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Siefker-Radtke AO, Necchi A, Park SH, García-Donas J, Huddart RA, Burgess EF, Fleming MT, Rezazadeh Kalebasty A, Mellado B, Varlamov S, Joshi M, Duran I, Tagawa ST, Zakharia Y, Akapame S, Santiago-Walker AE, Monga M, O'Hagan A, Loriot Y, Loriot Y, Park SH, Tagawa S, Flechon A, Alexeev B, Varlamov S, Huddart R, Burgess E, Rezazadeh A, Siefker-Radtke A, Vano Y, Gasparro D, Hamzaj A, Kopyltsov E, Gracia Donas J, Mellado B, Parikh O, Schatteman P, Culine S, Houédé N, Zanetta S, Facchini G, Scagliotti G, Schinzari G, Lee JL, Shkolnik M, Fleming M, Joshi M, O'Donnell P, Stöger H, Decaestecker K, Dirix L, Machiels JP, Borchiellini D, Delva R, Rolland F, Hadaschik B, Retz M, Rosenbaum E, Basso U, Mosca A, Lee HJ, Shin DB, Cebotaru C, Duran I, Moreno V, Perez Gracia JL, Pinto A, Su WP, Wang SS, Hainsworth J, Schnadig I, Srinivas S, Vogelzang N, Loidl W, Meran J, Gross Goupil M, Joly F, Imkamp F, Klotz T, Krege S, May M, Schultze-Seemann W, Strauss A, Zimmermann U, Keizman D, Peer A, Sella A, Berardi R, De Giorgi U, Sternberg CN, Rha SY, Bulat I, Izmailov A, Matveev V, Vladimirov V, Carles J, Font A, Saez M, Syndikus I, Tarver K, Appleman L, Burke J, Dawson N, Jain S, Zakharia Y. Efficacy and safety of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma: long-term follow-up of a phase 2 study. Lancet Oncol 2022; 23:248-258. [PMID: 35030333 DOI: 10.1016/s1470-2045(21)00660-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Erdafitinib, a pan-fibroblast growth factor receptor (FGFR) tyrosine kinase inhibitor, was shown to be clinically active and tolerable in patients with advanced urothelial carcinoma and prespecified FGFR alterations in the primary analysis of the BLC2001 study at median 11 months of follow-up. We aimed to assess the long-term efficacy and safety of the selected regimen of erdafitinib determined in the initial part of the study. METHODS The open-label, non-comparator, phase 2, BLC2001 study was done at 126 medical centres in 14 countries across Asia, Europe, and North America. Eligible patients were aged 18 years or older with locally advanced and unresectable or metastatic urothelial carcinoma, at least one prespecified FGFR alteration, an Eastern Cooperative Oncology Group performance status of 0-2, and progressive disease after receiving at least one systemic chemotherapy or within 12 months of neoadjuvant or adjuvant chemotherapy or were ineligible for cisplatin. The selected regimen determined in the initial part of the study was continuous once daily 8 mg/day oral erdafitinib in 28-day cycles, with provision for pharmacodynamically guided uptitration to 9 mg/day (8 mg/day UpT). The primary endpoint was investigator-assessed confirmed objective response rate according to Response Evaluation Criteria In Solid Tumors version 1.1. Efficacy and safety were analysed in all treated patients who received at least one dose of erdafitinib. This is the final analysis of this study. This study is registered with ClinicalTrials.gov, NCT02365597. FINDINGS Between May 25, 2015, and Aug 9, 2018, 2328 patients were screened, of whom 212 were enrolled and 101 were treated with the selected erdafitinib 8 mg/day UpT regimen. The data cutoff date for this analysis was Aug 9, 2019. Median efficacy follow-up was 24·0 months (IQR 22·7-26·6). The investigator-assessed objective response rate for patients treated with the selected erdafitinib regimen was 40 (40%; 95% CI 30-49) of 101 patients. The safety profile remained similar to that in the primary analysis, with no new safety signals reported with longer follow-up. Grade 3-4 treatment-emergent adverse events of any causality occurred in 72 (71%) of 101 patients. The most common grade 3-4 treatment-emergent adverse events of any cause were stomatitis (in 14 [14%] of 101 patients) and hyponatraemia (in 11 [11%]). There were no treatment-related deaths. INTERPRETATION With longer follow-up, treatment with the selected regimen of erdafitinib showed consistent activity and a manageable safety profile in patients with locally advanced or metastatic urothelial carcinoma and prespecified FGFR alterations. FUNDING Janssen Research & Development.
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Affiliation(s)
- Arlene O Siefker-Radtke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Andrea Necchi
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jesús García-Donas
- Medical Oncology Department, Fundacion Hospital de Madrid and IMMA Medicine Faculty, San Pablo CEU University, Madrid, Spain
| | - Robert A Huddart
- Section of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Earle F Burgess
- Medical Oncology Department, Levine Cancer Institute, Charlotte, NC, USA
| | - Mark T Fleming
- Medical Oncology Department, Virginia Oncology Associates, US Oncology Research, Norfolk, VA, USA
| | | | - Begoña Mellado
- Medical Oncology Department, Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Sergei Varlamov
- Department of Urologic Oncology, Altai Regional Cancer Center, Barnaul, Russia
| | - Monika Joshi
- Department of Medicine, Penn State Cancer Institute, Hershey, PA, USA
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Yousef Zakharia
- Department of Internal Medicine, University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | | | | | - Manish Monga
- Janssen Research & Development, Spring House, PA, USA
| | - Anne O'Hagan
- Janssen Research & Development, Spring House, PA, USA
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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McFarlane JJ, Kochenderfer MD, Olsen MR, Bauer TM, Molina A, Hauke RJ, Reeves JA, Babu S, Van Veldhuizen P, Somer B, Gunuganti V, Schnadig I, George S, Page RD, Arrowsmith E, Jain RK, Zhang J, McHenry MB, Johansen JL, Vogelzang NJ. Safety and Efficacy of Nivolumab in Patients With Advanced Clear Cell Renal Cell Carcinoma: Results From the Phase IIIb/IV CheckMate 374 Study. Clin Genitourin Cancer 2020; 18:469-476.e4. [PMID: 32641261 DOI: 10.1016/j.clgc.2020.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/17/2020] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The open-label, phase IIIb/IV CheckMate 374 study (NCT02596035) was conducted to validate the safety and efficacy of flat-dose nivolumab monotherapy 240 mg every 2 weeks (Q2W) in previously treated advanced/metastatic renal cell carcinoma (RCC). Three cohorts included patients with predominantly clear cell histology, non-clear cell histologies, or brain metastases. We report safety and efficacy from the CheckMate 374 advanced clear cell RCC (ccRCC) cohort. PATIENTS AND METHODS Eligible patients received prior treatment regimens (1-2 antiangiogenic; 0-3 systemic) with progression on/after last treatment and ≤ 6 months of enrollment. Patients received nivolumab 240 mg Q2W for ≤ 24 months or until confirmed progression/unacceptable toxicity. The primary endpoint was incidence of high-grade (grade 3-5) immune-mediated adverse events (IMAEs). Exploratory endpoints included objective response rate, progression-free survival, and overall survival. RESULTS Ninety-seven patients had advanced predominantly ccRCC; 75.3% received only 1 prior systemic regimen in the advanced/metastatic setting. After a median follow-up of 17 months (range, 0.4-26.9 months), no grade 5 IMAEs occurred, and 9.3% of patients reported grade 3/4 IMAEs (hepatitis, 4.1%; diabetes mellitus, 2.1%; nephritis and renal dysfunction, 1.0%; rash, 1.0%; adrenal insufficiency, 1.0%). The objective response rate was 22.7% (95% confidence interval [CI], 14.8%-32.3%). Three patients had a complete response; 19 had partial responses. The median progression-free survival was 3.6 months (95% CI, 2.0-5.5 months). The median overall survival was 21.8 months (95% CI, 17.4 months to not estimable). CONCLUSIONS This study validates the safety and efficacy of nivolumab 240 mg Q2W flat-dose monotherapy for previously treated advanced ccRCC and adds to previous safety and efficacy data using the 3 mg/kg Q2W dose.
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Affiliation(s)
| | | | - Mark R Olsen
- Medical Oncology, Oklahoma Cancer Specialists, Tulsa, OK
| | - Todd M Bauer
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | - Ana Molina
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - James A Reeves
- Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN
| | | | | | - Vijay Gunuganti
- Department of Oncology, Cancer Care Centers of South Texas, San Antonio, TX
| | | | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | - Edward Arrowsmith
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Chattanooga, TN
| | - Rohit K Jain
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
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Vogelzang NJ, Olsen MR, McFarlane JJ, Arrowsmith E, Bauer TM, Jain RK, Somer B, Lam ET, Kochenderfer MD, Molina A, Doshi G, Lingerfelt B, Hauke RJ, Gunuganti V, Schnadig I, Van Veldhuizen P, Fleming M, Galamaga R, Gupta M, Hool H, Hutson T, Zhang J, McHenry MB, Johansen JL, Tykodi SS. Safety and Efficacy of Nivolumab in Patients With Advanced Non-Clear Cell Renal Cell Carcinoma: Results From the Phase IIIb/IV CheckMate 374 Study. Clin Genitourin Cancer 2020; 18:461-468.e3. [PMID: 32718906 DOI: 10.1016/j.clgc.2020.05.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The open-label phase IIIb/IV CheckMate 374 study (NCT02596035) was conducted to validate the safety and efficacy of flat-dose nivolumab 240 mg every 2 weeks (Q2W) in previously treated advanced/metastatic renal cell carcinoma. Three cohorts included patients with predominantly clear cell histology, non-clear cell histologies, or brain metastases. We report safety and efficacy from the advanced non-clear cell RCC (nccRCC) cohort of CheckMate 374. METHODS Eligible patients received 0 to 3 prior systemic therapies. Patients received nivolumab 240 mg Q2W for ≤24 months or until confirmed progression or unacceptable toxicity. The primary endpoint was incidence of high-grade (grade 3-5) immune-mediated adverse events (IMAEs). Exploratory endpoints included objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). RESULTS Forty-four patients had advanced nccRCC (papillary [n = 24], chromophobe [n = 7], unclassified [n = 8], other [n = 5]); 34.1% received ≥1 prior systemic regimen in the advanced/metastatic setting. With median follow-up of 11 (range, 0.4-27) months, no all-cause grade 3-5 IMAEs or treatment-related grade 5 adverse events were reported. ORR was 13.6% (95% confidence interval [CI], 5.2-27.4), with 1 complete response (chromophobe) and 5 partial responses (papillary [n = 2], chromophobe [n = 1], collecting duct [n = 1], and unclassified [n = 1] histology). Median PFS was 2.2 months (95% CI, 1.8-5.4). Median OS was 16.3 months (95% CI, 9.2-not estimable). CONCLUSIONS Safety of flat-dose nivolumab 240 mg Q2W was consistent with previous results. Clinically meaningful efficacy was observed with responses in several histologies, supporting nivolumab as a treatment option for patients with advanced nccRCC, a patient population with high unmet need.
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Affiliation(s)
| | - Mark R Olsen
- Medical Oncology, Oklahoma Cancer Specialists, Tulsa, OK
| | | | - Edward Arrowsmith
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Chattanooga, TN
| | - Todd M Bauer
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | - Rohit K Jain
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Elaine T Lam
- Medical Oncology, University of Colorado Cancer Center, Aurora, CO
| | | | - Ana Molina
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Brian Lingerfelt
- Department of Medical Oncology and Hematology, Charleston Oncology, Charleston, SC
| | | | - Vijay Gunuganti
- Department of Oncology, Cancer Care Centers of South Texas, San Antonio, TX
| | | | | | - Mark Fleming
- Virginia Oncology Associates, US Oncology Research, Norfolk, VA
| | - Robert Galamaga
- Department of Hematology/Oncology Illinois Cancer Specialists, Niles, IL
| | - Mukul Gupta
- Department of Medical Oncology and Hematology, Sansum Clinic, Santa Barbara, CA
| | - Hugo Hool
- Department of Oncology and Hematology, Torrance Memorial Medical Center, Torrance, CA
| | - Thomas Hutson
- Texas Oncology, Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | | | | | | | - Scott S Tykodi
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Sartor AO, Higano CS, Cooperberg MR, Vogelzang NJ, Dakhil SR, Pieczonka CM, Vacirca J, Concepcion RS, Tutrone RF, Nordquist LT, Olsson CA, Penson DF, Schnadig I, Bailen JL, Mehlhaff B, Chang NN, Sheikh NA, Brown B, Armstrong AJ. Sipuleucel-T (sip-T) overall survival (OS) and clinical outcomes by baseline (BL) prostate-specific antigen (PSA) quartiles in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): PROCEED registry. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5041] [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)
| | - Celestia S. Higano
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | - Jeff Vacirca
- New York Cancer and Blood Specialists, New York, NY
| | | | | | | | - Carl A Olsson
- Integrated Medical Professionals, PLLC, Columbia University Medical Center, North Hills, NY
| | | | - Ian Schnadig
- Compass Oncology, US Oncology Research, Tualatin, OR
| | | | | | | | | | - Bruce Brown
- Dendreon Pharmaceuticals LLC, Seattle, WA, US
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Rapoport BL, Aapro M, Chasen MR, Jordan K, Navari RM, Schnadig I, Schwartzberg L. Recent developments in the clinical pharmacology of rolapitant: subanalyses in specific populations. Drug Des Devel Ther 2017; 11:2621-2629. [PMID: 28919712 PMCID: PMC5592904 DOI: 10.2147/dddt.s133943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Knowledge of the involvement of the neurokinin substance P in emesis has led to the development of the neurokinin-1 receptor antagonists (NK-1 RAs) for control of chemotherapy-induced nausea and vomiting (CINV), in combination with serotonin type 3 receptor antagonists and corticosteroids. The NK-1 RA rolapitant, recently approved in oral formulation, has nanomolar affinity for the NK-1 receptor, as do the other commercially available NK-1 RAs, aprepitant and netupitant. Rolapitant is rapidly absorbed and has a long half-life in comparison to aprepitant and netupitant. All three NK-1 RAs undergo metabolism by cytochrome P450 (CYP) 3A4, necessitating caution with the concomitant use of CYP3A4 inhibitors, but in contrast to aprepitant and netupitant, rolapitant does not inhibit or induce CYP3A4. However, rolapitant is a moderate inhibitor of CYP2D6, and concomitant use with CYP2D6 substrates with narrow therapeutic indices should be avoided. Aprepitant, netupitant, and rolapitant have all demonstrated efficacy in the control of delayed CINV in patients receiving moderately and highly emetogenic chemotherapy in randomized controlled trials, including over multiple cycles of chemotherapy. We reviewed recent post hoc analyses of clinical trial data demonstrating that rolapitant is efficacious in the control of CINV in patient populations with specific tumor types, namely, breast cancers, gastrointestinal/colorectal cancers, and lung cancers. In addition, we show that rolapitant has efficacy in the control of CINV in specific age groups of patients receiving chemotherapy (<65 and ≥65 years of age). Overall, the safety profile of rolapitant in these specific patient populations was consistent with that observed in primary analyses of phase 3 trials.
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Affiliation(s)
| | - Matti Aapro
- Breast Center, Genolier Cancer Center, Genolier, Switzerland
| | - Martin R Chasen
- Palliative Care, William Osler Health Services, Brampton, ON, Canada
| | - Karin Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Rudolph M Navari
- Division of Hematology Oncology, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Ian Schnadig
- Compass Oncology, US Oncology Research, Tualatin, OR, USA
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Navari R, Jordan K, Rapoport B, Schnadig I, Chasen M, Arora S, Powers D, Schwartzberg L. Efficacy of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with gastrointestinal and colorectal cancers. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.08] [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: 11/12/2022] Open
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Schwartzberg L, Jordan K, Rapoport B, Schnadig I, Chasen M, Arora S, Barbour S, Powers D, Navari R. Safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving breast cancer resistant protein (BCRP) substrate chemotherapy agents. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.10] [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: 11/13/2022] Open
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Schwartzberg L, Mosier M, Payne Y, Klepper M, Schnadig I. Phase 3 trial of APF530 vs. ondansetron, each with a neurokinin 1 antagonist and corticosteroid, for prevention of chemotherapy-induced nausea and vomiting in highly emetogenic chemotherapy regimens (MAGIC Trial): Outcomes in cisplatin-based regimen. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.125] [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: 11/17/2022]
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Schnadig I, Braun E, Mosier M, Geller RB, Schwartzberg LS. Effect of APF530 on health-related quality of life (QOL) and other chemotherapy-induced nausea and vomiting (CINV) end points: Phase III MAGIC trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- Ian Schnadig
- Compass Oncology, US Oncology Research, Tualatin, OR
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Schwartzberg LS, Gabrail NY, Hrom JS, Vogelzang NJ, Mosier M, Geller RB, Schnadig I. Phase III MAGIC trial of APF530 v ondansetron (Ond) with fosaprepitant (Fos) + dexamethasone (Dex) for highly emetogenic chemotherapy (HEC)-induced nausea and vomiting: analysis by age and gender. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Ian Schnadig
- Compass Oncology, US Oncology Research, Tualatin, OR
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Borate U, Mehta A, Reddy V, Tsai M, Josephson N, Schnadig I. Treatment of CD30-positive systemic mastocytosis with brentuximab vedotin. Leuk Res 2016; 44:25-31. [DOI: 10.1016/j.leukres.2016.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 12/20/2022]
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Bowles DW, Kochenderfer M, Cohn A, Sideris L, Nguyen N, Cline-Burkhardt V, Schnadig I, Choi M, Nabell L, Chaudhry A, Ruxer R, Ucar A, Hausman D, Walker L, Spira A, Jimeno A. A Randomized, Phase II Trial of Cetuximab With or Without PX-866, an Irreversible Oral Phosphatidylinositol 3-Kinase Inhibitor, in Patients With Metastatic Colorectal Carcinoma. Clin Colorectal Cancer 2016; 15:337-344.e2. [PMID: 27118441 DOI: 10.1016/j.clcc.2016.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/12/2016] [Accepted: 03/22/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase/mammalian target of rapamycin signaling pathway is frequently altered in colorectal cancer (CRC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. This randomized phase II study evaluated cetuximab with or without PX-866 in patients with metastatic, anti-epidermal growth factor receptor-naive, KRAS codon 12 and 13 wild-type CRC. PATIENTS AND METHODS Patients with metastatic CRC who had received both oxaliplatin and irinotecan were randomized (1:1) to cetuximab (400 mg/m2 loading then 250 mg/m2 weekly) with or without PX-866 (8 mg orally daily; arms A and B, respectively). The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate, overall survival (OS), toxicity, and correlation of relevant biomarkers with efficacy outcomes. RESULTS A total of 85 patients were enrolled. The median PFS was 59 days versus 104 days for arms A (cetuximab + PX-866) and B (cetuximab alone), respectively (P = .77). OS between the 2 arms (266 vs. 333 days for arm A vs. B) were similar (P = .83). Overall toxicity, including treatment-related toxicity, was higher in arm A compared with arm B, especially in terms of all-grade nausea (66% vs. 37%), vomiting (50% vs. 29%), diarrhea (64% vs. 18%), and rash (66% vs. 37%). Grade 3 diarrhea occurred in 19% of patients in Arm A and 0% in Arm B. PIK3CA mutations and PTEN loss by immunohistochemistry were infrequently seen. CONCLUSION The addition of PX-866 to cetuximab did not improve PFS, objective response rate, or OS in patients with metastatic CRC. The combination arm had greater toxicity and may have been harmful in this study.
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Affiliation(s)
- Daniel W Bowles
- Denver Veterans Affairs Medical Center, Denver, CO; Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO.
| | | | - Allen Cohn
- Rocky Mountain Cancer Centers, Denver, CO
| | - Lucas Sideris
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Nghia Nguyen
- Centre de Sante et de Services Sociaux Champlin-Charles-LeMoyne, Longueuil, Quebec, Canada
| | | | | | | | - Lisle Nabell
- University of Alabama-Birmingham, Birmingham, AL
| | | | | | | | | | | | | | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO
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Schnadig I, Agajanian R, Dakhil S, Taylor C, Wilks S, Cooper W, Mosier M, Payne Y, Klepper M, Vacirca J. Abstract P1-10-07: Phase 3 comparison of APF530 versus ondansetron, each in a guideline-recommended 3-drug regimen for prevention of chemotherapy-induced nausea and vomiting due to anthracycline + cyclophosphamide (AC)–based highly emetogenic chemotherapy (HEC) regimens: A post hoc subgroup analysis of the MAGIC trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Managing delayed chemotherapy-induced nausea and vomiting (CINV) associated with HEC is an unmet need. AC-based HEC is often administered to breast cancer patients (pts), a mostly female, high-CINV-risk population. APF530, an extended-release formulation of granisetron, demonstrated superior complete response (CR; no emesis [vomiting, retching] + no rescue medication use) in delayed-phase (>24-120 h) CINV with HEC (ASCO criteria) vs ondansetron (Ond) (65% vs 57%, P=0.014), each combined with a neurokinin-1 antagonist and dexamethasone (Dex) (NCT02106494). This post hoc analysis evaluated efficacy and safety of APF530 in pts receiving AC-based therapy.
Methods: In this randomized, double-blind, multicenter trial, pts scheduled to receive single-day HEC were stratified by cisplatin ≥50 mg/m2 yes/no and randomized 1:1 to APF530 500 mg SC (granisetron 10 mg) or Ond 0.15 mg/kg IV. Pts received concomitant Dex 12 mg IV and fosaprepitant 150 mg IV on day 1 and oral Dex on days 2-4. The primary end point was CR in the delayed phase. Secondary and other end points included CR in acute (0-24 h) and overall (0-120 h) phases, and complete control (CC; CR and no more than mild nausea) and total response (TR; CR and no nausea) in acute, delayed, and overall phases. Rates were compared using 95% confidence intervals (CIs) for treatment differences; post hoc analysis was not powered to detect treatment differences in the AC subgroup. Safety assessments included adverse events (AEs), injection-site reactions (ISRs), laboratory parameters, and vital signs.
Results: A total of 589/902 pts (65%) in the modified intent-to-treat population received AC-based HEC (APF530 291, Ond 298). Baseline demographics were balanced between treatment arms. The majority of pts in the AC subgroup were female (APF530 99%, Ond 98%). Delayed-phase CR was higher with APF530 vs Ond, approaching statistical significance (APF530 64%, Ond 56%; P=0.062) in the AC subgroup, similar to the benefit seen in the larger study. No appreciable benefit of APF530 vs Ond was observed in the acute phase, and trends favorable to APF530 were observed in the overall phase (Table). APF530 was well tolerated. Most AEs were ISRs, generally mild or moderate, and resolved by end of study.
Phase, n (%)APF530OndansetronTreatment DifferenceN=291N=298(95% CI), %Complete responseDelayed185 (64)167 (56)8 (-0.4, 15.4)Overall163 (56)153 (51)5 (-3.4, 12.7)Acute205 (70)204 (69)1 (-5.4, 9.4)Complete controlDelayed171 (59)156 (52)7 (-1.6, 14.4)Overall149 (51)143 (48)3 (-4.9, 11.3 )Acute193 (66)191 (64)2 (-5.5, 9.9)Total responseDelayed119 (41)107 (36)5 (-2.9, 12.8)Overall100 (34)94 (32)2 (-4.8, 10.4)Acute164 (56)173 (58)-2 (-9.7, 6.3)
Conclusions: APF530 demonstrated an apparent clinical benefit in delayed-phase CR in pts receiving AC-based HEC, concordant with the statistically significant benefit seen in the overall study population. Prevention of CINV in this patient population continues to be a treatment challenge and further investigation is needed.
Citation Format: Schnadig I, Agajanian R, Dakhil S, Taylor C, Wilks S, Cooper W, Mosier M, Payne Y, Klepper M, Vacirca J. Phase 3 comparison of APF530 versus ondansetron, each in a guideline-recommended 3-drug regimen for prevention of chemotherapy-induced nausea and vomiting due to anthracycline + cyclophosphamide (AC)–based highly emetogenic chemotherapy (HEC) regimens: A post hoc subgroup analysis of the MAGIC trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-07.
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Affiliation(s)
- I Schnadig
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - R Agajanian
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - S Dakhil
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - C Taylor
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - S Wilks
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - W Cooper
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - M Mosier
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - Y Payne
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - M Klepper
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
| | - J Vacirca
- Compass Oncology, US Oncology Network, Tualatin, OR; The Oncology Institute of Hope and Innovation, Whittier, CA; Cancer Center of Kansas, Wichita, KS; Tulsa Cancer Institute, Tulsa, OK; Cancer Care Centers of South Texas, San Antonio, TX; TFS International, Flemington, NJ; EMB Statistical Solutions, LLC, Overland Park, KS; Heron Therapeutics, Redwood City, CA; Drug Safety Navigator, LLC, Durham, NC; North Shore Hematology Oncology, East Setauket, NY
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Rapoport B, Schwartzberg L, Chasen M, Poma A, Arora S, Navari R, Schnadig I. 1525 Rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV): Efficacy and safety over multiple cycles of highly or moderately emetogenic chemotherapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30615-3] [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: 11/15/2022]
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Chasen M, Urban L, Schnadig I, Rapoport BL, Poma A, Arora S, Navari RM, Schwartzberg LS, Gridelli C. Impact of rolapitant on quality of life (QoL) in patients (pts) receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Martin Chasen
- Palliative Care, at The Ottawa Hospital Cancer Centre and the Medical Director of the Palliative Rehabilitation Program at the Élisabeth Bruyère Hospital, Ottawa, Ottawa, ON, Canada
| | | | - Ian Schnadig
- Compass Oncology, US Oncology Research, McKesson Specialty Health, Tualatin, OR
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16
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Jimeno A, Bauman JE, Weissman C, Adkins D, Schnadig I, Beauregard P, Bowles DW, Spira A, Levy B, Seetharamu N, Hausman D, Walker L, Rudin CM, Shirai K. A randomized, phase 2 trial of docetaxel with or without PX-866, an irreversible oral phosphatidylinositol 3-kinase inhibitor, in patients with relapsed or metastatic head and neck squamous cell cancer. Oral Oncol 2015; 51:383-8. [PMID: 25593016 PMCID: PMC4857706 DOI: 10.1016/j.oraloncology.2014.12.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [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: 10/16/2014] [Revised: 11/25/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase (AKT)/mammalian target of rapamycin (mTOR) signaling pathway is frequently altered in head and neck squamous cell cancer (HNSCC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. Preclinical models revealed synergy with docetaxel and a phase 1 trial demonstrated tolerability of this combination. This randomized phase 2 study evaluated PX-866 combined with docetaxel in patients with advanced, refractory HNSCC. METHODS Patients with locally advanced, recurrent or metastatic HNSCC who had received at least one and no more than two prior systemic treatment regimens were randomized (1:1) to a combination of docetaxel (75mg/m(2) IV every 21days) with or without PX-866 (8mg PO daily; Arms A and B, respectively). The primary endpoint was progression free survival (PFS). Secondary endpoints included objective response rate (RR), overall survival (OS), toxicity, and correlation of biomarker analyses with efficacy outcomes. RESULTS 85 patients were enrolled. There was a non-significant improvement in response rate in the combination arm (14% vs. 5%; P=0.13). Median PFS was 92days in Arm A and 82days in Arm B (P=0.42). There was no difference in OS between the two arms (263 vs. 195days; P=0.62). Grade 3 or higher adverse events were infrequent, but more common in the combination arm with respect to diarrhea (17% vs. 2%), nausea (7% vs. 0%), and febrile neutropenia (21% vs. 5%); grade 3 or higher anemia was more frequent in arm B (7% vs. 27%). PIK3CA mutations or PTEN loss were infrequently observed. CONCLUSION The addition of PX-866 to docetaxel did not improve PFS, RR, or OS in patients with advanced, refractory HNSCC without molecular pre-selection.
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Affiliation(s)
- Antonio Jimeno
- University of Colorado School of Medicine, Aurora, CO, United States.
| | - Julie E Bauman
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States
| | | | | | - Ian Schnadig
- Compass Oncology, Tualatin, OR, United States; US Oncology Research, The Woodlands, TX, United States
| | | | - Daniel W Bowles
- University of Colorado School of Medicine, Aurora, CO, United States; Denver Veterans Affairs Medical Center, Denver, CO, United States
| | - Alexander Spira
- Virginia Cancer Specialists, Fairfax, VA, United States; US Oncology Research, The Woodlands, TX, United States
| | - Benjamin Levy
- Beth Israel Hospital, St. Luke's Hospital, Mount Sinai Health System, New York, NY, United States
| | | | | | - Luke Walker
- Oncothyreon Inc., Seattle, WA, United States
| | | | - Keisuke Shirai
- Medical University of South Carolina, Charleston, SC, United States
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17
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Braiteh FS, Sharman JP, Richards DA, Skelton MR, DeMarco LC, Vukelja S, Schnadig I, Wilks S, Yasenchak CA, Goldschmidt JH, Resta R, Richey SL, Smith JW, Asmar L, Wang Y, Morcos A, Locke T, Li Y, Palmer GA. Effect of clinical NGS-based cancer genomic profiling on physician treatment decisions in advanced solid tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.11109] [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)
- Fadi S. Braiteh
- Comprehensive Cancer Centers of Nevada, Las Vegas, NV, and US Oncology Research, Houston, TX
| | - Jeff Porter Sharman
- Willamette Valley Cancer Institute and Research Center/US Oncology Research, Springfield, OR
| | - Donald A. Richards
- Tyler Cancer Center, US Oncology Research, McKesson Specialty Health, Houston, TX
| | - Matthew Rama Skelton
- Blue Ridge Cancer Care, US Oncology Research, McKesson Specialty Health, Roanoke, VA
| | - Linda Cheryl DeMarco
- New York Oncology Hematology PC, US Oncology Research, McKesson Specialty Health, Hudson, NY
| | - Sasha Vukelja
- Texas Oncology - Tyler, US Oncology Research, McKesson Specialty Health, Tyler, TX
| | - Ian Schnadig
- Compass Oncology, US Oncology Research, McKesson Specialty Health, Tualatin, OR
| | - Sharon Wilks
- Cancer Care Centers of South Texas, US Oncology Research, McKesson Specialty Health, San Antonio, TX
| | | | - Jerome H. Goldschmidt
- Oncology and Hematology Associates of Southwest Virginia, US Oncology Research, McKesson Specialty Health, Christiansburg, VA
| | - Regina Resta
- New York Oncology Hematology, US Oncology Research, McKesson Specialty Health, Hudson, NY
| | - Stephen Lane Richey
- Texas Oncology - Fort Worth, US Oncology, McKesson Specialty Health, Fort Worth, TX
| | - John W. Smith
- Compass Oncology, US Oncology Research, McKesson Specialty Health, Portland, OR
| | - Lina Asmar
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX
| | - Yunfei Wang
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX
| | - Ann Morcos
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX
| | - Tracy Locke
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX
| | - Yali Li
- Foundation Medicine, Inc., Cambridge, MA
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18
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Troxell ML, Griffiths R, Schnadig I, Houghton DC. Light chain renal amyloidosis with prominent giant cells. Am J Kidney Dis 2013; 62:1193-7. [PMID: 23891357 DOI: 10.1053/j.ajkd.2013.05.023] [Citation(s) in RCA: 3] [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: 12/15/2012] [Accepted: 05/15/2013] [Indexed: 11/11/2022]
Abstract
Clinical diagnosis of amyloidosis may be very challenging because signs, symptoms, and laboratory study results can be highly variable and may overlap with other disease entities. Amyloid has characteristic features on kidney biopsy, involving glomeruli, vessels, and/or interstitium as typically amorphous waxy material that is periodic acid-Schiff pale and Congo Red birefringent under polarized light. Electron microscopy demonstrates characteristic randomly oriented fibrils. However, in rare cases, amyloid may present with atypical morphologic features on kidney biopsy, closely mimicking other histopathologic diagnoses. We present a case of light chain (AL) κ amyloidosis with an unusual inflammatory infiltrate including prominent multinucleated giant cells in the interstitium and at the glomerular hilus. Amyloid was apparent within giant cells on Congo Red staining, as well as on ultrastructural evaluation. Together with prior studies of tumoral nonrenal amyloid and renal amyloid A, we suggest that the amyloid fibril constituents κ and serum amyloid A have some predilection for inciting the rare multinucleated giant cell reaction.
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Affiliation(s)
- Megan L Troxell
- Department of Pathology, Oregon Health & Science University, Portland, OR.
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19
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Patt D, Espirito J, Turnwald B, Denduluri N, Wang Y, Lina A, Hoverman R, Neubauer M, Bosserman L, Busby L, Brooks B, Cartwright T, Sitarik M, Schnadig I, Winter W, Garey J, Ginsburg-Arlen A, Bergstrom K, Beveridge R. Abstract P2-11-16: Cardiac Morbidity After Adjuvant Chemotherapy (CT) for Early Breast Cancer in the Community Setting. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-11-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cardiac morbidity after exposure to CT is a known and previously described risk. Anthracycline exposure can be complicated by acute or chronic cardiac toxicity. Trastuzumab exposure is largely associated with acute and reversible cardiac morbidity.
Methods: We retrospectively queried the electronic health record (EHR) from our network of community oncology practices, iKnowMed, for patients (pts) diagnosed with Stage I-III breast cancer (BC) from 2007–2010 with at least 5 visits and follow-up (f/u) through 2012. We stratified this group by CT utilization (yes/no), regimen type, age, and characterized the incidence of cardiac disease or initiation of cardiac medication through the f/u period to determine the association of cardiac disease or treatment with CT utilization. Cardiac diseases analyzed included congestive heart failure, valvular and ischemic heart disease, arrythmias, and hypertension. Cardiac medications included beta blockers, angiotensin-converting-enzyme inhibitors, angiotensin receptor II blockers, loop and thiazide diuretics. Hazard ratios by prespecified risk parameters were then analyzed by multivariate analysis for all pts who did not have cardiac disease preceding their diagnosis of BC.
Results: We identified 20,900 pts with a median f/u of 3.2 yrs (1.4–5.4). 11,295 (54%) pts received adjuvant CT and 9,605 (46%) did not. Median age at diagnosis in the CT-treated arm and non CT-treated arm was 54 and 64 yrs, respectively (p < 0.0001). Among both the non-CT and CT-treated group, the baseline prevalence of cardiac disease was 14%. Among the CT-treated group, 3475 pts or 31% (95% CI, 30 %−32%) had or developed cardiac disease within the study period. In the non-CT group, 3790 pts or 39% (95% CI, 38%−40%) had or developed cardiac disease with the study period (p < 0.01). Receiving CT conveyed a lower risk of cardiac morbidity overall, HR 0.86 (p < 0.01). Incidence of cardiac disease was higher among pts who were in the non-CT treated arm (39%) than among the various CT-treated arms: anthracycline and trastuzumab (30%), anthracycline without trastuzumab (26%), non-anthracycline with trastuzumab (33%), and non-anthracycline without trastuzumab (34%). Incidence of cardiac disease increased proportionally over time in all age groups as expected in both cohorts.
Conclusions: Age was a strong determinant of development of cardiac morbidity. Adjuvant CT did not increase the risk of cardiac morbidity compared to pts who did not receive CT in the community setting. Similarly, anthracycline and trastuzumab exposure did not increase cardiac morbidity when compared to no CT or other CT regimen types. While baseline cardiac comorbid illness was similar among both cohorts, the lack of increase in cardiac morbidity among pts who received CT may be due to confounding factors such as comorbid illness and age as they are often determinants of appropriate CT utilization.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-16.
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Affiliation(s)
- D Patt
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - J Espirito
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - B Turnwald
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - N Denduluri
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - Y Wang
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - A Lina
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - R Hoverman
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - M Neubauer
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - L Bosserman
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - L Busby
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - B Brooks
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - T Cartwright
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - M Sitarik
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - I Schnadig
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - W Winter
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - J Garey
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - A Ginsburg-Arlen
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - K Bergstrom
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
| | - R Beveridge
- Pathways Task Force, US Oncology Network, McKesson Specialty Health, Austin, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Arlington, VA; US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Kansas City Cancer Center, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Overland Park, KS; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Rancho Cucamonga, CA; Rocky Mountain Cancer Centers, Pathways Task Force, US Oncology Network, McKesson Specialty Health, Boulder, CO; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Dallas, TX; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Ocala, FL; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Tualatin, OR; Pathways Task Force, US Oncology Network, McKesson Specialty Health, Portland, OR
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