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Monk BJ, Parkinson C, Lim MC, O'Malley DM, Oaknin A, Wilson MK, Coleman RL, Lorusso D, Bessette P, Ghamande S, Christopoulou A, Provencher D, Prendergast E, Demirkiran F, Mikheeva O, Yeku O, Chudecka-Glaz A, Schenker M, Littell RD, Safra T, Chou HH, Morgan MA, Drochýtek V, Barlin JN, Van Gorp T, Ueland F, Lindahl G, Anderson C, Collins DC, Moore K, Marme F, Westin SN, McNeish IA, Shih D, Lin KK, Goble S, Hume S, Fujiwara K, Kristeleit RS. A Randomized, Phase III Trial to Evaluate Rucaparib Monotherapy as Maintenance Treatment in Patients With Newly Diagnosed Ovarian Cancer (ATHENA-MONO/GOG-3020/ENGOT-ov45). J Clin Oncol 2022; 40:3952-3964. [PMID: 35658487 PMCID: PMC9746782 DOI: 10.1200/jco.22.01003] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE ATHENA (ClinicalTrials.gov identifier: NCT03522246) was designed to evaluate rucaparib first-line maintenance treatment in a broad patient population, including those without BRCA1 or BRCA2 (BRCA) mutations or other evidence of homologous recombination deficiency (HRD), or high-risk clinical characteristics such as residual disease. We report the results from the ATHENA-MONO comparison of rucaparib versus placebo. METHODS Patients with stage III-IV high-grade ovarian cancer undergoing surgical cytoreduction (R0/complete resection permitted) and responding to first-line platinum-doublet chemotherapy were randomly assigned 4:1 to oral rucaparib 600 mg twice a day or placebo. Stratification factors were HRD test status, residual disease after chemotherapy, and timing of surgery. The primary end point of investigator-assessed progression-free survival was assessed in a step-down procedure, first in the HRD population (BRCA-mutant or BRCA wild-type/loss of heterozygosity high tumor), and then in the intent-to-treat population. RESULTS As of March 23, 2022 (data cutoff), 427 and 111 patients were randomly assigned to rucaparib or placebo, respectively (HRD population: 185 v 49). Median progression-free survival (95% CI) was 28.7 months (23.0 to not reached) with rucaparib versus 11.3 months (9.1 to 22.1) with placebo in the HRD population (log-rank P = .0004; hazard ratio [HR], 0.47; 95% CI, 0.31 to 0.72); 20.2 months (15.2 to 24.7) versus 9.2 months (8.3 to 12.2) in the intent-to-treat population (log-rank P < .0001; HR, 0.52; 95% CI, 0.40 to 0.68); and 12.1 months (11.1 to 17.7) versus 9.1 months (4.0 to 12.2) in the HRD-negative population (HR, 0.65; 95% CI, 0.45 to 0.95). The most common grade ≥ 3 treatment-emergent adverse events were anemia (rucaparib, 28.7% v placebo, 0%) and neutropenia (14.6% v 0.9%). CONCLUSION Rucaparib monotherapy is effective as first-line maintenance, conferring significant benefit versus placebo in patients with advanced ovarian cancer with and without HRD.
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Affiliation(s)
- Bradley J. Monk
- GOG Foundation, HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | | | - Myong Cheol Lim
- Gynecologic Oncology, National Cancer Center Korea, Goyang-si, Gyeonggi-do, South Korea
| | - David M. O'Malley
- Division of Gynecologic Oncology, The Ohio State University, James Cancer Center, Columbus, OH
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Michelle K. Wilson
- Department of Cancer and Blood, Auckland City Hospital, Auckland, New Zealand
| | | | - Domenica Lorusso
- MITO and Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Paul Bessette
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sharad Ghamande
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | | | - Diane Provencher
- Princess Margaret Consortium and Department of Obstetrics-Gynaecology, Centre Hospitalier de l'Université de Montréal (CHUM), Institut du Cancer de Montréal, Montréal, Canada
| | - Emily Prendergast
- Gynecologic Oncology, Minnesota Oncology and Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN
| | - Fuat Demirkiran
- Gynecologic Oncology Department, Medical Faculty, Istanbul University, Cerrahpaşa, Istanbul, Turkey
| | - Olga Mikheeva
- Limited Liability Company MedPomosch, Saint Petersburg, Russia
| | - Oladapo Yeku
- Gynecologic Cancers Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anita Chudecka-Glaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Michael Schenker
- Department of Medical Oncology, Sfantul Nectarie Oncology Center, Dolj, Romania
| | - Ramey D. Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA
| | - Tamar Safra
- Oncology Department, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou), Tao-Yuan, Taiwan
- College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Mark A. Morgan
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA
| | - Vít Drochýtek
- Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Joyce N. Barlin
- Women's Cancer Care Associates, Division of Gynecologic Oncology, Albany Medical College, Albany, NY
| | - Toon Van Gorp
- Division of Gynaecological Oncology, Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Fred Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, KY
| | - Gabriel Lindahl
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark
- Department of Oncology, Linköping University, Linköping, Sweden
| | - Charles Anderson
- Department of Gynecologic Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, OR
| | - Dearbhaile C. Collins
- Cancer Trials Ireland and Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Kathleen Moore
- Stevenson Cancer Center at the University of Oklahoma Health Sciences Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Frederik Marme
- AGO and Department Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Germany
| | - Shannon N. Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Iain A. McNeish
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Danny Shih
- Clinical Operations, Clovis Oncology Inc, Boulder, CO
| | - Kevin K. Lin
- Molecular Diagnostics, Clovis Oncology Inc, Boulder, CO
| | | | | | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Rebecca S. Kristeleit
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Fujiwara K, Kristeleit R, Ghamande S, Lim MC, Parkinson C, Morgan M, Wilson M, Oaknin A, Buscema J, Bessette P, Lorusso D, Ueland F, Safra T, Barlin J, Marmé F, Herzog T, McNeish I, Goble S, Hume S, Monk B. 178O Rucaparib maintenance treatment in patients (pts) with newly diagnosed ovarian cancer (OC): Defining benefit according to disease risk subgroups within the phase III ATHENA–MONO study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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McDowell A, Hill KS, McCorkle JR, Gorski J, Zhang Y, Salahudeen AA, Ueland F, Kolesar JM. Preclinical Evaluation of Artesunate as an Antineoplastic Agent in Ovarian Cancer Treatment. Diagnostics (Basel) 2021; 11:diagnostics11030395. [PMID: 33652561 PMCID: PMC7996621 DOI: 10.3390/diagnostics11030395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/01/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Ovarian cancer is the deadliest gynecologic malignancy despite current first-line treatment with a platinum and taxane doublet. Artesunate has broad antineoplastic properties but has not been investigated in combination with carboplatin and paclitaxel for ovarian cancer treatment. Methods: Standard cell culture technique with commercially available ovarian cancer cell lines were utilized in cell viability, DNA damage, and cell cycle progression assays to qualify and quantify artesunate treatment effects. Additionally, the sequence of administering artesunate in combination with paclitaxel and carboplatin was determined. The activity of artesunate was also assessed in 3D organoid models of primary ovarian cancer and RNAseq analysis was utilized to identify genes and the associated genetic pathways that were differentially regulated in artesunate resistant organoid models compared to organoids that were sensitive to artesunate. Results: Artesunate treatment reduces cell viability in 2D and 3D ovarian cancer cell models. Clinically relevant concentrations of artesunate induce G1 arrest, but do not induce DNA damage. Pathways related to cell cycle progression, specifically G1/S transition, are upregulated in ovarian organoid models that are innately more resistant to artesunate compared to more sensitive models. Depending on the sequence of administration, the addition of artesunate to carboplatin and paclitaxel improves their effectiveness. Conclusions: Artesunate has preclinical activity in ovarian cancer that merits further investigation to treat ovarian cancer.
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Affiliation(s)
- Anthony McDowell
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (A.M.J.); (J.G.); (F.U.)
| | - Kristen S. Hill
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA; (K.S.H.); (J.R.M.)
| | - Joseph Robert McCorkle
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA; (K.S.H.); (J.R.M.)
| | - Justin Gorski
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (A.M.J.); (J.G.); (F.U.)
| | - Yilin Zhang
- Tempus Labs, 600 W Chicago Ave. Ste 510, Chicago, IL 60654, USA; (Y.Z.); (A.A.S.)
| | - Ameen A. Salahudeen
- Tempus Labs, 600 W Chicago Ave. Ste 510, Chicago, IL 60654, USA; (Y.Z.); (A.A.S.)
| | - Fred Ueland
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (A.M.J.); (J.G.); (F.U.)
| | - Jill M. Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA; (K.S.H.); (J.R.M.)
- Department of Pharmacy Practice and Research, College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
- Correspondence:
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Kolesar J, Cavnar M, Miller R, Pickarski J, Zhang S, Nandakumar K, Schuh M, Belcher E, Durbin E, Poi M, Ueland F, Hands I, Bocklage T, Jeong JC, Arnold S, Evers M. Abstract A001: Improving cancer germline testing in rural Appalachian populations with ORIEN. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-a001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Reduced access to treatment advances in rural populations contributes to increased cancer mortality. Rural Appalachian Kentucky is a geographically isolated population with a unique carcinogen exposure and a low frequency guideline-recommended germline testing. To improve testing rates, a return of germline results program for patients enrolled in the Total Cancer Care (TCC) protocol at Markey Cancer Center (MCC) was initiated. Methods: Pre-intervention testing rates were obtained from the electronic health record. Patient and physician focus groups were conducted to assess barriers to germline testing. Whole exome germline data from TCC patients enrolled in the Avatar subset is analyzed using standard bioinformatics pipeline for known, clinically significant mutations in the 59 American College of Medical Genetics (ACMG) genes where return of incidental germline findings is recommended and 21 pharmacogenetic genes. Results are reviewed by our Molecular Tumor Board and a recommendation for confirmatory clinical testing, if needed, is made to the treating physician. Results: Baseline rates of guideline recommended germline testing at MCC in 2018 was 20% of ovarian, 15% of breast, 9% of colon, 3% of pancreas and no metastatic prostate patients. Testing was infrequent in rural communities. Almost all patients who had testing recommended by their physician, had testing performed. Unaffected family members were also rarely tested. Physician focus groups at MCC identified lack of time and low perceived value of the testing as barriers. Rural physicians also identified lack of access to genetic counselors. Patient focus groups in the Appalachian region demonstrated poor quality internet and low knowledge and self- efficacy as major barriers to patients discussing genetic testing with family members. To overcome patient barriers, a preloaded audio card was developed to facilitate discussion with family members. The preloaded audio card was tested in a rural Appalachian community, demonstrating significantly improved knowledge and self-efficacy. To overcome physician barriers, a genetic counselor telemedicine clinic and standing order were initiated. To improve physician perception of test value, the ORIEN return of germline results project was initiated. Of the more than 2000 patients enrolled on TCC at MCC, approximately 40% are from Appalachia, 173 have appropriate consent and specimen availability for germline sequencing and 5 have had results returned. Data describing the first 3 months of this initiative, including frequency of mutations in patients and unaffected family members and acceptance of genetic counselor referrals by physicians, patients and family members will be presented. Conclusion: Rural Appalachian communities identified significant barriers to guideline recommended germline testing, however, ORIEN and the TCC protocol are novel methods to reduce these barriers and improve the rates of testing in both patients and their family members.
Citation Format: Jill Kolesar, Micheal Cavnar, Rachel Miller, Justine Pickarski, Shulin Zhang, Kannabiran Nandakumar, Marissa Schuh, Elizabeth Belcher, Eric Durbin, Ming Poi, Fred Ueland, Isaac Hands, Therese Bocklage, JC Jeong, Susanne Arnold, Mark Evers. Improving cancer germline testing in rural Appalachian populations with ORIEN [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A001.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - JC Jeong
- 1University of Kentucky, Lexington, USA,
| | | | - Mark Evers
- 1University of Kentucky, Lexington, USA,
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Longoria T, Ueland F, Zhang Z, Chan D, Smith A, Fung E, Munroe D, Bristow R. Clinical performance of a multivariate index assay for detecting early-stage ovarian cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santoso JT, Robinson A, Suganda S, Praservit S, Wan JY, Ueland F. Computed tomography adnexal mass score to estimate risk for ovarian cancer. Arch Gynecol Obstet 2013; 289:595-600. [PMID: 23995674 DOI: 10.1007/s00404-013-3013-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/19/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We wish to develop a CT scan-based scoring system which estimates the probability of adnexal mass malignancy. METHODS Patients (324) undergoing adnexal mass surgery were recruited into the study from June 1, 2002, to January 1, 2009. All study patients had a preoperative CT scan and serum CA-125 test. CT scan abnormalities included any solid tumor components, ascites, and pelvic or abdominal lymphadenopathy and omental caking. RESULTS There were 225 (70%) benign and 99 (30%) malignant ovarian masses. Using logistic regression with the area under the curve of the receiver operating curve of 82%, the cancer probability was determined by the equation. e(-3.6372+0.0306*(A)+0.001*(C)+1.551*(D)+1.7377*(E)+2.76*(F)) / 1+e(-3.6372+0.0306*(A)+0.001*(B)+0.876*(C)+1.551*(D)+1.7377*(E)+2.76*(F)) where A = age, B = CA-125, C = solid adnexal mass is 1 and cystic is 0, D = ascites is 1, E = omental caking is 1 and absence is 0, F = node size ≥1 cm is 1 and <1 cm is 0 value. The natural logarithm e is a constant [2.718281828]. For example, for a woman of age 60, CA-125 = 50 U/mL, with solid adnexal mass, ascites, omental caking, and lymphadenopathy, the probability is 0.994. Hence, this woman has a 99.4% probability of having cancer. CONCLUSION The computed tomography adnexal mass score combines CT scan findings, CA-125, and patient age into an equation to predict the malignant probability of an adnexal mass.
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Affiliation(s)
- Joseph T Santoso
- Department of Obstetrics and Gynecology, University of Tennessee, West Clinic, 1588 Union Avenue, Memphis, TN, 38104, USA,
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DeSimone C, Elder J, Edwards A, Slone S, Feddock J, Miller R, Baldwin L, van Nagell J, Ueland F. Endometrial cancer lesion size is predictive of disease recurrence and long-term survival. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Elder J, Long A, Miller R, Ueland W, DeSimone C, Hoff J, Kryscio R, van Nagell J, Pavlik E, Ueland F. Monitoring ovarian tumors using serial ultrasound with tumor morphology index. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seamon L, Cohn D, Carlson M, Elder J, Ferda A, Taege S, Ueland F, Shelton B, Slone S, DeSimone C. Selective versus systematic lymphadenectomy for endometrial cancer: A cohort survival analysis. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Podzielinski I, Saunders B, Kimbler K, Ferguson K, Branscum A, Fung E, DePriest P, Van Nagell J, Ueland F, Baron A. Apolipoproteins are highly expressed in malignant ovarian cyst fluids. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elder J, Mattingly M, Ferda A, DeSimone C, Ware R, Ueland F, van Nagell J, Carlson J, Seamon L. The use of bevacizumab and cytotoxic and consolidation chemotherapy for the upfront treatment of advanced ovarian cancer: Practice patterns among medical and gynecologic oncology SGO members. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seamon L, Podzielinski I, Huang B, DeSimone C, Shelton B, Randall M, Ware R, van Nagell J, Cibull M, Ueland F. Survival following ovarian versus uterine carcinosarcoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Miller R, DeSimone C, Ueland F, Seamon L, Podzielinski I, Goodrich S, Elder J, Pavlik E, van Nagell J. Long-term survival of patients with epithelial ovarian cancer detected by sonographic screening. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pavlik E, DeSimone C, Miller R, Podzielinski I, Ubellacker J, Goodrich S, Ueland F, Seamon L, Kryscio R, van Nagell J. Women without ovarian cancer reporting disease-specific symptoms. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ueland F, DeSimone C, Seamon L, Miller R, Goodrich S, Podzielinski I, Sokoll L, Smith A, van Nagell J, Zhang Z. OVA1 has high sensitivity in identifying ovarian malignancy compared with preoperative assessment and CA-125. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baldwin L, Ware R, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Vannagell J, Ueland F, Seamon LG. Ten-year relative suvival for ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ware R, Baldwin L, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Ueland F, Vannagell J, Seamon LG. Relative conditional survival in 41,476 patients with ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cooper A, Nelson D, Doran S, Ueland F, DeSimone C, DePriest P, McDonald J, Saunders B, Ware R, Pavlik E, Kryscio R, Karpf M, van Nagell J, Radestad A. Testosterone Treatment in Women – An Overview. CWHR 2009. [DOI: 10.2174/157340409787721267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Louis L, Christophe S, Cooper A, Nelson D, Doran S, Ueland F, DeSimone C, DePriest P, McDonald J, Saunders B, Ware R, Pavlik E, Kryscio R, Karpf M, van Nagell J. Long-Term Survival and Cost of Treatment in Patients with Stage IIIC Epithelial Ovarian Cancer. CWHR 2009. [DOI: 10.2174/157340409787721294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Makhija S, Glenn D, Ueland F, Dizon D, Paton V, Lin C, Amler L, Sliwkowski M, Strauss A, Matulonis U. 5002 ORAL Results from a Phase II randomized, placebo-controlled, double-blind trial suggest improved PFS with the addition of pertuzumab to gemcitabine in patients with platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Makhija S, Glenn D, Ueland F, Gold M, Dizon D, Paton V, Birkner M, Lin C, Derynck M, Matulonis U. Results from a phase II randomized, placebo-controlled, double-blind trial suggest improved PFS with the addition of pertuzumab to gemcitabine in patients with platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5507 Background: Pertuzumab (P) is a humanized monoclonal antibody that blocks the ability of HER2 to heterodimerize with other HER/ErbB receptors. As a single agent, P has demonstrated clinical activity in relapsed/refractory epithelial ovarian cancer (EOC). Since platinum-resistant (CDDP-R) EOC remains a difficult disease to treat, this phase II study was conducted to determine if addition of P to gemcitabine (G) would improve results. Methods: Patients with CDDP-R EOC (including ovarian, fallopian tube, or primary peritoneal cancer) who had received up to one prior treatment for CDDP-R disease were randomized to Gem 800 mg/m2 on D1, 8 of a 21-day cycle ± P or placebo (pl). P was given as an 840 mg initial dose followed by 420mg IV every 3 weeks. Tumor response was assessed by RECIST every 6 weeks using GOG criteria. The primary endpoint was progression free survival (PFS). Results: One hundred thirty patients (n = 65 each treatment cohort) were treated. Clinical characteristics were balanced between the treatment groups. Pts received a median of 2 prior regimens (range 1–6) for EOC. Based on 83 events, the adjusted hazard ratio for PFS was 0.67 (95% CI: 0.43–1.02), p =0.06 in favor of P+Gem. The median PFS was 3.0 months (0–8.7 months) vs. 2.6 months (0–9+ months), and the PFS rate at 4 months was 49% vs. 34% in the P+Gem and Gem/pl arms, respectively. The most common AEs increased in the P-treated pts were fatigue, nausea, diarrhea, back pain, Gr 3–4 neutropenia, rash, headache, stomatitis, epistaxis, and rhinorrhea. Clinically significant CHF was reported in one patient in the pertuzumab cohort. There was no imbalance in the LVEF results between treatment arms. One patient who received pertuzumab + gemcitabine experienced an adverse event that resulted in death (hemolytic-uremic syndrome). Conclusions: These data suggest that pertuzumab may add activity to gemcitabine as reflected by improvements in PFS in patients with CDDP-R ovarian, primary peritoneal, or fallopian tube cancer. Survival data will be presented at ASCO. No significant financial relationships to disclose.
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Affiliation(s)
- S. Makhija
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Glenn
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - F. Ueland
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Gold
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Dizon
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - V. Paton
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Birkner
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - C. Lin
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Derynck
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - U. Matulonis
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
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Glenn D, Ueland F, Bicher A, Dizon D, Gold M, Makhija S, Fleming GF, Matulonis U, McGuire WP, Lieberman G. A randomized phase II trial with gemcitabine with or without pertuzumab (rhuMAb 2C4) in platinum-resistant ovarian cancer (OC): Preliminary safety data. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13001 Background: Pertuzumab (P), a humanized HER2 antibody, represents a new class of targeted agents called HER dimerization inhibitors (HDIs). P inhibits dimerization of HER2 with EGFR, HER3 and HER4, and subsequently inhibits signaling through MAP and PI3 kinases. Single agent P has demonstrated clinical benefit in advanced OC (ASCO 2005 abstract #5051). Methods: 40 pts with platinum-resistant OC (progressed within 6 months of receiving a platinum-based chemotherapy) were enrolled in this 1:1 randomized, double blind, placebo controlled trial of gemcitabine with or without P. Gemcitabine was administered IV on day 1 and 8 at 800 mg/m2 of a 21 day cycle. Blinded placebo or 420 mg P was administered IV on day 1. Gemcitabine was dose reduced for neutropenia or thrombocytopenia. P was not dose reduced. Results: 40 pts have been enrolled and treated with at least 1 cycle of gemcitabine in combination with blinded study drug. The median age was 58.5 (range 18–82); 26 had PS ECOG 0, 13 ECOG 1, 1 ECOG 2. The most common grade 3/4 events were neutropenia in 7 pts (17.5%), thrombocytopenia in 6 pts (15%), small bowel obstruction in 4 pts (10%), constipation in 3 pts (7.5%) and elevated ALT in 3 pts (7.4%). There was one grade 3 diarrhea, but no grade 3 or 4 rash. There were 4 serious adverse events (SAEs) attributed to study drug. These were a pleural effusion, thrombocytopenia, febrile neutropenia, and a deep vein thrombosis. Nine pts required one or two dose reductions of gemcitabine for hematological toxicity. Of 29 pts with post-baseline echo or MUGA values obtained, no pt had LVEF drop to <50%. The adverse events evaluated after 40 pts did not meet the prespecified criteria to call for an independent safety monitoring board evaluation of unblinded data. Conclusions: Preliminary safety data indicate that pertuzumab or placebo combined with gemcitabine is well tolerated with no unexpected additive toxicity. The nature and frequency of the adverse events are similar to what has been observed with either single agent gemcitabine or P. Updated data will be presented at ASCO. [Table: see text]
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Affiliation(s)
- D. Glenn
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - F. Ueland
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - A. Bicher
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - D. Dizon
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - M. Gold
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - S. Makhija
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - G. F. Fleming
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - U. Matulonis
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - W. P. McGuire
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
| | - G. Lieberman
- Sharp Rees Stealy Medical Group, San Diego, CA; University of Kentucky, Lexington, KY; Northern Virginia Pelvic Surgery Associates, Annandale, VA; Women & Infants Hospital, Providence, RI; Oklahoma University Medical Center, Oklahoma City, OK; University of Alabama, Birmingham, AL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Franklin Square Hospital Center, Baltimore, MD; Genentech, Inc., South San Francisco, CA
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Disis ML, Rivkin SE, Baron A, Markman M, Connolly D, Ueland F, Kohn E, Trimble E, Berek JS. Progress in ovarian cancer research: Proceedings of the 5th Biennial Ovarian Cancer Research Symposium. Int J Gynecol Cancer 2006; 16:463-9. [PMID: 16681712 DOI: 10.1111/j.1525-1438.2006.00559.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Ovarian cancer remains the most lethal gynecological malignancy. The 5th Biennial Symposium overviewed the progress of ovarian cancer research over the last few years. Molecularly based technologies have allowed the identification of multiple biomarkers to aid in ovarian cancer diagnosis and treatment. Furthermore, data analysis systems evaluating the behavior of these markers have been designed. Therapeutic use of ovarian cancer protein markers has been fueled by the development of animal models that more closely simulate the pathogenesis of ovarian cancer, and multiple new therapies are being developed that may have impact against the disease. Finally, the design of clinical trials both for ovarian cancer treatment and prevention are key in advancing the science of ovarian cancer into the clinic. The need for strategies that would optimize patient participation in clinical trials is paramount.
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Affiliation(s)
- M L Disis
- University of Washington, Seattle, Washington, USA.
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24
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Reedy MB, Richards WE, Ueland F, Uy K, Lee EY, Bryant C, van Nagell JR. Ovarian steroid cell tumors, not otherwise specified: a case report and literature review. Gynecol Oncol 1999; 75:293-7. [PMID: 10525390 DOI: 10.1006/gyno.1999.5549] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Steroid cell tumors, not otherwise specified, are rare ovarian sex cord-stromal tumors with malignant potential. The majority of these tumors produce steroids with testosterone being the most common. A case of a 46-year-old woman who presented with sudden onset of virilization and a pelvic mass is reported. Various aspects of the presentation, diagnosis, and treatment of these tumors are discussed.
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Affiliation(s)
- M B Reedy
- Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center, Lexington, Kentucky 40536-0298, USA
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