difference between olaparib and chemotherapy was observed. CONCLUSION Combination olaparib/cediranib did not improve PFS compared with chemotherapy and resulted in reduced PROs. Notably, in patients with a germline BRCA mutation, both olaparib and olaparib/cediranib had significant clinical activity.
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Affiliation(s)
- Joyce F Liu
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA
| | - Mark F Brady
- NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ursula A Matulonis
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA
| | - Austin Miller
- NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elise C Kohn
- Gynecologic Cancer Therapeutics, National Cancer Institute, Rockville, MD
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Health System, Chicago, IL
| | - William P Tew
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - David P Bender
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Richard G Moore
- Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - David P Michelin
- Gynecologic Oncology, Cancer Research Consortium of West Michigan, Munson Medical Center, Traverse City, MI
| | | | - Melissa A Geller
- Ob/Gyn & Women's Health, University of Minnesota, Minneapolis, MN
| | - Keiichi Fujiwara
- Gynecologic Oncology, Saitama Medical University International Medical Center; Hidaka-Shi, Japan
| | - Stacy D D'Andre
- Executive Chair, Sutter Cancer Research Consortium, Sutter Health Research Enterprise, Sacramento, CA
| | - Michael Carney
- Kapialoni Medical Center for Women & Children, University of Hawaii, Honolulu, HI
| | | | - Katherine M Moxley
- Stephenson Cancer Center Gynecologic Cancers Clinic, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michael A Bookman
- Director, Gynecologic Oncology Therapeutics, Kaiser Permanente Northern California, San Francisco, CA
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13
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Das S, Du L, Lee CL, Arhin ND, Chan JA, Kohn EC, Halperin DM, Berlin J, LaFerriere H, Singh S, Kunz PL, Dasari A. Comparison of Design, Eligibility, and Outcomes of Neuroendocrine Neoplasm Trials Initiated From 2000 to 2009 vs 2010 to 2020. JAMA Netw Open 2021; 4:e2131744. [PMID: 34705010 PMCID: PMC8552059 DOI: 10.1001/jamanetworkopen.2021.31744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Neuroendocrine neoplasms (NENs) have historically been grouped homogenously in clinical trials, despite their heterogeneity. Given the adoption of a more advanced pathologic classification system and drug licensure of several targeted therapies over the last decade, information is needed on whether study characteristics of NEN studies have evolved. Objective To assess changes in study design, eligibility, accrual, sponsorship, and outcomes between phase II or III NEN clinical trials that began enrollment from 2000 to 2009 vs 2010 to 2020. Design, Setting, and Participants This quality improvement study used a systematic survey of completed studies published between January 1, 2000, and December 31, 2020. Therapeutic phase II and III NEN studies were identified through a database search of Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (EBSCOhost), Web of Science (Clarivate), Cochrane Database of Systematic Reviews (Wiley), ClinicalTrials.gov (National Institutes of Health), EU Clinical Trials Register, and National Cancer Institute Clinical Trials. Data were analyzed between March and June 2021. Main Outcomes and Measures Study characteristic proportions between the 2 enrollment periods. Results Of 3243 identified studies, 119 studies met criteria for inclusion, of which 117 studies (54 studies that began enrollment between 2000-2009 and 63 studies that began enrollment between 2010-2020) included exact dates of enrollment and were compared. Studies that began enrollment after 2010, compared with studies that began enrollment from 2000 to 2009, were less likely to include all NENs (13 studies [21%] vs 34 studies [63%]; P < .001) and more likely to include select NENs (eg, gastrointestinal neuroendocrine tumors, 25 studies [40%] vs 11 studies [20%]; P = .02; pancreatic neuroendocrine tumors, 32 studies [51%] vs 16 studies [30%]; P = .02). Studies that began enrollment after 2010, compared with studies that began enrollment from 2000 to 2009, were more likely to specify tumor differentiation (59 studies [98%] vs 34 studies [63%]; P < .001) or Ki-67 index (23 studies [38%] vs 5 studies [9%]; P < .001) in inclusion criteria. Studies that began enrollment after 2010, compared with studies that began enrollment from 2000 to 2009, were more likely to use progression-free survival (22 studies [35%] vs 9 studies [18%]; P = .04) rather than objective response rate (19 studies [30%] vs 27 studies [53%]; P = .01) as a primary or coprimary end point. Conclusions and Relevance These findings suggest that NEN trials enrolling over the last decade were more focused on select tumor populations, compared with studies that began enrollment before 2010. Despite this shift, more than 20% of studies still included all NENs. Studying novel agents in specific disease populations may enhance drug development in the field.
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Affiliation(s)
- Satya Das
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cody L. Lee
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nina D. Arhin
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Daniel M. Halperin
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jordan Berlin
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Simron Singh
- Sunybrook Health Sciences Centre, Toronto, Canada
| | | | - Arvind Dasari
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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14
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Vanderpuye VD, Clemenceau JRV, Temin S, Aziz Z, Burke WM, Cevallos NL, Chuang LT, Colgan TJ, Del Carmen MG, Fujiwara K, Kohn EC, Gonzáles Nogales JE, Konney TO, Mukhopadhyay A, Paudel BD, Tóth I, Wilailak S, Ghebre RG. Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2021; 7:1032-1066. [PMID: 34185571 PMCID: PMC8457806 DOI: 10.1200/go.21.00085] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide expert guidance to clinicians and policymakers in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. METHODS A multidisciplinary, multinational ASCO Expert Panel reviewed existing guidelines, conducted a modified ADAPTE process, and conducted a formal consensus process with additional experts. RESULTS Existing sets of guidelines from eight guideline developers were found and reviewed for resource-constrained settings; adapted recommendations from nine guidelines form the evidence base, informing two rounds of formal consensus; and all recommendations received ≥ 75% agreement. RECOMMENDATIONS Evaluation of adult symptomatic women in all settings includes symptom assessment, family history, and ultrasound and cancer antigen 125 serum tumor marker levels where feasible. In limited and enhanced settings, additional imaging may be requested. Diagnosis, staging, and/or treatment involves surgery. Presurgical workup of every suspected ovarian cancer requires a metastatic workup. Only trained clinicians with logistical support should perform surgical staging; treatment requires histologic confirmation; surgical goal is staging disease and performing complete cytoreduction to no gross residual disease. In first-line therapy, platinum-based chemotherapy is recommended; in advanced stages, patients may receive neoadjuvant chemotherapy. After neoadjuvant chemotherapy, all patients should be evaluated for interval debulking surgery. Targeted therapy is not recommended in basic or limited settings. Specialized interventions are resource-dependent, for example, laparoscopy, fertility-sparing surgery, genetic testing, and targeted therapy. Multidisciplinary cancer care and palliative care should be offered.Additional information can be found at www.asco.org/resource-stratified-guidelines. It is ASCO's view that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | - Zeba Aziz
- Hameed Latif Hospital, Lahore, Pakistan
| | | | | | | | | | | | | | - Elise C Kohn
- Saitama Medical University International Medical Center, Saitama, Japan
| | | | | | - Asima Mukhopadhyay
- Chittaranjan National Cancer Institute, Kolkata, India
- Northern Gynaecological Oncology Centre, Gateshead, Newcastle, United Kingdom
| | | | - Icó Tóth
- Mallow Flower Foundation, Dunaharaszti, Hungary
| | | | - Rahel G Ghebre
- University of Minnesota Medical School, Minneapolis, MN
- St Paul's Hospital Millennium Medical School, Addis Ababa, Ethiopia
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15
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Temkin SM, Chapman E, Kohn EC, Nair N, Blank SV. Minding the gap: Gynecologic oncology practices differ by gender. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11011] [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
11011 Background: Although most gynecologic oncologists (GOs) are now women, gender differences in clinical practice and compensation persist. Practice characteristics and infrastructural support that may influence gender-based differences were explored. Methods: Every 5 years, the Society of Gynecologic Oncology (SGO) conducts a member survey that provides details on member demographics, practice characteristics, activities, and revenue. Between 8/15-9/30/19 SGO members received a direct link to the survey. Gender was self-identified. Differences in responses were evaluated by gender. Results: Of 1425 surveys delivered, 690 were completed (48% response rate). 312 (45%) identified as male; 367 (53%) as female; 1 nonbinary; 1 other; 7 no response. Male GOs were more likely white (75 vs 68%, p=0.048), married (91 vs 81%, p<0.001), heterosexual (94 vs 90%, p=0.045), and hold an academic rank of professor (23 vs 12%, p<0.001). Practice setting and number of partners were similar. Chemotherapy prescribing was more common for females (82 vs 73%, p=0.004), but other clinical activities were similar (Table). Female GOs had lower clinical volumes than males for cervical, ovarian, vaginal/vulvar cancer and benign gynecologic procedures. Females reported fewer medical assistants and transcriptionists supporting their clinical activities. Overall and practice support was higher for male GOs although hospital support was similar for both genders. Female GOs reported more time spent on research (26 vs 19%, p=0.005), but the same research support. Conclusions: Clinical activities, specifically chemotherapy prescribing, and support differ for male and female GOs and may explain gender inequities. Clinical support should be equalized to maximize workplace productivity regardless of gender. Coordination of support between the practice and hospital and standard compensation for chemotherapy prescribing could decrease the large gender wage gap in this specialty.[Table: see text]
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Affiliation(s)
| | | | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Navya Nair
- Icahn School of Medicine at Mount Sinai, Manhattan, NY
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16
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Harkenrider MM, Markham MJ, Dizon DS, Jhingran A, Salani R, Serour RK, Lynn J, Kohn EC. Moving Forward in Cervical Cancer: Enhancing Susceptibility to DNA Repair Inhibition and Damage, an NCI Clinical Trials Planning Meeting Report. J Natl Cancer Inst 2021; 112:1081-1088. [PMID: 32219419 DOI: 10.1093/jnci/djaa041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women worldwide, and prognosis is poor for those who experience recurrence or develop metastatic disease, in part due to the lack of active therapeutic directions. The National Cancer Institute convened a Cervical Cancer Clinical Trials Planning Meeting in October 2018 to facilitate the design of hypothesis-driven clinical trials focusing on locally advanced, metastatic, and recurrent cervical cancer around the theme of enhancing susceptibility to DNA repair inhibition and DNA damage. Before the meeting, a group of experts in the field summarized available preclinical and clinical data to identify potentially active inducers and inhibitors of DNA. The goals of the Clinical Trials Planning Meeting focused on identification of novel experimental strategies capitalizing on DNA damage and repair (DDR) regulators and cell cycle aberrations, optimization of radiotherapy as a DDR agent, and design of clinical trials incorporating DDR regulation into the primary and recurrent or metastatic therapies for cervical carcinoma. Meeting deliverables were novel clinical trial concepts to move into the National Clinical Trials Network. This report provides an overview for the rationale of this meeting and the state of the science related to DDR regulation in cervical cancer.
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Affiliation(s)
- Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Don S Dizon
- Division of Hematology and Oncology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ritu Salani
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Jean Lynn
- Coordinating Center for Clinical Trials, National Cancer Institute, Bethesda, MD, USA
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
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17
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Duska LR, Filiaci VL, Walker JL, Holman LL, Hill EK, Moore RG, Ring KL, Pearl ML, Muller CY, Kushnir CL, Lankes HA, Samuelson MI, Carrick KS, Rajan A, Rodgers WH, Kohn EC, Piekarz R, Leslie KK. A Surgical Window Trial Evaluating Medroxyprogesterone Acetate with or without Entinostat in Patients with Endometrial Cancer and Validation of Biomarkers of Cellular Response. Clin Cancer Res 2021; 27:2734-2741. [PMID: 33766814 DOI: 10.1158/1078-0432.ccr-20-4618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/23/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This surgical window of opportunity (window) study assessed the short-term effect of medroxyprogesterone acetate (MPA) alone versus MPA plus the histone deacetylase (HDAC) inhibitor entinostat on regulation of progesterone receptor (PR) in women with newly diagnosed endometrioid endometrial adenocarcinoma. PATIENTS AND METHODS This multisite, randomized, open-label surgical window study treated women intramuscularly on day 1 with 400 mg MPA. Entinostat given 5 mg by mouth on days 1, 8, and 15 was randomly assigned with equal probability. Surgery followed on days 21-24. Pretreatment and posttreatment tissue was assessed for PR H-scores, Ki-67 levels, and histologic response. RESULTS Fifty patients were accrued in 4 months; 22 and 20 participants had PR evaluable pretreatment and posttreatment slides in the MPA and MPA/entinostat arms, respectively. Median posttreatment PR H-scores were significantly lower than pretreatment H-scores in both arms but did not differ significantly (MPA: 247 vs. 27, MPA/entinostat 260 vs. 23, respectively, P = 0.87). Decreased Ki-67 was shown in 90% treated with MPA/entinostat compared with 68% treated with MPA alone (P = 0.13). Median PR H-score decreases were larger when Ki-67 was decreased (208) versus not decreased (45). The decrease in PR pretreatment versus posttreatment was associated with loss of Ki-67 nuclear staining, consistent with reduced cellular proliferation (P < 0.008). CONCLUSIONS This surgical window trial rapidly accrued in a multisite setting and evaluated PR as its primary endpoint and Ki-67 as secondary endpoint. Despite no immediate effect of entinostat on PR in this short-term study, lessons learned can inform future window and treatment trials.
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Affiliation(s)
- Linda R Duska
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Virginia L Filiaci
- NRG Oncology SDMC, CTD Division, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Laura L Holman
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Emily K Hill
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Richard G Moore
- Department of Obstetrics and Gynecology, Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Kari L Ring
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Michael L Pearl
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Gynecologic Oncology, Stony Brook University Medical Center, Stony Brook, New York
| | - Carolyn Y Muller
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of New Mexico, Albuquerque, New Mexico
| | - Christina L Kushnir
- Department of Obstetrics and Gynecology, Women's Cancer Center, Las Vegas, Nevada
| | - Heather A Lankes
- NRG Oncology, Operations Center-Philadelphia East, Philadelphia, Pennsylvania.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Megan I Samuelson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kelley S Carrick
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anand Rajan
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - William H Rodgers
- Department of Pathology, New York Hospital Queens, Weill Medical College of Cornell University, Flushing, New York
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, NCI, Rockville, Maryland
| | | | - Kimberly K Leslie
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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18
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Wheeler DA, Takebe N, Hinoue T, Hoadley KA, Cardenas MF, Hamilton AM, Laird PW, Wang L, Johnson A, Dewal N, Miller V, Piñeyro D, Castro de Moura M, Esteller M, Shen H, Zenklusen JC, Tarnuzzer R, McShane LM, Tricoli JV, Williams PM, Lubensky I, O'Sullivan-Coyne G, Kohn EC, Little RF, White J, Malik S, Harris L, Weil C, Chen AP, Karlovich C, Rodgers B, Shankar L, Jacobs P, Nolan T, Hu J, Muzny DM, Doddapaneni H, Korchina V, Gastier-Foster J, Bowen J, Leraas K, Edmondson EF, Doroshow JH, Conley BA, Ivy SP, Staudt LM. Molecular Features of Cancers Exhibiting Exceptional Responses to Treatment. Cancer Cell 2021; 39:38-53.e7. [PMID: 33217343 PMCID: PMC8478080 DOI: 10.1016/j.ccell.2020.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/23/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
A small fraction of cancer patients with advanced disease survive significantly longer than patients with clinically comparable tumors. Molecular mechanisms for exceptional responses to therapy have been identified by genomic analysis of tumor biopsies from individual patients. Here, we analyzed tumor biopsies from an unbiased cohort of 111 exceptional responder patients using multiple platforms to profile genetic and epigenetic aberrations as well as the tumor microenvironment. Integrative analysis uncovered plausible mechanisms for the therapeutic response in nearly a quarter of the patients. The mechanisms were assigned to four broad categories-DNA damage response, intracellular signaling, immune engagement, and genetic alterations characteristic of favorable prognosis-with many tumors falling into multiple categories. These analyses revealed synthetic lethal relationships that may be exploited therapeutically and rare genetic lesions that favor therapeutic success, while also providing a wealth of testable hypotheses regarding oncogenic mechanisms that may influence the response to cancer therapy.
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Affiliation(s)
- David A Wheeler
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maria F Cardenas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alina M Hamilton
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Linghua Wang
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Ninad Dewal
- Foundation Medicine Inc, Cambridge, MA 02141, USA
| | | | - David Piñeyro
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Catalonia, Spain
| | - Manuel Castro de Moura
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cancer (CIBERONC), 28029 Madrid, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Catalonia, Spain; Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Hui Shen
- Van Andel Institute, Grand Rapids, MI 49503, USA
| | | | - Roy Tarnuzzer
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lisa M McShane
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Paul M Williams
- Frederick National Laboratory for Cancer Research, Frederick, MD 21701, USA
| | - Irina Lubensky
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Elise C Kohn
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jeffrey White
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Shakun Malik
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lyndsay Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Carol Weil
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Alice P Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chris Karlovich
- Frederick National Laboratory for Cancer Research, Frederick, MD 21701, USA
| | - Brian Rodgers
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Paula Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Tracy Nolan
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jianhong Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Viktoriya Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Jay Bowen
- Nationwide Children's Hospital, Columbus, OH 43205, USA
| | | | - Elijah F Edmondson
- Pathology and Histology Laboratory, Frederick National Laboratory for Cancer Research, National Cancer Institute, NIH, Frederick, MD 21701, USA
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Barbara A Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - S Percy Ivy
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Louis M Staudt
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD 20892, USA.
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Affiliation(s)
- Helen J Mackay
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Tew WP, Lacchetti C, Ellis A, Maxian K, Banerjee S, Bookman M, Jones MB, Lee JM, Lheureux S, Liu JF, Moore KN, Muller C, Rodriguez P, Walsh C, Westin SN, Kohn EC. PARP Inhibitors in the Management of Ovarian Cancer: ASCO Guideline. J Clin Oncol 2020; 38:3468-3493. [PMID: 32790492 DOI: 10.1200/jco.20.01924] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To provide recommendations on the use of poly(ADP-ribose) polymerase inhibitors (PARPis) for management of epithelial ovarian, tubal, or primary peritoneal cancer (EOC). METHODS Randomized, controlled, and open-labeled trials published from 2011 through 2020 were identified in a literature search. Guideline recommendations were based on the review of the evidence, US Food and Drug Administration approvals, and consensus when evidence was lacking. RESULTS The systematic review identified 17 eligible trials. RECOMMENDATIONS The guideline pertains to patients who are PARPi naïve. All patients with newly diagnosed, stage III-IV EOC whose disease is in complete or partial response to first-line, platinum-based chemotherapy with high-grade serous or endometrioid EOC should be offered PARPi maintenance therapy with niraparib. For patients with germline or somatic pathogenic or likely pathogenic variants in BRCA1 (g/sBRCA1) or BRCA2 (g/sBRCA2) genes should be treated with olaparib. The addition of olaparib to bevacizumab may be offered to patients with stage III-IV EOC with g/sBRCA1/2 and/or genomic instability and a partial or complete response to chemotherapy plus bevacizumab combination. Maintenance therapy (second line or more) with single-agent PARPi may be offered for patients with EOC who have not received a PARPi and have responded to platinum-based therapy regardless of BRCA mutation status. Treatment with a PARPi should be offered to patients with recurrent EOC that has not recurred within 6 months of platinum-based therapy, who have not received a PARPi and have a g/sBRCA1/2, or whose tumor demonstrates genomic instability. PARPis are not recommended for use in combination with chemotherapy, other targeted agents, or immune-oncology agents in the recurrent setting outside the context of a clinical trial. Recommendations for managing specific adverse events are presented. Data to support reuse of PARPis in any setting are needed.Additional information is available at www.asco.org/gynecologic-cancer-guidelines.
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Affiliation(s)
- William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Annie Ellis
- SHARE Cancer Support, New York, NY.,Ovarian Cancer Research Alliance, New York, NY
| | | | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
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21
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Lee JM, Annunziata CM, Hays JL, Cao L, Choyke P, Yu M, An D, Turkbey IB, Minasian LM, Steinberg SM, Chen H, Wright J, Kohn EC. Phase II trial of bevacizumab and sorafenib in recurrent ovarian cancer patients with or without prior-bevacizumab treatment. Gynecol Oncol 2020; 159:88-94. [PMID: 32747013 DOI: 10.1016/j.ygyno.2020.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine whether blocking multiple points of the angiogenesis pathway by addition of sorafenib, a multi-kinase inhibitor against VEGFR2/3, Raf, c-Kit, and PDGFR, to bevacizumab would yield clinical activity in ovarian cancer (OvCa). METHODS This phase II study tested bevacizumab plus sorafenib in two cohorts; bevacizumab-naïve and bevacizumab-exposed patients. Bevacizumab (5 mg/kg IV every 2 weeks) was given with sorafenib 200 mg bid 5 days-on/2 days-off. The primary objective was response rate using a Simon two-stage optimal design. Progression-free survival (PFS) and toxicity were the secondary endpoints. Exploratory correlative studies included plasma cytokine concentrations, tissue proteomics and dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI). RESULTS Between March 2007 and August 2012, 54 women were enrolled, 41 bevacizumab-naive and 13 bevacizumab-prior, with median 5 (2-9) and 6 (5-9) prior systemic therapies, respectively. Nine of 35 (26%) evaluable bevacizumab-naive patients attained partial responses (PR), and 18 had stable disease (SD) ≥ 4 months. No responses were seen in the bevacizumab-prior group and 7 (54%) patients had SD ≥ 4 months, including one exceptional responder with SD of 27 months. The overall median PFS was 5.5 months (95%CI: 4.0-6.8 months). Treatment-related grade 3/4 adverse events (≥5%) included hypertension (17/54 [31%]; grade 3 in 16 patients and grade 4 in one patient) and venous thrombosis or pulmonary embolism (5/54 [9%]; grade 3 in 4 patients and grade 4 in one patient). Pretreatment low IL8 concentration was associated with PFS ≥ 4 months (p = .031). CONCLUSIONS The bevacizumab and sorafenib combination did not meet the pre-specified primary endpoint although some clinical activity was seen in heavily-pretreated bevacizumab-naive OvCa patients with platinum-resistant disease. Anticipated class toxicities required close monitoring and dose modifications.
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Affiliation(s)
- Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America.
| | - Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America
| | - John L Hays
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Liang Cao
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, United States of America
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, United States of America
| | - Minshu Yu
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America
| | - Daniel An
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America
| | - Ismail Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, United States of America
| | - Lori M Minasian
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, United States of America
| | - Helen Chen
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, United States of America
| | - John Wright
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, United States of America
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, United States of America
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22
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Konstantinopoulos PA, Cheng SC, Wahner Hendrickson AE, Penson RT, Schumer ST, Doyle LA, Lee EK, Kohn EC, Duska LR, Crispens MA, Olawaiye AB, Winer IS, Barroilhet LM, Fu S, McHale MT, Schilder RJ, Färkkilä A, Chowdhury D, Curtis J, Quinn RS, Bowes B, D'Andrea AD, Shapiro GI, Matulonis UA. Berzosertib plus gemcitabine versus gemcitabine alone in platinum-resistant high-grade serous ovarian cancer: a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2020; 21:957-968. [PMID: 32553118 PMCID: PMC8023719 DOI: 10.1016/s1470-2045(20)30180-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [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: 01/02/2020] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND High-grade serous ovarian cancers show increased replication stress, rendering cells vulnerable to ATR inhibition because of near universal loss of the G1/S checkpoint (through deleterious TP53 mutations), premature S phase entry (due to CCNE1 amplification, RB1 loss, or CDKN2A mRNA downregulation), alterations of homologous recombination repair genes, and expression of oncogenic drivers (through MYC amplification and other mechanisms). We hypothesised that the combination of the selective ATR inhibitor, berzosertib, and gemcitabine could show acceptable toxicity and superior efficacy to gemcitabine alone in high-grade serous ovarian cancer. METHODS In this multicentre, open-label, randomised, phase 2 study, 11 different centres in the US Experimental Therapeutics Clinical Trials Network enrolled women (aged ≥18 years) with recurrent, platinum-resistant high-grade serous ovarian cancer (determined histologically) and Eastern Cooperative Oncology Group performance status of 0 or 1, who had unlimited previous lines of cytotoxic therapy in the platinum-sensitive setting but no more than one line of cytotoxic therapy in the platinum-resistant setting. Eligible patients were randomly assigned (1:1) to receive intravenous gemcitabine (1000 mg/m2) on day 1 and day 8, or gemcitabine plus intravenous berzosertib (210 mg/m2) on day 2 and day 9 of a 21-day cycle until disease progression or intolerable toxicity. Randomisation was done centrally using the Theradex Interactive Web Response System, stratified by platinum-free interval, and with a permuted block size of six. Following central randomisation, patients and investigators were not masked to treatment assignment. The primary endpoint was investigator-assessed progression-free survival, and analyses included all patients who received at least one dose of the study drugs. The study is registered with ClinicalTrials.gov, NCT02595892, and is active but closed to enrolment. FINDINGS Between Feb 14, 2017, and Sept 7, 2018, 88 patients were assessed for eligibility, of whom 70 were randomly assigned to treatment with gemcitabine alone (36 patients) or gemcitabine plus berzosertib (34 patients). At the data cutoff date (Feb 21, 2020), the median follow-up was 53·2 weeks (25·6-81·8) in the gemcitabine plus berzosertib group and 43·0 weeks (IQR 23·2-69·1) in the gemcitabine alone group. Median progression-free survival was 22·9 weeks (17·9-72·0) for gemcitabine plus berzosertib and 14·7 weeks (90% CI 9·7-36·7) for gemcitabine alone (hazard ratio 0·57, 90% CI 0·33-0·98; one-sided log-rank test p=0·044). The most common treatment-related grade 3 or 4 adverse events were decreased neutrophil count (14 [39%] of 36 patients in the gemcitabine alone group vs 16 [47%] of 34 patients in the gemcitabine plus berzosertib group) and decreased platelet count (two [6%] vs eight [24%]). Serious adverse events were observed in ten (28%) patients in the gemcitabine alone group and nine (26%) patients in the gemcitabine plus berzosertib group. There was one treatment-related death in the gemcitabine alone group due to sepsis and one treatment-related death in the gemcitabine plus berzosertib group due to pneumonitis. INTERPRETATION To our knowledge, this is the first randomised study of an ATR inhibitor in any tumour type. This study shows a benefit of adding berzosertib to gemcitabine in platinum-resistant high-grade serous ovarian cancer. This combination warrants further investigation in this setting. FUNDING US National Cancer Institute.
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Affiliation(s)
| | - Su-Chun Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Richard T Penson
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Susan T Schumer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - L Austin Doyle
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elise C Kohn
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Linda R Duska
- Department of Obstetrics and Gynecology, Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Marta A Crispens
- Department of Obstetrics and Gynecology, Ingram Cancer Center, Vanderbilt University Nashville, TN, USA
| | - Alexander B Olawaiye
- Department of Obstetrics and Gynecology, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ira S Winer
- Department of Obstetrics and Gynecology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Lisa M Barroilhet
- Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T McHale
- Department of Obstetrics and Gynecology, Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Russell J Schilder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anniina Färkkilä
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dipanjan Chowdhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Curtis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roxanne S Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brittany Bowes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alan D D'Andrea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Lee JM, Minasian L, Kohn EC. New strategies in ovarian cancer treatment. Cancer 2020; 125 Suppl 24:4623-4629. [PMID: 31967682 DOI: 10.1002/cncr.32544] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
Abstract
Insights from basic science dissecting carcinogenesis in the fallopian tube and ovary have led to a deeper understanding of the origin, molecular characteristics, and types of ovarian cancers. This logically then has led to the development of novel approaches to treat ovarian cancer. Increasingly, novel agents are being developed to target the different growth pathways. The identification of molecular markers associated with different histopathologies has resulted in newer clinical trial designs to capture both clinical and translational endpoints. Unique molecular characteristics in DNA damage and repair pathways and unique cell surface markers have driven new drug development, yielding promise for both patients with platinum-sensitive and platinum-resistant ovarian cancers. Specific examples described include the histology-selective mutations, such as ARID1A in clear cell and endometrioid ovarian cancers; the rationale for using cell cycle checkpoint inhibitors when there already is a p53-mediated loss of cell cycle checkpoint regulation or combinations of agents that will both induce neoantigen formation and unleash immune modulators; and techniques to enhance the therapeutic delivery of known agents. A systematic and thoughtful approach to combining agents in clinical trials is needed so that irrespective of the trial outcomes, the results inform both clinical and translational endpoints.
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Affiliation(s)
- Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Elise C Kohn
- Gynecologic Cancer Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
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Chauhan A, Kunos C, El Khouli R, Kolesar J, Weiss H, Carson WE, Evers MB, Kidd MS, Beumer JH, Arnold SM, Kohn EC, Anthony LB. Etctn 10388: A phase I trial of triapine and lutetium Lu 177 dotatate in well-differentiated somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps4660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
TPS4660 Background: Radiolabeled somatostatin analogues provide a means of delivering targeted radiation with a high therapeutic index to NETs that express somatostatin receptors (SSTRs). Radiolabeled somatostatin analogue Lutetium Lu 177 Dotatate (Lutathera) is a beta-emitting radionuclide, recently FDA approved for use in SSTR positive gastroenteropancreatic neuroendocrine tumors (GEPNETS) in the US based on the NETTER-1 Phase III trial. Despite favorable PFS and safety profile, the drug has limited cytoreductive capability with a 17% ORR. We hypothesize that addition of an effective radiation sensitizer could help improve antitumor activity of Lutathera. Ribonucleotide reductase (RNR) is the only enzyme responsible for conversion of ribonucleoside diphosphate to deoxyribonucleotide diphosphate (dNDP), the key building blocks for DNA synthesis. Radiation is a potent inducer of DNA double-strand breaks (DSBs), and RNR is the rate-limiting enzyme in the repair of DNA in this setting. Triapine is an inhibitor of RNR. This study will test the hypothesis that radiation sensitizer triapine can be safely combined with peptide receptor radionuclide therapy and ultimately may improve antitumor activity of Lutetium Lu 177 Dotatate. Methods: This study is an investigator initiated, NCI sponsored, multicenter phase 1 trial of triapine and Lutetium Lu 177 Dotatate in well-differentiated somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumor (GEP-NETs) after the failure of at least one line of prior systemic cancer treatment. A total of 29 patients will be enrolled in the dose escalation with help of Bayesian optimal interval design (BOIN) and dose expansion cohorts. The study will be open through the NCI ETCTN (National Cancer Institute Experimental Therapeutics Clinical Trials Network) program. Patients will be treated with 177 lutetium dotatate in combination with triapine. Triapine will be administered orally (100 mg once a day starting dose) from D1-14 with each dose of PRRT [200 mCi]. Primary endpoint is to evaluate recommended phase II dose (RP2D). Secondary endpoints are to evaluate safety, pharmacokinetics, and clinical activity (ORR and PFS). We are also evaluating NETEST, a novel blood based test that evaluates levels of 51 neuroendocrine tumor gene transcripts. In addition, the study will correlate clinical outcome with baseline somatostatin receptor density, somatic tumor mutations and germline mutations. Clinical trial information: 04234568 .
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Affiliation(s)
- Aman Chauhan
- University of Kentucky, Division of Medical Oncology, Lexington, KY
| | | | | | | | - Heidi Weiss
- University of Kentucky and Markey Cancer Center, Lexington, KY
| | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
| | | | | | - Jan Hendrik Beumer
- NSABP Foundation and University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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25
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Liu JF, Brady MF, Matulonis UA, Miller A, Kohn EC, Swisher EM, Tew WP, Cloven NG, Muller C, Bender D, Moore RG, Michelin DP, Waggoner SE, Geller MA, Fujiwara K, D'Andre SD, Carney M, Secord AA, Moxley KM, Bookman MA. A phase III study comparing single-agent olaparib or the combination of cediranib and olaparib to standard platinum-based chemotherapy in recurrent platinum-sensitive ovarian cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6003 Background: Combination cediranib (C) and olaparib (O) improved progression-free survival (PFS) in patients (pts) with relapsed platinum (plat)-sensitive high-grade ovarian cancer (ovca) compared to O alone in a Phase 2 trial (NCT01116648). We conducted this randomized, open-label Phase 3 trial (NCT02446600) to assess whether combination C+O, or O alone, was superior to standard of care (SOC) plat-based therapy in relapsed plat-sensitive ovca. Methods: Eligible pts had recurrent plat-sensitive [ > 6-month plat-free interval (PFI)] high-grade serous or endometrioid, or BRCA-related, ovca. One prior non-plat therapy and unlimited prior plat-therapies were allowed; prior anti-angiogenics in the recurrent setting or prior PARP inhibitor were exclusions. Pts were randomized 1:1:1 to SOC (carboplatin/paclitaxel; carboplatin/gemcitabine; or carboplatin/liposomal doxorubicin), O (300mg twice daily), or C+O (C 30mg daily + O 200mg twice daily). Randomization was stratified by g BRCA status, PFI (6-12 vs > 12 months), and prior anti-angiogenic therapy. Target sample size was 549 pts; primary analysis occurred 2 years after the last pt enrolled. The primary endpoint was PFS. Type 1 error = 0.025 was controlled by a gatekeeping hierarchy that assessed C+O vs SOC, then O alone vs SOC, and finally C+O vs O. All maintenance therapy was prohibited. Results: Between 4FEB2016 and 13NOV2017, 565 pts enrolled (187 SOC, 189 O, 189 C+O), and 528 pts initiated treatment (166 SOC, 183 O, 179 C+O). 23.7% of patients had g BRCAmut. Median follow-up was 29.1 months. 53 pts on SOC initiated non-protocol therapy (predominantly PARP inhibitor maintenance) before disease progression. The hazard ratio (HR) for PFS was 0.856 (95% CI 0.66-1.11, p = 0.08, 1-tail) between C+O and SOC and 1.20 (95% CI 0.93-1.54) between O and SOC, with median PFS of 10.3, 8.2, and 10.4 months for SOC, O, and C+O, respectively. Response rates were 71.3% (SOC), 52.4% (O), and 69.4% (C+O). In gBRCA pts, HR for PFS was 0.55 (95% CI 0.73-1.30) for C+O vs SOC, and 0.63 (95% CI 0.37-1.07) for O vs SOC. In non-g BRCA pts, HR for these comparisons was 0.97 (95% CI 0.73-1.30) and 1.41 (1.07-1.86). No OS differences between arms were observed at 44% events. Pts receiving C+O (vs SOC) had more frequent Grade 3 or higher gastrointestinal (30.1% vs 8.4%), hypertension (31.7% vs 1.8%), and fatigue events (17.5% vs 1.8%). Conclusion: C+O demonstrated similar activity to SOC in relapsed plat-sensitive ovca but did not meet the primary endpoint of improved PFS. Clinical trial information: NCT02446600.
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Affiliation(s)
| | | | | | - Austin Miller
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | - Steven E. Waggoner
- Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH
| | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
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Lampert EJ, An D, McCoy A, Kohn EC, Annunziata CM, Trewhitt K, Zimmer ADS, Lipkowitz S, Lee JM. Prexasertib, a cell cycle checkpoint kinase 1 inhibitor, in BRCA mutant recurrent high-grade serous ovarian cancer (HGSOC): A proof-of-concept single arm phase II study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6038 Background: Preclinical data suggest cell cycle checkpoint inhibition induces greater cell death in BRCA mutant HGSOC by causing replication stress and dysregulation of DNA damage responses. We hypothesized that prexasertib, a cell cycle checkpoint kinase 1 (CHK1) inhibitor, would be active in BRCA mutated HGSOC patients. Methods: We conducted a single center, two-stage phase II study of prexasertib (105mg/m2 IV every 2 weeks) in HGSOC patients with known germline or somatic BRCA mutations. The primary endpoint was RECIST response rate (RR). Progression-free survival (PFS) and safety (CTCAE v4) were secondary endpoints. Baseline research biopsies and blood samples were collected for exploratory biomarker endpoints. Results: Between February 2015 and July 2019, 22 heavily pretreated (median 5 prior systemic therapies [1-12]) women with BRCA mutant HGSOC (median age 58.7 [44-74.8]) received at least one dose of prexasertib. 13 (59%) patients were secondary platinum-resistant (median 8 [3-12] prior therapies) and 9 (41%) maintained platinum-sensitivity (median 4 [1-5] prior therapies). All but one received prior PARP inhibitor (PARPi) either in combination (10 [48%]) or as monotherapy (11 [52%]), with a median 5 month [mo; 1-29] PARPi-free interval prior to study entry. There was one complete response (41+mo, platinum-sensitive, no prior PARPi) and one partial response (9+mo, platinum-sensitive, 13.5mo PARPi-free interval) yielding an 11% RR (2/18 evaluable). No response was seen in platinum-resistant patients with prior PARPi. Median duration on study treatment was 4mo [1-9] among 21 patients with prior PARPi and 4mo [1.5-9] among 17 evaluable patients with prior PARPi. Common (>10%) grade 3/4 adverse events were neutropenia (82%), leukopenia (64%), and thrombocytopenia (14%); only one patient had grade 3 febrile neutropenia. 16 of 18 (89%) patients with grade 3/4 neutropenia received prophylactic growth factors for subsequent treatments. Conclusions: Prexasertib is tolerable and has modest activity in heavily pretreated BRCA mutant HGSOC patients. Further evaluation of predictive biomarkers for exceptional responders is ongoing. Clinical trial information: NCT02203513.
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Affiliation(s)
- Erika Joelle Lampert
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Daniel An
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Ann McCoy
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Christina M. Annunziata
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Kathryn Trewhitt
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Stanley Lipkowitz
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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Lee YC, Wang L, Kohn EC, Rubinstein L, Ivy SP, Harris PJ, Lheureux S. Evaluation of toxicities related to novel therapy in clinical trials for women with gynecologic cancer. Cancer 2020; 126:2139-2145. [PMID: 32097505 PMCID: PMC10693932 DOI: 10.1002/cncr.32783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with gynecologic cancer may be at increased risk for adverse events (AEs) due to peritoneal disease burden and prior treatment (surgery, chemotherapy, and pelvic radiotherapy). This study compared the toxicity profiles of patients with and without gynecologic cancer enrolled in phase 1 trials. METHODS This was a retrospective analysis of the National Cancer Institute phase 1 database for all trials enrolling 1 or more patients with gynecologic cancer over 2 decades (1995-2015). Clinical parameters collected included demographics, cancer history, trial information, AEs, and responses. AEs (according to the Common Terminology Criteria for Adverse Events) were documented for each patient during treatment, and they were counted once and analyzed on the basis of the highest grade and drug attribution. Multiple regression models were used to compare AEs at the baseline and during treatment. RESULTS A total of 4269 patients enrolled in 150 trials were divided into 3 groups: 1) women with gynecologic cancer (n = 685), 2) women with nongynecologic cancer (n = 1698), and 3) men with cancer (n = 1886). The median age was 58 years. The mean number of total AEs reported during treatment was highest for women with gynecologic cancer (17.1 vs 14.7 vs 13.5; P < .001), even though they were similar at the baseline (7.0 vs 7.4 vs 7.0; P = .09). The mean number of drug-related AEs was also highest for women with gynecologic cancer (8.3 vs 6.9 vs 6.2; P < .001). Grade 3 to 5 AEs were similar (2.3 vs 2.3 vs 2.1); however, grade 2 AEs were more frequent in women with gynecologic cancer (4.6 vs 3.9 vs 3.5). Treatment discontinuations due to AEs were similar (9% vs 9% vs 10%). CONCLUSIONS Women with gynecologic cancer experienced more frequent low-grade AEs during treatment, and this warrants attention to support their symptom burden. Study dose management should be considered for recurrent grade 2 AEs, particularly during continuous therapy.
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Affiliation(s)
- Yeh Chen Lee
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Elise C. Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Lawrence Rubinstein
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - S. Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Pamela J. Harris
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Stephanie Lheureux
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Konstantinopoulos PA, Norquist B, Lacchetti C, Armstrong D, Grisham RN, Goodfellow PJ, Kohn EC, Levine DA, Liu JF, Lu KH, Sparacio D, Annunziata CM. Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1222-1245. [PMID: 31986064 PMCID: PMC8842911 DOI: 10.1200/jco.19.02960] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [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] [Accepted: 11/10/2019] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To provide recommendations on genetic and tumor testing for women diagnosed with epithelial ovarian cancer based on available evidence and expert consensus. METHODS A literature search and prospectively defined study selection criteria sought systematic reviews, meta-analyses, randomized controlled trials (RCTs), and comparative observational studies published from 2007 through 2019. Guideline recommendations were based on the review of the evidence. RESULTS The systematic review identified 19 eligible studies. The evidence consisted of systematic reviews of observational data, consensus guidelines, and RCTs. RECOMMENDATIONS All women diagnosed with epithelial ovarian cancer should have germline genetic testing for BRCA1/2 and other ovarian cancer susceptibility genes. In women who do not carry a germline pathogenic or likely pathogenic BRCA1/2 variant, somatic tumor testing for BRCA1/2 pathogenic or likely pathogenic variants should be performed. Women with identified germline or somatic pathogenic or likely pathogenic variants in BRCA1/2 genes should be offered treatments that are US Food and Drug Administration (FDA) approved in the upfront and the recurrent setting. Women diagnosed with clear cell, endometrioid, or mucinous ovarian cancer should be offered somatic tumor testing for mismatch repair deficiency (dMMR). Women with identified dMMR should be offered FDA-approved treatment based on these results. Genetic evaluations should be conducted in conjunction with health care providers familiar with the diagnosis and management of hereditary cancer. First- or second-degree blood relatives of a patient with ovarian cancer with a known germline pathogenic cancer susceptibility gene variant should be offered individualized genetic risk evaluation, counseling, and genetic testing. Clinical decision making should not be made based on a variant of uncertain significance. Women with epithelial ovarian cancer should have testing at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Elise C Kohn
- Gynecologic Cancer Therapeutics, National Cancer Institute, Bethesda, MD
| | | | | | - Karen H Lu
- The University of Texas MD Anderson Cancer Center, Houston,TX
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Ivy SP, Kunos CA, Arnaldez FI, Kohn EC. Defining and targeting wild-type BRCA high-grade serous ovarian cancer: DNA repair and cell cycle checkpoints. Expert Opin Investig Drugs 2019; 28:771-785. [PMID: 31449760 DOI: 10.1080/13543784.2019.1657403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Molecular analyzes including molecular descriptor/phenotype interactions have led to better characterization of epithelial ovarian cancer patients, including a definition of a BRCA wild-type (BRCAwt) phenotype. Understanding how and when to use agents targeted against dependent BRCAwt pathways or other molecular events at disease progression is an important translational and therapeutic direction in ovarian cancer research. Areas covered: In this overview, we provide definitions and descriptions of a BRCAwt genotype and phenotype. We discuss novel investigational drugs that hold promise for the treatment of BRCAwt ovarian cancer, including inhibitors of poly(ADP-ribose) polymerase, ribonucleotide reductase, DNA protein kinase-catalytic subunit, ataxia-telangiectasia-mutated kinase (ATM), ataxia-telangiectasia mutated and Rad3-related kinase (ATR), CHK 1/2, cyclin kinases, glutaminase-1, WEE1 kinase, as well as tumor microenvironment and angiogenesis inhibitors. This article explores the known and the emerging areas of clinical research on patients with BRCAwt ovarian cancer. Expert opinion: Discovery of molecular changes tied to annotated disease information, along with an expanding array of pathway targets and targeted therapeutic agents, creates optimism and opportunity for women with ovarian cancer. Using precision oncology approaches, clinical researchers are, and will be, poised to select more effective treatments for ovarian cancer patients.
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Affiliation(s)
- S Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute (NCI) , Bethesda , MD , USA
| | - Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute (NCI) , Bethesda , MD , USA
| | - Fernanda I Arnaldez
- Cancer Therapy Evaluation Program, National Cancer Institute (NCI) , Bethesda , MD , USA
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute (NCI) , Bethesda , MD , USA
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30
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Lee JM, Botesteanu DA, Tomita Y, Yuno A, Lee MJ, Kohn EC, Annunziata CM, Matulonis U, MacDonald LA, Nair JR, Macneill KM, Trepel JB. Patients with BRCA mutated ovarian cancer may have fewer circulating MDSC and more peripheral CD8 + T cells compared with women with BRCA wild-type disease during the early disease course. Oncol Lett 2019; 18:3914-3924. [PMID: 31516602 DOI: 10.3892/ol.2019.10731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/04/2019] [Indexed: 12/31/2022] Open
Abstract
Immunosuppressive myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) are associated with immunologic tolerance and poor prognosis in ovarian cancer (OvCa). We hypothesized that women with germline BRCA1 and BRCA2 mutation-associated (gBRCAm) OvCa would have fewer circulating immunosuppressive immune cells compared to those with BRCA wild-type (BRCAwt) disease during their early disease course (<5 years post-diagnosis) where gBRCAm is a favorable prognostic factor. We collected and viably froze peripheral blood mononuclear cells (PBMCs) from patients with recurrent OvCa olaparib clinical trials (NCT01445418/NCT01237067). Immune subset analyses were performed using flow cytometry for Tregs, exhausted CD8+ T cells, monocytes and MDSCs. Functional marker expression, including cytotoxic T lymphocyte-associated protein 4 (CTLA-4), T cell immunoglobulin and mucin domain 3 (TIM-3) and programmed cell death protein 1 (PD-1) was evaluated. Data were analyzed using FlowJo. Pretreatment PBMCs were collected from 41 patients (16 gBRCAm/25 BRCAwt). The percentage of MDSCs among viable CD45+ PBMC was lower in gBRCAm OvCa compared with BRCAwt OvCa (median 0.565 vs. 0.93%, P=0.0086) but this difference was not seen in those women >5 years post-diagnosis. CD8+ T cells among viable CD45+ PBMCs and CTLA-4+/CD8+ T cells were higher in gBRCAm carriers than patients with BRCAwt, in particular for those <5 years post-diagnosis (median 20.4 vs. 9.78%, P=0.031 and median MFI 0.19 vs. 0.22, P=0.0074, respectively). TIM-3 expression on Tregs was associated with poor progression-free survival, independent of gBRCAm status (P<0.001). Our pilot data suggested that patients with gBRCAm OvCa may have fewer circulating MDSCs but higher CD8+ T cells in PBMCs during their early disease course. This may contribute to the observed survival benefit for these women in their first post-diagnosis decade.
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Affiliation(s)
- Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Dana-Adriana Botesteanu
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Yusuke Tomita
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Akira Yuno
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Ursula Matulonis
- Division of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Lauren A MacDonald
- Division of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Jayakumar R Nair
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Kimberley M Macneill
- Division of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Jane B Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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Zimmer AS, Nichols E, Cimino-Mathews A, Peer C, Cao L, Lee MJ, Kohn EC, Annunziata CM, Lipkowitz S, Trepel JB, Sharma R, Mikkilineni L, Gatti-Mays M, Figg WD, Houston ND, Lee JM. A phase I study of the PD-L1 inhibitor, durvalumab, in combination with a PARP inhibitor, olaparib, and a VEGFR1-3 inhibitor, cediranib, in recurrent women's cancers with biomarker analyses. J Immunother Cancer 2019; 7:197. [PMID: 31345267 PMCID: PMC6657373 DOI: 10.1186/s40425-019-0680-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 05/06/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Strategies to improve activity of immune checkpoint inhibitors are needed. We hypothesized enhanced DNA damage by olaparib, a PARP inhibitor, and reduced VEGF signaling by cediranib, a VEGFR1-3 inhibitor, would complement anti-tumor activity of durvalumab, a PD-L1 inhibitor, and the 3-drug combination would be tolerable. METHODS This phase 1 study tested the 3-drug combination in a 3 + 3 dose escalation. Cediranib was taken intermittently (5 days on/2 days off) at 15 or 20 mg (dose levels 1 and 2, respectively) with durvalumab 1500 mg IV every 4 weeks, and olaparib tablets 300 mg twice daily. The primary end point was the recommended phase 2 dose (RP2D). Response rate, pharmacokinetic (PK), and correlative analyses were secondary endpoints. RESULTS Nine patients (7 ovarian/1 endometrial/1 triple negative breast cancers, median 3 prior therapies [2-6]) were treated. Grade 3/4 adverse events include hypertension (1/9), anemia (1/9) and lymphopenia (3/9). No patients experienced dose limiting toxicities. The RP2D is cediranib, 20 mg (5 days on/2 days off) with full doses of durvalumab and olaparib. Four patients had partial responses (44%) and 3 had stable disease lasting ≥6 months, yielding a 67% clinical benefit rate. No significant effects on olaparib or cediranib PK parameters from the presence of durvalumab, or the co-administration of cediranib or olaparib were identified. Tumoral PD-L1 expression correlated with clinical benefit but cytokines and peripheral immune subsets did not. CONCLUSIONS The RP2D is tolerable and has preliminary activity in recurrent women's cancers. A phase 2 expansion study is now enrolling for recurrent ovarian cancer patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02484404. Registered June 29, 2015.
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Affiliation(s)
- Alexandra S. Zimmer
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Erin Nichols
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, MD USA
| | - Ashley Cimino-Mathews
- Johns Hopkins Hospital Department of Pathology, Baltimore, MD USA
- Johns Hopkins Hospital Department of Oncology, Baltimore, MD USA
| | - Cody Peer
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD USA
| | - Liang Cao
- Genetics Branch, National Cancer Institute, Bethesda, MD USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Christina M. Annunziata
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Stanley Lipkowitz
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Jane B. Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Rajni Sharma
- Johns Hopkins Hospital Department of Oncology, Baltimore, MD USA
| | - Lekha Mikkilineni
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Margaret Gatti-Mays
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - William D. Figg
- Johns Hopkins Hospital Department of Pathology, Baltimore, MD USA
| | - Nicole D. Houston
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Jung-Min Lee
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
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Abstract
Uterine cervix cancers pose therapeutic challenges because of an overactive ribonucleotide reductase, which provides on-demand deoxyribonucleotides for DNA replication or for a DNA damage repair response. Ribonucleotide reductase overactivity bestows cancer cell resistance to the effects of radiotherapy and chemotherapy used to treat disease; but nevertheless, this same biologic overexpression provides opportune vulnerabilities relatively specific to uterine cervix cancers for new therapeutic strategies to take advantage. The discovery of human epidermal growth factor receptor 2 (ErbB2 or HER2) overexpression on metastatic uterine cervix cancer cells provides an opportunity for clinical trials of targeted radiopharmaceuticals in combination with DNA damage response modifying drugs. The National Cancer Institute's clinical trial infrastructure and its experimental therapeutics portfolio can now offer clinical trial evaluation of molecularly-targeted and tolerated radiopharmaceutical-drug combinations for women with persistent or recurrent metastatic uterine cervix cancer. This article discusses the current thinking of the National Cancer Institute in regard to attractive radiopharmaceutical strategies for this disease and others.
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Affiliation(s)
- Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - Jacek Capala
- Radiation Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - Susan Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
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Bast RC, Matulonis UA, Sood AK, Ahmed AA, Amobi AE, Balkwill FR, Wielgos-Bonvallet M, Bowtell DDL, Brenton JD, Brugge JS, Coleman RL, Draetta GF, Doberstein K, Drapkin RI, Eckert MA, Edwards RP, Elias KM, Ennis D, Futreal A, Gershenson DM, Greenberg RA, Huntsman DG, Ji JXY, Kohn EC, Iavarone C, Lengyel ER, Levine DA, Lord CJ, Lu Z, Mills GB, Modugno F, Nelson BH, Odunsi K, Pilsworth JA, Rottapel RK, Powell DJ, Shen L, Shih LM, Spriggs DR, Walton J, Zhang K, Zhang R, Zou L. Critical questions in ovarian cancer research and treatment: Report of an American Association for Cancer Research Special Conference. Cancer 2019; 125:1963-1972. [PMID: 30835824 PMCID: PMC6557260 DOI: 10.1002/cncr.32004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/24/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
Abstract
Substantial progress has been made in understanding ovarian cancer at the molecular and cellular level. Significant improvement in 5-year survival has been achieved through cytoreductive surgery, combination platinum-based chemotherapy, and more effective treatment of recurrent cancer, and there are now more than 280,000 ovarian cancer survivors in the United States. Despite these advances, long-term survival in late-stage disease has improved little over the last 4 decades. Poor outcomes relate, in part, to late stage at initial diagnosis, intrinsic drug resistance, and the persistence of dormant drug-resistant cancer cells after primary surgery and chemotherapy. Our ability to accelerate progress in the clinic will depend on the ability to answer several critical questions regarding this disease. To assess current answers, an American Association for Cancer Research Special Conference on "Critical Questions in Ovarian Cancer Research and Treatment" was held in Pittsburgh, Pennsylvania, on October 1-3, 2017. Although clinical, translational, and basic investigators conducted much of the discussion, advocates participated in the meeting, and many presentations were directly relevant to patient care, including treatment with poly adenosine diphosphate ribose polymerase (PARP) inhibitors, attempts to improve immunotherapy by overcoming the immune suppressive effects of the microenvironment, and a better understanding of the heterogeneity of the disease.
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Affiliation(s)
- Robert C. Bast
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anil K. Sood
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | - Zhen Lu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Brad H. Nelson
- University of British Columbia, Canada
- BC Cancer Agency, Canada
| | | | | | | | | | - Li Shen
- Roswell Park Cancer Institute, Buffalo, NY
| | - le-Ming Shih
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Lee Zou
- Massachusetts General Hospital, Boston, MD
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Affiliation(s)
- Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Shakun Malik
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
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Lampert EJ, Hays JL, Kohn EC, Annunziata CM, Minasian L, Yu M, Gordon N, Sissung TM, Chiou VL, Figg WD, Houston N, Lee JM. Phase I/Ib study of olaparib and carboplatin in heavily pretreated recurrent high-grade serous ovarian cancer at low genetic risk. Oncotarget 2019; 10:2855-2868. [PMID: 31080557 PMCID: PMC6499601 DOI: 10.18632/oncotarget.26869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/04/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose: To investigate maximum tolerated dose (MTD), activity and predictive biomarkers of olaparib with carboplatin in BRCA wild-type (BRCAwt) high grade serous ovarian carcinoma (HGSOC) patients. Methods: A 3+3 dose escalation study examined olaparib capsules (400 mg twice daily [BID], days 1-7) with carboplatin (AUC3-5 on day 1) every 21 days for 8 cycles, followed by olaparib 400 mg BID maintenance. Blood and tumor biopsy samples were collected pre- and on-treatment in the expansion cohort for PAR levels and proteomic endpoints. Results: 30 patients (median 7 prior regimens [2-12], 63% (19/30) platinum-resistant) were enrolled. Dose-limiting toxicity was thrombocytopenia/neutropenia, and infection with carboplatin AUC5 (2/6 patients). MTD was olaparib 400 mg BID + carboplatin AUC4. Grade 3/4 adverse events (>10%) included neutropenia (23%), thrombocytopenia (20%), and anemia (13%). Five of 25 (20%) evaluable patients had partial response (PR; median 4.5 months [3.3-9.5]). Clinical benefit rate (PR + stable disease ≥4 months) was 64% (16/25). A greater decrease in tissue PAR levels was seen in the clinical benefit group versus no benefit (median normalized linear change -1.84 [-3.39- -0.28] vs 0.51 [-0.27- 1.29], p = 0.001) and a DNA repair score by proteomics did not correlate with response. Conclusions: The olaparib and carboplatin combination is tolerable and has clinical benefit in subsets of heavily pretreated BRCAwt HGSOC, independent of platinum sensitivity.
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Affiliation(s)
- Erika J. Lampert
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christina M. Annunziata
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lori Minasian
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Minshu Yu
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nicolas Gordon
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tristan M. Sissung
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Victoria L. Chiou
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - William D. Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nicole Houston
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jung-Min Lee
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Liu JF, Barry WT, Birrer M, Lee JM, Buckanovich RJ, Fleming GF, Rimel BJ, Buss MK, Nattam SR, Hurteau J, Luo W, Curtis J, Whalen C, Kohn EC, Ivy SP, Matulonis UA. Overall survival and updated progression-free survival outcomes in a randomized phase II study of combination cediranib and olaparib versus olaparib in relapsed platinum-sensitive ovarian cancer. Ann Oncol 2019; 30:551-557. [PMID: 30753272 PMCID: PMC6503628 DOI: 10.1093/annonc/mdz018] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Olaparib is a poly(ADP-ribose) polymerase inhibitor and cediranib is an oral anti-angiogenic. In the primary analysis of this phase II study, combination cediranib/olaparib improved progression-free survival (PFS) compared with olaparib alone in relapsed platinum-sensitive ovarian cancer. This updated analysis was conducted to characterize overall survival (OS) and update PFS outcomes. PATIENTS AND METHODS Ninety patients were enrolled to this randomized, open-label, phase II study between October 2011 and June 2013 across nine United States-based academic centers. Data cut-off was 21 December 2016, with a median follow-up of 46 months. Participants had relapsed platinum-sensitive ovarian cancer of high-grade serous or endometrioid histology or had a deleterious germline BRCA1/2 mutation (gBRCAm). Participants were randomized to receive olaparib capsules 400 mg twice daily or cediranib 30 mg daily and olaparib capsules 200 mg twice daily until disease progression. RESULTS In this updated analysis, median PFS remained significantly longer with cediranib/olaparib compared with olaparib alone (16.5 versus 8.2 months, hazard ratio 0.50; P = 0.007). Subset analyses within stratum defined by BRCA status demonstrated statistically significant improvement in PFS (23.7 versus 5.7 months, P = 0.002) and OS (37.8 versus 23.0 months, P = 0.047) in gBRCA wild-type/unknown patients, although OS was not statistically different in the overall study population (44.2 versus 33.3 months, hazard ratio 0.64; P = 0.11). PFS and OS appeared similar between the two arms in gBRCAm patients. The most common CTCAE grade 3/4 adverse events with cediranib/olaparib remained fatigue, diarrhea, and hypertension. CONCLUSIONS Combination cediranib/olaparib significantly extends PFS compared with olaparib alone in relapsed platinum-sensitive ovarian cancer. Subset analyses suggest this margin of benefit is driven by PFS prolongation in patients without gBRCAm. OS was also significantly increased by the cediranib/olaparib combination in this subset of patients. Additional studies of this combination are ongoing and should incorporate analyses based upon BRCA status. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT0111648.
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Affiliation(s)
- J F Liu
- Division of Gynecologic Oncology, Department of Medical Oncology.
| | - W T Barry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - M Birrer
- Department of Medical Oncology, Massachusetts General Hospital, Boston
| | - J-M Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda
| | - R J Buckanovich
- Department of Internal Medicine, University of Pittsburgh Hillman Cancer Center, Pittsburgh
| | - G F Fleming
- Section of Hematology/Oncology, University of Chicago, Chicago
| | - B J Rimel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles
| | - M K Buss
- Division of Hematology/Oncology, Beth-Israel Deaconess Medical Center, Boston
| | - S R Nattam
- Department of Oncology, Fort Wayne Medical Oncology and Hematology, Fort Wayne
| | - J Hurteau
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston Hospital, Evanston
| | - W Luo
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - J Curtis
- Division of Gynecologic Oncology, Department of Medical Oncology
| | - C Whalen
- Division of Gynecologic Oncology, Department of Medical Oncology
| | - E C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, USA
| | - S P Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, USA
| | - U A Matulonis
- Division of Gynecologic Oncology, Department of Medical Oncology
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Bagnoli M, Shi TY, Gourley C, Speiser P, Reuss A, Nijman HW, Creutzberg CL, Scholl S, Negrouk A, Brady MF, Hasegawa K, Oda K, McNeish IA, Kohn EC, Oza AM, MacKay H, Millan D, Bennett K, Scott C, Mezzanzanica D. Gynecological Cancers Translational, Research Implementation, and Harmonization: Gynecologic Cancer InterGroup Consensus and Still Open Questions. Cells 2019; 8:E200. [PMID: 30813545 PMCID: PMC6468728 DOI: 10.3390/cells8030200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/08/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
In the era of personalized medicine, the introduction of translational studies in clinical trials has substantially increased their costs, but provides the possibility of improving the productivity of trials with a better selection of recruited patients. With the overall goal of creating a roadmap to improve translational design for future gynecological cancer trials and of defining translational goals, a main discussion was held during a brainstorming day of the Gynecologic Cancer InterGroup (GCIG) Translational Research Committee and overall conclusions are here reported. A particular emphasis was dedicated to the new frontier of the immunoprofiling of gynecological cancers. The discussion pointed out that to maximize patients' benefit, translational studies should be integral to clinical trial design with standardization and optimization of procedures including a harmonization program of Standard Operating Procedures. Pathology-reviewed sample collection should be mandatory and ensured by dedicated funding. Biomarker validation and development should be made public and transparent to ensure rapid progresses with positive outcomes for patients. Guidelines/templates for patients' informed consent are needed. Importantly for the public, recognized goals are to increase the involvement of advocates and to improve the reporting of translational data in a forum accessible to patients.
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Affiliation(s)
- Marina Bagnoli
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
| | - Ting Yan Shi
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, MRC IGMM, Edinburgh EH4 2XU, UK.
| | - Paul Speiser
- Department of Gynaecologic Oncology, Medical University Vienna, General Hospital Vienna, 1090 Wien, Austria.
| | - Alexander Reuss
- Coordinating Center for Clinical Trials, at the Philipps-University of Marburg, 35043 Marburg, Germany.
| | - Hans W Nijman
- Department of Obstetrics & Gynecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Suzy Scholl
- Department of Drug Development and Innovation, Institut Curie, 75005 Paris, France.
| | - Anastassia Negrouk
- European Organisation for Research and Treatment of Cancer (EORTC), 1200 Brussels, Belgium.
| | - Mark F Brady
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama 1397-1, Japan.
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan.
| | - Iain A McNeish
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
| | - Elise C Kohn
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD 20852, USA.
| | - Amit M Oza
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada.
| | - Helen MacKay
- Division of Medical Oncology, University of Toronto/Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada.
| | - David Millan
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TR, UK.
| | - Katherine Bennett
- Gynecologic Cancer InterGroup, Operations, Kingston, ON K7K-7A6, Canada.
| | - Clare Scott
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia.
| | - Delia Mezzanzanica
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
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Liu JF, Lee JM, Strock E, Phillips R, Mari K, Killiam B, Bonam M, Milenkova T, Kohn EC, Ivy SP. Technology Applications: Use of Digital Health Technology to Enable Drug Development. JCO Clin Cancer Inform 2018; 2:1-12. [PMID: 30652584 PMCID: PMC6874035 DOI: 10.1200/cci.17.00153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This pilot study developed and evaluated the feasibility, usability, and perceived satisfaction with an end-user mobile medical application and provider web portal. The two interfaces allowed for remote monitoring, provided daily guidance in the management of hypertension and diarrhea, and allowed for rapid management of adverse events during a clinical trial of olaparib and cediranib. PATIENTS AND METHODS eCO (eCediranib/Olaparib) was designed for patient self-reported, real-time management of hypertension and diarrhea using remote monitoring. eCO links to a Bluetooth-enabled blood pressure (BP) monitor and transmits data to a secure provider web portal. eCO use was assessed for suitability, usability, and satisfaction after 4 weeks using a 17-item questionnaire. Metrics regarding patient-reported BP and diarrhea events were analyzed. RESULTS Sixteen patients enrolled in the pilot. A total of 98.2% of expected BP values were reported: 94.2% via Bluetooth and 5.8% entered manually. Twelve patients experienced 21 BP events (systolic BP > 140 and/or diastolic BP > 90 mmHg on two consecutive readings); data from cycle 1 were comparable to the study database. Thirteen patients reported diarrhea (more than one stool per 24 hours over baseline) categorized as grade 1 or 2, which was comparable to the study database. Survey analysis showed that patients had statistically significant, positive responses to the use of the eCO application. Patients indicated eCO use made them feel more involved in their care and better connected to their health care team. The only aspect of the application that did not show a statistically significant positive response was the process of reporting diarrhea. CONCLUSION The eCO application was designed to assist in managing acute treatment-related events most often associated with treatment discontinuation, need for drug holidays, or dose interruption. Hypertension and diarrhea events reported via eCO allowed rapid provider response and a positive overall patient experience.
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Affiliation(s)
- Joyce F. Liu
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Jung-min Lee
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Ellie Strock
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Ruth Phillips
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Karine Mari
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Bill Killiam
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Matthew Bonam
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Tsveta Milenkova
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Elise C. Kohn
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - S. Percy Ivy
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
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Liu JF, Barry WT, Wenham RM, Wahner Hendrickson AE, Armstrong DK, Chan N, Cohn DE, Lee JM, Penson RT, Cristea MC, Abbruzzese JL, MATSUO KOJI, Olawaiye A, Farooq S, Swisher EM, Van Allen EM, Shapiro G, Kohn EC, Ivy SP, Matulonis UA. A phase 2 biomarker trial of combination cediranib and olaparib in relapsed platinum (plat) sensitive and plat resistant ovarian cancer (ovca). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Nancy Chan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Jung-min Lee
- National Cancer Institute Women's Malignancies Branch, Bethesda, MD
| | | | | | | | - KOJI MATSUO
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | | | | | | | | | - Elise C. Kohn
- National Cancer Institute at the National Institutes of Health, Rockville, MD
| | - S. Percy Ivy
- National Cancer Institute at the National Institutes of Health, Rockville, MD
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40
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Lee YC, Wang L, Kohn EC, Rubinstein L, Ivy SP, Harris P, Lheureux S. Toxicity profile of patients with gynecological cancers (Gyne) enrolled in phase I trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yeh Chen Lee
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lisa Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elise C. Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | | | - S. Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Pamela Harris
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Stephanie Lheureux
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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41
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Duska LR, Kohn EC. The new classifications of ovarian, fallopian tube, and primary peritoneal cancer and their clinical implications. Ann Oncol 2018; 28:viii8-viii12. [PMID: 29232468 DOI: 10.1093/annonc/mdx445] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The roles of histologic characterization and staging are to provide reproducible metrics for cancer classification with which to direct the most appropriate clinical care and to yield the most stable reliable system to allow both prospective and retrospective data analysis. Both the histologic and staging classifications of malignant ovarian/tubal/peritoneal cancers have recently changed. The World Health Organization sponsored a review and reclassification of the pathology of cancers of the ovaries, fallopian tubes, and peritoneum, and published these updates in 2014. In so doing, they codified the two-tiered grading system that has been in use in serous ovarian cancers for nearly a decade. In parallel, FIGO reviewed and updated the surgical staging system, applied to all histotypes of ovarian, tubal, and peritoneal cancers, also published in 2014. In both cases, the changes made are meant to encompass a better understanding of disease, but both have important merits and drawbacks. Changes in staging complicate analysis of retrospective data against current data. Though in some aspects controversial, the changes overall are meant to represent a better biologic understanding of disease that we hope will lead to an improvement in patient care and directed therapy.
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Affiliation(s)
- L R Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville VA
| | - E C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, USA
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Kunos CA, Kohn EC. Editorial: New Approaches to Radiation-Therapeutic Agent Cancer Care for Women. Front Oncol 2018; 7:276. [PMID: 29473016 PMCID: PMC5696330 DOI: 10.3389/fonc.2017.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
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Lheureux S, McCourt C, Rimel BJ, Duska L, Fleming G, Mackay H, Mutch D, Temkin SM, Lynn J, Kohn EC. Moving forward with actionable therapeutic targets and opportunities in endometrial cancer: A NCI clinical trials planning meeting report. Gynecol Oncol 2018; 149:S0090-8258(18)30124-0. [PMID: 29477660 PMCID: PMC9465931 DOI: 10.1016/j.ygyno.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 02/08/2023]
Abstract
The incidence of endometrial cancer (EC) in the U.S. has been rising, from an estimated annual incidence of 49,560 in 2013 to 61,380 in 2017. Meanwhile, the SEER-based relative survival of women with EC in the U.S. has remained flat [82.3% from 1987 to 1989, 82.8% from 2007 to 2013] and our recent increased understanding of EC biology and subtypes has not been translated into therapeutic advances. The U.S. National Cancer Institute (NCI) therefore convened a Uterine Clinical Trials Planning Meeting in January 2016 to initiate and accelerate design of molecularly-targeted EC trials. Prior to the meeting a group of experts in this field summarized available data, emphasizing data on human samples, to identify potentially actionable alterations in EC, and the results of their work has been separately published. The Clinical Trials Meeting planners focused on discussion of (1) novel trial designs, including window-of opportunity trials and appropriate control groups for randomized trials, (2) targets specific to serous carcinoma and promises and pitfalls of separate trials for women with tumors of this histology (3) specific recommendations for future randomized trials.
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Affiliation(s)
| | | | - B J Rimel
- Cedars Sinai Cancer Center, Los Angeles, CA, United States
| | - Linda Duska
- University of Virginia, Charlottesville, VA, United States
| | - Gini Fleming
- University of Chicago, Chicago, IL, United States
| | - Helen Mackay
- University of Toronto, Sunnybrook, Toronto, Canada
| | - David Mutch
- Washington University St. Louis, MO, United States
| | - Sarah M Temkin
- Virginia Commonwealth University, Richmond, VA, United States
| | - Jean Lynn
- Coordinating Center for Clinical Trials, National Cancer Institute, Bethesda, MD, United States
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States.
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Lee JM, Nair J, Zimmer A, Lipkowitz S, Annunziata CM, Merino MJ, Swisher EM, Harrell MI, Trepel JB, Lee MJ, Bagheri MH, Botesteanu DA, Steinberg SM, Minasian L, Ekwede I, Kohn EC. Prexasertib, a cell cycle checkpoint kinase 1 and 2 inhibitor, in BRCA wild-type recurrent high-grade serous ovarian cancer: a first-in-class proof-of-concept phase 2 study. Lancet Oncol 2018; 19:207-215. [PMID: 29361470 PMCID: PMC7366122 DOI: 10.1016/s1470-2045(18)30009-3] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023]
Abstract
Background High-grade serous ovarian carcinoma (HGSOC) is characterized by
TP53 mutations, DNA repair defects, and genomic
instability. We hypothesized that prexasertib, a cell cycle checkpoint
kinase 1 and 2 inhibitor, would be active in BRCA wild-type
HGSOC. Methods In this open label, single centre, two-stage proof-of-concept phase 2
study, women aged 18 years or older with measurable, recurrent high-grade
serous or high-grade endometrioid ovarian carcinoma were enrolled. All
patients must have had either a negative family history of hereditary breast
and ovarian cancer or known BRCA wild-type for
BRCA wild-type cohort. Other key eligibility criteria
were an Eastern Cooperative Oncology Group performance status of 0 or 1 or
2, and adequate haematological, renal, and hepatic function. Patients
received intravenous prexasertib 105mg/m2 once every 2 weeks
until disease progression, unacceptable toxicity or patient withdrawal of
consent. The primary endpoint was investigator-assessed tumour response per
protocol based on Response Evaluation Criteria in Solid Tumors, version
1·1 in evaluable patients. The final analysis of this cohort is
reported here. This ongoing trial is registered with ClinicalTrials.gov
(NCT02203513) and enrolling the patients of BRCA mutation
cohort. Findings Between January 2015 and November 2016, 28 women (median age
64-year-old [IQR 58–69·5], with median 5
prior systemic therapies [IQR 2·5–5]) were
enrolled and received at least one dose of prexasertib. Eight of 24
evaluable patients had a partial response (PR; 33%, 95% CI:
16–55) and 50% had a GCIG CA125 response. The RR in the
intention-to-treat population was 29% (8/28, 95% CI:
13–49). The common (>10%) grade 3 or 4 treatment-emergent
adverse events were neutropenia (26 [93%] patients),
thrombocytopenia (seven [25%] patients), and anaemia
(three [11%] patients). Grade 4 neutropenia occurred
in 22 (79%) patients after the first dose and was transient
≤ 7 days (median 6 days [IQR 4–8]) without
growth factor support; the incidence of febrile neutropenia was 7%
(2/28). Interpretation We demonstrate clinical activity of prexasertib in
BRCA wild-type HGSOC, especially patients with
platinum-resistant or refractory ovarian cancer. These results warrant
further development for this unmet patient need. Funding Intramural Research Program of the National Institutes of Health,
National Cancer Institute, Center for Cancer Research, USA.
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Affiliation(s)
- Jung-Min Lee
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA.
| | - Jayakumar Nair
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Alexandra Zimmer
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Stanley Lipkowitz
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | | | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Maria I Harrell
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Jane B Trepel
- Developmental Therapeutics Branch, National Cancer Institute, Bethesda, MD, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, National Cancer Institute, Bethesda, MD, USA
| | - Mohammad H Bagheri
- Department of Radiology and Imaging Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Seth M Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, Bethesda, MD, USA
| | - Lori Minasian
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Irene Ekwede
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | - Elise C Kohn
- Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
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45
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Annunziata CM, Kohn EC. Clinical trials in gynecologic oncology: Past, present, and future. Gynecol Oncol 2017; 148:393-402. [PMID: 29212614 DOI: 10.1016/j.ygyno.2017.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
The Gynecologic Oncology Group has historically performed ground-breaking, practice-changing clinical trials in women's cancers. The current standard of care for initial treatment of ovarian, endometrial, cervical, and trophoblastic cancers was determined by clinical trials completed within this cooperative group structure. For example, trial GOG-0111 set the standard for combining platinum and taxane chemotherapy in ovarian cancer, and more recently GOG-0240 provided evidence for adding bevacizumab to chemotherapy for women with advanced cervical cancer. The landscape of clinical trial design has markedly changed in recent decades, with a clear emphasis on streamlining drug development towards specific patient populations and indications for investigational agents. Translational science in gynecologic cancers can set the stage for rapid and efficient introduction of new therapies for our patients. The gynecologic oncology community of researchers and clinicians is well positioned to enter into the new era of drug development, with breakthrough discoveries increasing each year. It is clear that we must incorporate smarter clinical trial design to get the right drugs to the right patients expeditiously, so we can continue to improve outcome for women with gynecologic cancers.
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Affiliation(s)
- Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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MacKay HJ, Levine DA, Bae-Jump VL, Bell DW, McAlpine JN, Santin A, Fleming GF, Mutch DG, Nephew KP, Wentzensen N, Goodfellow PJ, Dorigo O, Nijman HW, Broaddus R, Kohn EC. Moving forward with actionable therapeutic targets and opportunities in endometrial cancer: NCI clinical trials planning meeting report on identifying key genes and molecular pathways for targeted endometrial cancer trials. Oncotarget 2017; 8:84579-84594. [PMID: 29137450 PMCID: PMC5663622 DOI: 10.18632/oncotarget.19961] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022] Open
Abstract
The incidence and mortality rates from endometrial cancer are increasing. There have been no new drugs approved for the treatment of endometrial cancer in decades. The National Cancer Institute, Gynecologic Cancer Steering Committee identified the integration of molecular and/or histologic stratification into endometrial cancer management as a top strategic priority. Based on this, they convened a group of experts to review the molecular data in this disease. Here we report on the actionable opportunities and therapeutic directions identified for incorporation into future clinical trials.
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Affiliation(s)
- Helen J. MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Douglas A. Levine
- Division of Gynecologic Cancer, Department of OB/GYN, NYU Langone Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Victoria L. Bae-Jump
- Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, CA, United States
| | - Daphne W. Bell
- Reproductive Cancer Genetics Section, Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute/NIH, MSC 8000, Bethesda, ML, United States
| | - Jessica N. McAlpine
- University of British Columbia & BC Cancer Agency, Division of Gynecologic Oncology, Vancouver, British Columbia, Canada
| | - Alessandro Santin
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Gini F. Fleming
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - David G. Mutch
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kenneth P. Nephew
- Medical Sciences Program, Indiana University School of Medicine, Bloomington, IN, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, ML, United States
| | - Paul J. Goodfellow
- James Comprehensive Cancer Center and The Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States
| | - Oliver Dorigo
- Division Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford, CA, United States
| | - Hans W. Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Russell Broaddus
- Department of Pathology, Unit 85, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Elise C. Kohn
- Clinical Investigations Branch of The Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, ML, United States
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Kohn EC, Lee JM, Ivy SP. The HRD Decision -Which PARP Inhibitor to Use for Whom and When. Clin Cancer Res 2017; 23:7155-7157. [PMID: 28974545 DOI: 10.1158/1078-0432.ccr-17-2186] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/31/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/16/2022]
Abstract
Rucaparib, a polyADPribose polymerase inhibitor (PARPi), was approved recently for use in women with high-grade serous ovarian cancer (HGSOC). It is now one of three approved PARPi for use in recurrent ovarian cancer, a family of agents that has changed the HGSOC treatment landscape and outcome. Clin Cancer Res; 23(23); 7155-7. ©2017 AACRSee related article by Balasubramaniam et al., p. 7165.
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Affiliation(s)
| | | | - S Percy Ivy
- National Cancer Institute, Bethesda, Maryland
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Lheureux S, Lai Z, Dougherty BA, Runswick S, Hodgson DR, Timms KM, Lanchbury JS, Kaye S, Gourley C, Bowtell D, Kohn EC, Scott C, Matulonis U, Panzarella T, Karakasis K, Burnier JV, Gilks CB, O'Connor MJ, Robertson JD, Ledermann J, Barrett JC, Ho TW, Oza AM. Long-Term Responders on Olaparib Maintenance in High-Grade Serous Ovarian Cancer: Clinical and Molecular Characterization. Clin Cancer Res 2017. [PMID: 28223274 DOI: 10.1158/1078-0432.ccr-16-2615] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Maintenance therapy with olaparib has improved progression-free survival in women with high-grade serous ovarian cancer (HGSOC), particularly those harboring BRCA1/2 mutations. The objective of this study was to characterize long-term (LT) versus short-term (ST) responders to olaparib.Experimental Design: A comparative molecular analysis of Study 19 (NCT00753545), a randomized phase II trial assessing olaparib maintenance after response to platinum-based chemotherapy in HGSOC, was conducted. LT response was defined as response to olaparib/placebo >2 years, ST as <3 months. Molecular analyses included germline BRCA1/2 status, three-biomarker homologous recombination deficiency (HRD) score, BRCA1 methylation, and mutational profiling. Another olaparib maintenance study (Study 41; NCT01081951) was used as an additional cohort.Results: Thirty-seven LT (32 olaparib) and 61 ST (21 olaparib) patients were identified. Treatment was significantly associated with outcome (P < 0.0001), with more LT patients on olaparib (60.4%) than placebo (11.1%). LT sensitivity to olaparib correlated with complete response to chemotherapy (P < 0.05). In the olaparib LT group, 244 genetic alterations were detected, with TP53, BRCA1, and BRCA2 mutations being most common (90%, 25%, and 35%, respectively). BRCA2 mutations were enriched among the LT responders. BRCA methylation was not associated with response duration. High myriad HRD score (>42) and/or BRCA1/2 mutation was associated with LT response to olaparib. Study 41 confirmed the correlation of LT response with olaparib and BRCA1/2 mutation.Conclusions: Findings show that LT response to olaparib may be multifactorial and related to homologous recombination repair deficiency, particularly BRCA1/2 defects. The type of BRCA1/2 mutation warrants further investigation. Clin Cancer Res; 23(15); 4086-94. ©2017 AACR.
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Affiliation(s)
- Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | | | | | | | | | - Stan Kaye
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - David Bowtell
- Peter MacCallum Cancer Centre, Melbourne, and Garvan Institute for Medical Research, Sydney, Australia
| | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | | | | | - Tony Panzarella
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Katherine Karakasis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Julia V Burnier
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C Blake Gilks
- Department of Pathology, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Jonathan Ledermann
- Cancer Institute, University College London, and University College London Hospitals, London, United Kingdom
| | | | | | - Amit M Oza
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
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Ivy SP, Kohn EC. Drug development and registration: Challenges and opportunities in ovarian cancer. Cancer 2017; 123:2597-2599. [DOI: 10.1002/cncr.30645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- S. Percy Ivy
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis; National Cancer Institute; Rockville Maryland
| | - Elise C. Kohn
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis; National Cancer Institute; Rockville Maryland
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50
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Ellis LM, Blanke CD, Kohn EC. Words matter: Restoring respect and dignity when referring to individuals with cancer. Cancer 2017; 123:2390-2391. [PMID: 28182266 DOI: 10.1002/cncr.30625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Lee M Ellis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles D Blanke
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,SWOG Group Chair's Office, Oregon Health and Science University, Portland, Oregon
| | - Elise C Kohn
- Gynecologic Cancer Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
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