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Smith KL, Zhao F, Mayer IA, Tevaarwerk AJ, Garcia SF, Arteaga CL, Symmans WF, Park BH, Burnette BL, Makower DF, Block M, Morley KA, Jani CR, Mescher C, Dewani SJ, Brown-Glaberman U, Flaum LE, Mayer EL, Sikov WM, Rodler ET, DeMichele AM, Sparano JA, Wolff AC, Miller KD, Wagner LI. Adjuvant platinum versus capecitabine for residual, invasive, triple-negative breast cancer: Patient-reported outcomes in ECOG-ACRIN EA1131. Cancer 2024; 130:1747-1757. [PMID: 38236702 DOI: 10.1002/cncr.35187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/19/2023] [Accepted: 11/20/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are a better tool for evaluating the experiences of patients who have symptomatic, treatment-associated adverse events (AEs) compared with clinician-rated AEs. The authors present PROs assessing health-related quality of life (HRQoL) and treatment-related neurotoxicity for adjuvant capecitabine versus platinum on the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) EA1131 trial (ClinicalTrials.gov identifier NCT02445391). METHODS Participants completed the National Comprehensive Cancer Network Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) and the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group neurotoxicity subscale (platinum arm only) at baseline, cycle 3 day 1 (C3D1), 6 months, and 15 months. Because of early termination, power was insufficient to test the hypothesis that HRQoL, as assessed by the NFBSI-16 treatment side-effect (TSE) subscale, would be better at 6 and 15 months in the capecitabine arm; all analyses were exploratory. Means were compared by using t-tests or the Wilcoxon rank-sum test, and proportions were compared by using the χ2 test. RESULTS Two hundred ninety-six of 330 eligible patients provided PROs. The mean NFBSI-16 TSE subscale score was lower for the platinum arm at baseline (p = .02; absolute difference, 0.6 points) and for the capecitabine arm at C3D1 (p = .04; absolute difference, 0.5 points), but it did not differ at other times. The mean change in TSE subscale scores differed between the arms from baseline to C3D1 (platinum arm, 0.15; capecitabine arm, -0.72; p = .03), but not from baseline to later time points. The mean decline in Functional Assessment of Cancer Therapy-Gynecologic Oncology Group neurotoxicity subscale scores exceeded the minimal meaningful change (1.38 points) from baseline to each subsequent time point (all p < .05). CONCLUSIONS Despite the similar frequency of clinician-rated AEs, PROs identified greater on-treatment symptom burden with capecitabine and complemented clinician-rated AEs by characterizing patients' experiences during chemotherapy.
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Affiliation(s)
- Karen L Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
- Sibley Memorial Hospital, Washington, District of Columbia, USA
| | - Fengmin Zhao
- Dana Farber Cancer Institute, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Biostatistics Center, Boston, Massachusetts, USA
| | - Ingrid A Mayer
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sofia F Garcia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carlos L Arteaga
- University of Texas Southwestern Simmons Cancer Center, Dallas, Texas, USA
| | - William F Symmans
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ben H Park
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian L Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, Wisconsin, USA
| | | | - Margaret Block
- Alegent Health Bergan Mercy Medical Center, Omaha, Nebraska, USA
| | | | - Chirag R Jani
- Phoebe Putney Memorial Hospital, Albany, Georgia, USA
| | - Craig Mescher
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park, Minnesota, USA
| | - Shabana J Dewani
- Columbus Oncology and Hematology Associates Inc., Columbus, Ohio, USA
| | - Ursa Brown-Glaberman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Lisa E Flaum
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erica L Mayer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - William M Sikov
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Eve T Rodler
- University of California, Davis, Davis, California, USA
| | - Angela M DeMichele
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania, USA
| | - Joseph A Sparano
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, USA
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
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2
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Stearns V, Jegede OA, Chang VTS, Skaar TC, Berenberg JL, Nand R, Shafqat A, Jacobs NL, Luginbuhl W, Gilman P, Benson AB, Goodman JR, Buchschacher GL, Henry NL, Loprinzi CL, Flynn PJ, Mitchell EP, Fisch MJ, Sparano JA, Wagner LI. A Cohort Study to Evaluate Genetic Predictors for Aromatase Inhibitor Musculoskeletal Symptoms (AIMSS): Results from ECOG-ACRIN E1Z11. Clin Cancer Res 2024:743149. [PMID: 38640040 DOI: 10.1158/1078-0432.ccr-23-2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/13/2023] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Aromatase Inhibitor-Associated Musculoskeletal Symptoms (AIMSS) are common and frequently lead to AI discontinuation. Single nucleotide polymorphisms (SNPs) in candidate genes have been associated with AIMSS and AI discontinuation. E1Z11 is a prospective cohort study designed to validate associations between 10 SNPs and AI discontinuation due to AIMSS. PATIENTS AND METHODS Postmenopausal women with stage I-III hormone receptor-positive breast cancer received anastrozole 1 mg daily and completed patient-reported outcomes (PRO) to assess AIMSS (Stanford Health Assessment Questionnaire; HAQ) at baseline, 3, 6, 9, and 12 months. We estimated that 40% of participants would develop AIMSS, and 25% would discontinue AI treatment within 12 months. Enrollment of 1,000 women with a fixed number per racial strata provided 80% power to detect an effect size of 1.5-4. SNPs were in ESR1 (rs2234693, rs2347868, rs9340835), CYP19A1 (rs1062033, rs4646), TCL1A (rs11849538, rs2369049, rs7158782, rs7159713), and HTR2A (rs2296972). RESULTS Of 970 evaluable women, 43% developed AIMSS and 12% discontinued AI therapy within 12 months. While more Black and Asian women developed AIMSS compared to White women (49% vs 39%, p=0.017; 50% vs 39%, p=0.004, respectively), AI discontinuation rates were similar across groups. None of the SNPs were significantly associated with AIMSS or AI discontinuation in the overall population, or in distinct cohorts. The odds ratio for rs2296972 (HTR2A) approached significance for developing AIMSS. CONCLUSION We were unable to prospectively validate candidate SNPs previously associated with AI discontinuation due to AIMSS. Future analyses will explore additional genetic markers, PRO predictors of AIMSS, and differences by race.
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Affiliation(s)
- Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | - Todd C Skaar
- Indiana University Bloomington, Indianapolis, IN, United States
| | | | | | - Atif Shafqat
- Missouri Baptist Medical Center, St. Louis, MO, United States
| | | | - William Luginbuhl
- University of Pennsylvania Health System, West Chester, PA, United States
| | - Paul Gilman
- Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Al B Benson
- Northwestern Medicine, Chicago, Illinois, United States
| | | | | | - N Lynn Henry
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Patrick J Flynn
- Metro Minnesota Clinical Oncology Research Consortium, St. Louis Park, Minnesota, United States
| | | | | | - Joseph A Sparano
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lynne I Wagner
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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3
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Rajdev L, Wang CCJ, Joshi H, Lensing S, Lee J, Ramos JC, Baiocchi R, Ratner L, Rubinstein PG, Ambinder R, Henry D, Streicher H, Little RF, Chiao E, Dittmer DP, Einstein MH, Cesarman E, Mitsuyasu R, Sparano JA. Assessment of the safety of nivolumab in people living with HIV with advanced cancer on antiretroviral therapy: the AIDS Malignancy Consortium 095 Study. Cancer 2024; 130:985-994. [PMID: 37962072 PMCID: PMC10922055 DOI: 10.1002/cncr.35110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Although immunotherapy has emerged as a therapeutic strategy for many cancers, there are limited studies establishing the safety and efficacy in people living with HIV (PLWH) and cancer. METHODS PLWH and solid tumors or Kaposi sarcoma (KS) receiving antiretroviral therapy and a suppressed HIV viral load received nivolumab at 3 mg/kg every 2 weeks, in two dose deescalation cohorts stratified by CD4 count (stratum 1: CD4 count > 200/µL and stratum 2: CD4 count 100-199/µL). An expansion cohort of 24 participants with a CD4 count > 200/µL was then enrolled. RESULTS A total of 36 PLWH received nivolumab, including 15 with KS and 21 with a variety of other solid tumors. None of the first 12 participants had dose-limiting toxicity in both CD4 strata, and five patients (14%) overall had grade 3 or higher immune related adverse events. Objective partial response occurred in nine PLWH and cancer (25%), including in six of 15 with KS (40%; 95% CI, 16.3-64.7). The median duration of response was 9.0 months overall and 12.5 months in KS. Responses were observed regardless of PDL1 expression. There were no significant changes in CD4 count or HIV viral load. CONCLUSIONS Nivolumab has a safety profile in PLWH similar to HIV-negative subjects with cancer, and also efficacy in KS. Plasma HIV remained suppressed and CD4 counts remained stable during treatment and antiretroviral therapy, indicating no adverse impact on immune function. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02408861.
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Affiliation(s)
- Lakshmi Rajdev
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Himanshu Joshi
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jeannette Lee
- University of Arkansas for Medical Sciences, Little Rock, AK
| | | | - Robert Baiocchi
- Ohio State University James Comprehensive Cancer Center, Columbus OH
| | | | - Paul G. Rubinstein
- Stroger Hospital of Cook County (Cook County Hospital), Ruth M. Rothstein Core Center, Division of Hematology/Oncology, University of Illinois, Chicago, IL
| | | | | | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD
| | - Richard F. Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Ronald Mitsuyasu
- University of California Los Angeles Care Center, Los Angeles, CA
| | - Joseph A. Sparano
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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4
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Wright JL, Gray R, Rahbar H, Comstock CE, Tjoe JA, Badve S, Recht A, Sparano JA, Davidson NE, Wolff AC. Lumpectomy without radiation for ductal carcinoma in situ of the breast: 20-year results from the ECOG-ACRIN E5194 study. NPJ Breast Cancer 2024; 10:16. [PMID: 38396024 PMCID: PMC10891055 DOI: 10.1038/s41523-024-00622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
We report the 20-year rate of ipsilateral breast event (IBE) for patients with ductal carcinoma in situ (DCIS) treated with lumpectomy without radiation on a non-randomized prospective clinical trial. Patients were enrolled in cohort 1: low- or intermediate-grade DCIS, size ≤ 2.5 cm (n = 561); or cohort 2: high-grade DCIS, size ≤ 1 cm (n = 104). The Kaplan-Meier method was used to estimate time-to-event distributions. Cox proportional hazard methods were used to estimate hazard ratios (HRs) and tests for significance for event times. 561 patients were enrolled in cohort 1 and 104 in cohort 2. After central pathology review, 26% in cohort 1 were recategorized as high-grade and 26% in cohort 2 as low- or intermediate-grade. Mean DCIS size was similar at 7.5 mm in cohort 1 and 7.8 mm in cohort 2. Surgical margin was ≥3 mm in 96% of patients, and about 30% received tamoxifen. Median follow-up was 19.2 years. There were 104 IBEs, of which 54 (52%) were invasive. The IBE and invasive IBE rates increased in both cohorts up to 15 years, then plateaued. The 20-year IBE rates were 17.8% for cohort 1 and 28.7% for cohort 2 (p = 0.005), respectively. Invasive IBE occurred in 9.8% and 15.1% (p = 0.09), respectively. On multivariable analysis, IBE risk increased with size and was higher in cohort 2, but grade and margin width were not significantly associated with IBE. For patients with DCIS treated with excision without radiation, the rate of IBE increased with size and assigned cohort mostly in the first 15 years.
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Affiliation(s)
- Jean L Wright
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Robert Gray
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Habib Rahbar
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Judy A Tjoe
- Department of Surgical Oncology, Green Bay Oncology, Green Bay, WI, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | - Abram Recht
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph A Sparano
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Center and University of Washington, Seattle, WA, USA
| | - Antonio C Wolff
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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O'Connell NS, Zhao F, Lee JW, Ip EH, Peipert JD, Graham N, Smith ML, Gareen IF, Carlos RC, Obeng-Gyasi S, Sparano JA, Shanafelt TD, Thomas ML, Cella D, Wagner LI, Gray R. Importance of Low- and Moderate-Grade Adverse Events in Patients' Treatment Experience and Treatment Discontinuation: An Analysis of the E1912 Trial. J Clin Oncol 2024; 42:266-272. [PMID: 37801678 PMCID: PMC10824381 DOI: 10.1200/jco.23.00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/20/2023] [Accepted: 08/16/2023] [Indexed: 10/08/2023] Open
Abstract
PURPOSE Despite defined grades of 1 to 5 for adverse events (AEs) on the basis of Common Terminology Criteria for Adverse Events criteria, mild (G1) and moderate (G2) AEs are often not reported in phase III trials. This under-reporting may inhibit our ability to understand patient toxicity burden. We analyze the relationship between the grades of AEs experienced with patient side-effect bother and treatment discontinuation. METHODS We analyzed a phase III Eastern Cooperative Oncology Group-American College of Radiology Imaging Network trial with comprehensive AE data. The Likert response Functional Assessment of Cancer Therapy-GP5 item, "I am bothered by side effects of treatment" was used to define side-effect bother. Bayesian mixed models were used to assess the impact of G1 and G2 AE counts on patient side-effect bother and treatment discontinuation. AEs were further analyzed on the basis of symptomatology (symptomatic or asymptomatic). The results are given as odds ratios (ORs) and 95% credible interval (CrI). RESULTS Each additional G1 and G2 AEs experienced during a treatment cycle increased the odds of increased self-reported patient side-effect bother by 13% (95% CrI, 1.06 to 1.21) and 35% (95% CrI, 1.19 to 1.54), respectively. Furthermore, only AEs defined as symptomatic were associated with increased side-effect bother, with asymptomatic AEs showing no association regardless of grade. Count of G2 AEs increased the odds of treatment discontinuation by 59% (95% CrI, 1.32 to 1.95), with symptomatic G2 AEs showing a stronger association (OR, 1.75; 95% CrI, 1.28 to 2.39) relative to asymptomatic G2 AEs (OR, 1.45; 95% CrI, 1.12 to 1.89). CONCLUSION Low- and moderate-grade AEs are related to increased odds of increased patient side-effect bother and treatment discontinuation, with symptomatic AEs demonstrating greater magnitude of association than asymptomatic. Our findings suggest that limiting AE capture to grade 3+ misses important contributors to treatment side-effect bother and discontinuation.
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Affiliation(s)
| | - Fengmin Zhao
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Ju-Whei Lee
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Edward H. Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Noah Graham
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Ilana F. Gareen
- Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Ruth C. Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Joseph A. Sparano
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | | | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lynne I. Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Robert Gray
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
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6
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Cescon DW, Hilton J, Morales Murilo S, Layman RM, Pluard T, Yeo B, Park IH, Provencher L, Kim SB, Im YH, Wyce A, Krishnatry AS, Hicks K, Zhang Q, Barbash O, Khaled A, Horner T, Dhar A, Oliveira M, Sparano JA. A Phase I/II Study of GSK525762 Combined with Fulvestrant in Patients with Hormone Receptor-positive/HER2-negative Advanced or Metastatic Breast Cancer. Clin Cancer Res 2024; 30:334-343. [PMID: 37992310 PMCID: PMC10792358 DOI: 10.1158/1078-0432.ccr-23-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Endocrine-based therapy is the initial primary treatment option for hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC). However, patients eventually experience disease progression due to resistance to endocrine therapy. Molibresib (GSK525762) is a small-molecule inhibitor of bromodomain and extraterminal (BET) family proteins (BRD2, BRD3, BRD4, and BRDT). Preclinical data suggested that the combination of molibresib with endocrine therapy might overcome endocrine resistance. This study aimed to investigate the safety, tolerability, pharmacokinetics, pharmacodynamics, and efficacy [objective response rate (ORR)] of molibresib combined with fulvestrant in women with HR+/HER2- mBC. PATIENTS AND METHODS In this phase I/II dose-escalation and dose-expansion study, patients received oral molibresib 60 or 80 mg once daily in combination with intramuscular fulvestrant. Patients enrolled had relapsed/refractory, advanced/metastatic HR+/HER2- breast cancer with disease progression on prior treatment with an aromatase inhibitor, with or without a cyclin-dependent kinase 4/6 inhibitor. RESULTS The study included 123 patients. The most common treatment-related adverse events (AE) were nausea (52%), dysgeusia (49%), and fatigue (45%). At a 60-mg dosage of molibresib, >90% of patients experienced treatment-related AE. Grade 3 or 4 treatment-related AE were observed in 47% and 48% of patients treated with molibresib 60 mg and molibresib 80 mg, respectively. The ORR was 13% [95% confidence interval (CI), 8-20], not meeting the 25% threshold for proceeding to phase II. Among 82 patients with detected circulating tumor DNA and clinical outcome at study enrollment, a strong association was observed between the detection of copy-number amplification and poor progression-free survival (HR, 2.89; 95% CI, 1.73-4.83; P < 0.0001). CONCLUSIONS Molibresib in combination with fulvestrant did not demonstrate clinically meaningful activity in this study.
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Affiliation(s)
- David W. Cescon
- Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - John Hilton
- Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada
| | | | | | | | - Belinda Yeo
- Olivia Newton-John Cancer Research and Wellness Centre and Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - In Hae Park
- National Cancer Center, Goyang, Republic of South Korea
- Korea University Guro Hospital, Seoul, Republic of South Korea
| | | | - Sung-Bae Kim
- Asan Medical Center, Seoul, Republic of South Korea
| | | | | | | | | | | | | | | | | | | | - Mafalda Oliveira
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joseph A. Sparano
- Icahn School of Medicine, Tisch Cancer Institute, New York, New York (formerly Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York)
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7
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Haigentz M, Lee JY, Chiao EY, Aboulafia DM, Ratner L, Ambinder RF, Baiocchi RA, Mitsuyasu RT, Wachsman W, Sparano JA, Rudek MA. Phase I Trial of the Multi-kinase Inhibitor Cabozantinib, a CYP3A4 Substrate, plus CYP3A4-Interacting Antiretroviral Therapy in People Living with HIV and Cancer (AMC-087). Clin Cancer Res 2023; 29:5038-5046. [PMID: 37523145 PMCID: PMC10829065 DOI: 10.1158/1078-0432.ccr-23-1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To evaluate the safety, pharmacokinetics, and pharmacodynamic effects of cabozantinib, a CYP3A4 substrate, in people living with human immunodeficiency virus and cancer receiving antiretrovirals (ARV). PATIENTS AND METHODS Patients received a reduced dose of cabozantinib (20 mg orally daily) with strong CYP3A4 inhibitors (ARV ritonavir or non-ARV cobicistat, stratum A), or a standard 60 mg dose with ARVs that are CYP3A4 inducers (efavirenz or etravirine, stratum B) or noninteracting ARVs (stratum C). Initial dose escalation in stratum A and stratum B was performed on the basis of tolerability. RESULTS 36 patients received cabozantinib plus ARVs, including 20 in stratum A, 9 in B, and 7 in C. The recommended initial cabozantinib doses for stratum A, B, and C were 20, 60, and 60 mg, respectively. Doses of 40 or 60 mg plus CYP3A4 inhibitors in stratum A and 100 mg plus CYP3A4 inducers in stratum B were associated with excessive toxicity, whereas 60 mg with noninteracting ARVs was not. The steady state minimal concentrations were lower at 20 mg in stratum A or 60 mg in stratum B compared with 60 mg in stratum C, while total exposure was only lower in 60 mg in stratum B compared with 60 mg in stratum C. Activity was observed in Kaposi sarcoma and an AXL-amplified sarcoma. CONCLUSIONS Cabozantinib as a single agent should be initiated at 20 mg daily and 60 mg daily when taken concurrently with ARVs that are strong CYP3A4 inhibitors and inducers, respectively, with consideration for subsequent escalation per current cabozantinib guidelines. See related commentary by Eisenmann and Sparreboom, p. 4999.
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Affiliation(s)
- Missak Haigentz
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | | | | | - David M. Aboulafia
- The Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center and the University of Washington, Seattle, Washington
| | - Lee Ratner
- Siteman Cancer Center, University of Washington in Saint Louis, St. Louis, MO
| | - Richard F. Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | - Ronald T. Mitsuyasu
- University of California, Los Angeles, UCLA Clinical AIDS Research and Education Center, Los Angeles, CA
| | - William Wachsman
- University of California San Diego Moores Cancer Center, San Diego, CA
| | - Joseph A. Sparano
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Michelle A. Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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8
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Chadha M, White J, Swain SM, Rakovitch E, Jagsi R, Whelan T, Sparano JA. Optimal adjuvant therapy in older (≥70 years of age) women with low-risk early-stage breast cancer. NPJ Breast Cancer 2023; 9:99. [PMID: 38097623 PMCID: PMC10721824 DOI: 10.1038/s41523-023-00591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/06/2023] [Indexed: 12/17/2023] Open
Abstract
Older women are under-represented in breast cancer (BC) clinical trials, and treatment guidelines are primarily based on BC studies in younger women. Studies uniformly report an increased incidence of local relapse with omission of breast radiation therapy. Review of the available literature suggests very low rates of distant relapse in women ≥70 years of age. The incremental benefit of endocrine therapy in decreasing rate of distant relapse and improving disease-free survival in older patients with low-risk BC remains unclear. Integration of molecular genomic assays in diagnosis and treatment of estrogen receptor positive BC presents an opportunity for optimizing risk-tailored adjuvant therapies in ways that may permit treatment de-escalation among older women with early-stage BC. The prevailing knowledge gap and lack of risk-specific adjuvant therapy guidelines suggests a compelling need for prospective trials to inform selection of optimal adjuvant therapy, including omission of adjuvant endocrine therapy in older women with low risk BC.
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Affiliation(s)
- M Chadha
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - J White
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - S M Swain
- Department of Medicine, Georgetown Lombardi Comprehensive Cancer Center, MedStar Health, Washington, DC, USA
| | - E Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - R Jagsi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - T Whelan
- Division of Radiation Oncology, Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - J A Sparano
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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9
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Kim G, Karadal-Ferrena B, Qin J, Sharma VP, Oktay IS, Lin Y, Ye X, Asiry S, Pastoriza JM, Cheng E, Ladak N, Condeelis JS, Adler E, Ginter PS, D'Alfonso T, Entenberg D, Xue X, Sparano JA, Oktay MH. Racial disparity in tumor microenvironment and distant recurrence in residual breast cancer after neoadjuvant chemotherapy. NPJ Breast Cancer 2023; 9:52. [PMID: 37311792 PMCID: PMC10264351 DOI: 10.1038/s41523-023-00547-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/28/2023] [Indexed: 06/15/2023] Open
Abstract
Black, compared to white, women with residual estrogen receptor-positive (ER+) breast cancer after neoadjuvant chemotherapy (NAC) have worse distant recurrence-free survival (DRFS). Such racial disparity may be due to difference in density of portals for systemic cancer cell dissemination, called TMEM doorways, and pro-metastatic tumor microenvironment (TME). Here, we evaluate residual cancer specimens after NAC from 96 Black and 87 white women. TMEM doorways are visualized by triple immunohistochemistry, and cancer stem cells by immunofluorescence for SOX9. The correlation between TMEM doorway score and pro-metastatic TME parameters with DRFS is examined using log-rank and multivariate Cox regression. Black, compared to white, patients are more likely to develop distant recurrence (49% vs 34.5%, p = 0.07), receive mastectomy (69.8% vs 54%, p = 0.04), and have higher grade tumors (p = 0.002). Tumors from Black patients have higher TMEM doorway and macrophages density overall (p = 0.002; p = 0.002, respectively) and in the ER+/HER2- (p = 0.02; p = 0.02, respectively), but not in the triple negative disease. Furthermore, high TMEM doorway score is associated with worse DRFS. TMEM doorway score is an independent prognostic factor in the entire study population (HR, 2.02; 95%CI, 1.18-3.46; p = 0.01), with a strong trend in ER+/HER2- disease (HR, 2.38; 95%CI, 0.96-5.95; p = 0.06). SOX9 expression is not associated with racial disparity in TME or outcome. In conclusion, higher TMEM doorway density in residual breast cancer after NAC is associated with higher distant recurrence risk, and Black patients are associated with higher TMEM doorway density, suggesting that TMEM doorway density may contribute to racial disparities in breast cancer.
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Affiliation(s)
- Gina Kim
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Burcu Karadal-Ferrena
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Department of Basic Oncology, Hacettepe University, Ankara, Turkey
| | - Jiyue Qin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Ved P Sharma
- Bio-Imaging Resource Center, The Rockefeller University, New York, NY, USA
| | - Isabelle S Oktay
- College of Art and Sciences, New York University, New York, NY, USA
| | - Yu Lin
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Xianjun Ye
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Saeed Asiry
- Department of Pathology, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Jessica M Pastoriza
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Nurfiza Ladak
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - John S Condeelis
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Department of Cell Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Esther Adler
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Paula S Ginter
- Department of Pathology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Timothy D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Entenberg
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Joseph A Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Maja H Oktay
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
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10
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Kantor O, King TA, Freedman RA, Mayer EL, Chavez-MacGregor M, Korde LA, Sparano JA, Mittendorf EA. Racial and Ethnic Disparities in Locoregional Recurrence Among Patients With Hormone Receptor-Positive, Node-Negative Breast Cancer: A Post Hoc Analysis of the TAILORx Randomized Clinical Trial. JAMA Surg 2023; 158:583-591. [PMID: 37043210 PMCID: PMC10099173 DOI: 10.1001/jamasurg.2023.0297] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/04/2022] [Indexed: 04/13/2023]
Abstract
Importance Whether racial and ethnic disparities in locoregional recurrence (LRR) exist among patients with similar access to care treated in randomized clinical trials is unknown. Objective To examine racial and ethnic differences in LRR among patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (ERBB2 [formerly HER2 or HER2/neu])-negative, node-negative breast cancer enrolled in the Trial Assigning Individualized Options for Treatment (TAILORx). Design, Setting, and Participants This unplanned retrospective post hoc analysis examined a prospective multicenter clinical trial population of women with breast cancer enrolled between 2006 and 2010, with 9 years of follow-up. The TAILORx investigators randomized patients to treatment based on their Oncotype DX recurrence score, including endocrine therapy alone (recurrence score <11), endocrine therapy alone vs chemotherapy followed by endocrine therapy (recurrence score 11-25), or chemotherapy followed by endocrine therapy (recurrence score >25). Patients with unknown race and ethnicity or lack of follow-up were excluded from this analysis. Data analysis was performed between December 2021 and March 2022. Main Outcome and Measures Locoregional recurrence was defined as ipsilateral in breast, skin, chest wall, or regional nodal recurrence without concurrent distant recurrence, and was stratified by racial and ethnic group. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards regression models were used for survival analyses. Results Of the 10 273 women enrolled in TAILORx, this analysis included 9369 with T1-2N0 HR-positive, ERBB2-negative breast cancer. Of these patients, 428 (4.6%) were Asian, 886 (9.4%) were Hispanic, 676 (7.2%) were non-Hispanic Black (hereinafter Black), and 7406 (78.8%) were non-Hispanic White (hereinafter White). Assigned treatment receipt was high, with a 9.3% (n = 870) crossover of treatment groups and a median endocrine therapy duration of longer than 60 months, ranging from 61.1 to 65.9 months, across racial and ethnic groups. A total of 6818 patients (72.6%) received radiation (6474 [96.1%] after breast-conserving surgery and 344 [13.0%] after mastectomy). At a median follow-up of 94.8 months (range, 1-138 months), 8-year LRR rates were 3.6% (95% CI, 1.6%-5.6%) in Asian patients, 3.9% (95% CI, 2.2%-5.4%) in Black patients, 3.1% in Hispanic patients (95% CI, 1.7%-4.5%), and 1.8% (95% CI, 1.5%-2.3%) in White patients (P < .001). In survival analyses adjusted for patient, tumor, and treatment factors, Asian race (hazard ratio, 1.91 [95% CI, 1.12-3.29]) and Black race (1.78 [1.15-2.77]) were independently associated with LRR. In adjusted survival analyses for breast cancer mortality, LRR was independently associated with increased breast cancer mortality (hazard ratio, 5.71 [95% CI, 3.50-9.31]). Conclusions and Relevance In this post hoc analysis, racial and ethnic differences in LRR were observed among patients with T1-2N0 HR-positive, ERBB2-negative breast cancer despite high rates of treatment receipt in this clinical trial population, with the highest LRR rates in Asian and Black patients. Further study is needed to understand whether failure to rescue after LRR may contribute to racial disparities in breast cancer mortality. Trial Registration ClinicalTrials.gov Identifier: NCT00310180.
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Affiliation(s)
- Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tari A. King
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Rachel A. Freedman
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Erica L. Mayer
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mariana Chavez-MacGregor
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Joseph A. Sparano
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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11
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Patel R, Klein P, Tiersten A, Sparano JA. An emerging generation of endocrine therapies in breast cancer: a clinical perspective. NPJ Breast Cancer 2023; 9:20. [PMID: 37019913 PMCID: PMC10076370 DOI: 10.1038/s41523-023-00523-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
Anti-estrogen therapy is a key component of the treatment of both early and advanced-stage hormone receptor (HR)-positive breast cancer. This review discusses the recent emergence of several anti-estrogen therapies, some of which were designed to overcome common mechanisms of endocrine resistance. The new generation of drugs includes selective estrogen receptor modulators (SERMs), orally administered selective estrogen receptor degraders (SERDs), as well as more unique agents such as complete estrogen receptor antagonists (CERANs), proteolysis targeting chimeric (PROTACs), and selective estrogen receptor covalent antagonists (SERCAs). These drugs are at various stages of development and are being evaluated in both early and metastatic settings. We discuss the efficacy, toxicity profile, and completed and ongoing clinical trials for each drug and highlight key differences in their activity and study population that have ultimately influenced their advancement.
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Affiliation(s)
- Rima Patel
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA.
| | - Paula Klein
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Amy Tiersten
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Joseph A Sparano
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
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12
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Sparano JA, Sahni G. The ESC Cardio-Oncology Guidelines: A Roadmap for Clinical Practice and Generating Needed Evidence. JACC CardioOncol 2023; 5:141-144. [PMID: 36875899 PMCID: PMC9982278 DOI: 10.1016/j.jaccao.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Joseph A Sparano
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gagan Sahni
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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13
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Kantor O, Burstein HJ, King TA, Shak S, Russell CA, Giuliano AE, Hortobagyi GN, Winer EP, Korde LA, Sparano JA, Mittendorf EA. ASO Visual Abstract: Expanding Staging Criteria in T1-2N0 Hormone Receptor-Positive Breast Cancer Patients Enrolled in TAILORx. Ann Surg Oncol 2022; 29:8024-8025. [PMID: 35902504 DOI: 10.1245/s10434-022-12294-6] [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: 11/18/2022]
Affiliation(s)
- Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Harold J Burstein
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven Shak
- Exact Sciences Corporation, Redwood City, CA, USA
| | | | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric P Winer
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Larissa A Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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14
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Patel R, Hovstadius M, Kier MW, Moshier EL, Zimmerman BS, Cascetta K, Jaffer S, Sparano JA, Tiersten A. Correlation of the Ki67 Working Group prognostic risk categories with the Oncotype DX Recurrence Score in early breast cancer. Cancer 2022; 128:3602-3609. [PMID: 35947048 PMCID: PMC9529824 DOI: 10.1002/cncr.34426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The relationship between Ki67 assessed by immunohistochemistry (IHC) and the Oncotype DX Recurrence Score (RS) is unclear. The objective of this study was to determine the correlation between the 21-gene RS and IHC-measured Ki67 with the prognostic classification groups recommended by the International Ki67 Working Group (IKWG). METHODS The authors performed a retrospective chart review of women who had hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative early breast cancer with zero to three positive lymph nodes and both Ki67 and the 21-gene RS performed at their institution from 2013 to 2021. Patients were categorized into low (≤5%), intermediate (6%-29%), and high Ki67 groups (≥30%) according to IKWG recommendations. Overall agreement and risk-stratified agreement between Ki67 and RS were assessed with the proportion of agreement and the κ statistic. RESULTS The study included 525 patients with HR-positive breast cancer. Among the 49% of patients with intermediate Ki67 values of 6%-29%, the distribution of low (0-10), intermediate (11-25), and high RS (26-100) was 19%, 66%, and 15%, respectively. There was slight agreement (κ = 0.01-0.20) between Ki67 and RS (κ = 0.027) in the overall population, although this was not significant (p = .1985). There was fair agreement (κ = 0.21-0.40) between high Ki67 and RS values (κ = 0.280; p < .0001). A higher progesterone receptor percentage was associated with lower RS values (p > .0001) but not lower Ki67 values. A positive nodal status and a larger tumor size were associated with higher Ki67 values (p = .0059 and p < .0001) but not with RS. CONCLUSIONS In this group of patients selected to have a 21-gene RS, there was no significant correlation between Ki67 and RS in the overall population, and there was fair agreement between high Ki67 and high RS values. LAY SUMMARY In patients with early-stage, hormone receptor-positive breast cancer, decisions on adjuvant chemotherapy are based on certain biological features of the cancer and genomic assays such as the Oncotype DX Recurrence Score (RS). The goal of this study was to determine the correlation between Ki67, a marker of proliferation, and the Oncotype DX RS, a 21-gene assay demonstrated to be predictive of an adjuvant chemotherapy benefit in patients with early-stage breast cancer. In 525 patients, the authors did not find a significant correlation between Ki67 and RS.
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Affiliation(s)
- Rima Patel
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Malin Hovstadius
- Frank H. Netter School of Medicine at Quinnipiac University, Hamden, Connecticut, United States
| | - Melanie W. Kier
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Erin L. Moshier
- Division of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Krystal Cascetta
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Shabnam Jaffer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Joseph A. Sparano
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Amy Tiersten
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
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15
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Kantor O, Burstein HJ, King TA, Shak S, Russell CA, Giuliano AE, Hortobagyi GN, Winer EP, Korde LA, Sparano JA, Mittendorf EA. Expanding the Staging Criteria for T1-2N0 Hormone-Receptor Positive Breast Cancer Patients Enrolled in TAILORx. Ann Surg Oncol 2022; 29:8016-8023. [PMID: 35900648 DOI: 10.1245/s10434-022-12225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) 8th edition pathologic prognostic staging (PPS) incorporates anatomic and biologic factors. The OncotypeDX Breast Recurrence Score (RS) was included based on the initial report of the TAILORx trial, with T1-2N0 hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer patients who had a RS < 11 staged as PPS 1A. This study examined whether the RS criteria for PPS 1A can be further expanded using patients enrolled in the TAILORx trial. METHODS The TAILORx trial enrolled 10,273 HR+HER2- T1-2N0 patients. Those with incomplete HR-status/grade and T3 disease were excluded for analysis. The recurrence-free interval (RFI) was compared between the patients who did and those who did not fall into the current PPS 1A category using the Kaplan-Meier method. RESULTS The study enrolled 9535 patients for analysis. The RS was < 11 in 16.1%, 11-17 in 35.9%, 18-25 in 32.4%, and > 25 in 15.6% of the patients. The majority (91.2%) of the patients (including all the T1N0 patients regardless of RS) were PPS 1A, and 8.8% were not-PPS 1A. The median follow-up time was 95 months. The PPS 1A patients had an 8-year RFI of 94.2%, which was similar to that of the patients with a RS of 11-17 who were not-PPS 1A (91.7%; p = 0.07) and better than that of the patients with a RS ≥ 18 who were not-PPS 1A (85.4% for a RS of 18-25, 76.0% for a RS > 25; both p < 0.01). Similar RFI trends were seen in patients who received endocrine therapy or chemotherapy followed by endocrine therapy. CONCLUSIONS Patients with T1-2N0 HR+HER2- breast cancer and a RS < 18 have an RFI similar to that of patients staged as PPS 1A by the current AJCC staging system, regardless of treatment, suggesting that the criteria for PPS 1A can be expanded to include a RS < 18.
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Affiliation(s)
- Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Harold J Burstein
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven Shak
- Exact Sciences Corporation, Redwood City, CA, USA
| | | | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric P Winer
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Larissa A Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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16
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Palefsky JM, Lee JY, Jay N, Goldstone SE, Darragh TM, Dunlevy HA, Rosa-Cunha I, Arons A, Pugliese JC, Vena D, Sparano JA, Wilkin TJ, Bucher G, Stier EA, Tirado Gomez M, Flowers L, Barroso LF, Mitsuyasu RT, Lensing SY, Logan J, Aboulafia DM, Schouten JT, de la Ossa J, Levine R, Korman JD, Hagensee M, Atkinson TM, Einstein MH, Cracchiolo BM, Wiley D, Ellsworth GB, Brickman C, Berry-Lawhorn JM. Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. N Engl J Med 2022; 386:2273-2282. [PMID: 35704479 PMCID: PMC9717677 DOI: 10.1056/nejmoa2201048] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The incidence of anal cancer is substantially higher among persons living with the human immunodeficiency virus (HIV) than in the general population. Similar to cervical cancer, anal cancer is preceded by high-grade squamous intraepithelial lesions (HSILs). Treatment for cervical HSIL reduces progression to cervical cancer; however, data from prospective studies of treatment for anal HSIL to prevent anal cancer are lacking. METHODS We conducted a phase 3 trial at 25 U.S. sites. Persons living with HIV who were 35 years of age or older and who had biopsy-proven anal HSIL were randomly assigned, in a 1:1 ratio, to receive either HSIL treatment or active monitoring without treatment. Treatment included office-based ablative procedures, ablation or excision under anesthesia, or the administration of topical fluorouracil or imiquimod. The primary outcome was progression to anal cancer in a time-to-event analysis. Participants in the treatment group were treated until HSIL was completely resolved. All the participants underwent high-resolution anoscopy at least every 6 months; biopsy was also performed for suspected ongoing HSIL in the treatment group, annually in the active-monitoring group, or any time there was concern for cancer. RESULTS Of 4459 participants who underwent randomization, 4446 (99.7%) were included in the analysis of the time to progression to cancer. With a median follow-up of 25.8 months, 9 cases were diagnosed in the treatment group (173 per 100,000 person-years; 95% confidence interval [CI], 90 to 332) and 21 cases in the active-monitoring group (402 per 100,000 person-years; 95% CI, 262 to 616). The rate of progression to anal cancer was lower in the treatment group than in the active-monitoring group by 57% (95% CI, 6 to 80; P = 0.03 by log-rank test). CONCLUSIONS Among participants with biopsy-proven anal HSIL, the risk of anal cancer was significantly lower with treatment for anal HSIL than with active monitoring. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT02135419.).
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Affiliation(s)
- Joel M Palefsky
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Jeannette Y Lee
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Naomi Jay
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Stephen E Goldstone
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Teresa M Darragh
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Hillary A Dunlevy
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Isabella Rosa-Cunha
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Abigail Arons
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Julia C Pugliese
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Don Vena
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Joseph A Sparano
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Timothy J Wilkin
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Gary Bucher
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Elizabeth A Stier
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Maribel Tirado Gomez
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Lisa Flowers
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Luis F Barroso
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Ronald T Mitsuyasu
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Shelly Y Lensing
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Jeffrey Logan
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - David M Aboulafia
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Jeffrey T Schouten
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Juan de la Ossa
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Rebecca Levine
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Jessica D Korman
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Michael Hagensee
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Thomas M Atkinson
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Mark H Einstein
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Bernadette M Cracchiolo
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Dorothy Wiley
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Grant B Ellsworth
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - Cristina Brickman
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
| | - J Michael Berry-Lawhorn
- From the University of California, San Francisco School of Medicine, San Francisco (J.M.P., N.J., T.M.D., A.A., C.B., J.M.B.-L.); University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); Icahn School of Medicine at Mount Sinai (S.E.G., J.A.S.), Weill Cornell Medicine (T.J.W., G.B.E.), Montefiore Medical Center, Albert Einstein School of Medicine (R.L.), and Memorial Sloan Kettering Cancer Center (T.M.A.) - all in New York; University of Colorado School of Medicine, Aurora (H.A.D.); University of Miami School of Medicine, Miami (I.R.-C.); the Emmes Company, Rockland, MD (J.C.P., D.V.); Anal Dysplasia Clinic Midwest, Chicago (G.B.); Boston University School of Medicine, Boston (E.A.S.); University of Puerto Rico Comprehensive Cancer Center, San Juan (M.T.G.); Emory University School of Medicine, Atlanta (L.F.); Wake Forest University Health Sciences, Winston-Salem, NC (L.F.B.); University of California, Los Angeles Schools of Medicine (R.T.M.) and Nursing (D.W.), Los Angeles; Denver Public Health, Denver (J.L.); University of Washington School of Medicine (D.M.A., J.T.S.) and the Polyclinic, Virginia Mason Medical Center (J.O.) - both in Seattle; Capital Digestive Care, Washington, DC (J.D.K.); Louisiana State University School of Medicine, New Orleans (M.H.); and Rutgers New Jersey Medical School, Newark (M.H.E., B.M.C.)
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Martínez LE, Lensing S, Chang D, Magpantay LI, Mitsuyasu R, Ambinder RF, Sparano JA, Martínez-Maza O, Epeldegui M. Plasma extracellular vesicles bearing PD-L1, CD40, CD40L or TNF-RII are significantly reduced after treatment of AIDS-NHL. Sci Rep 2022; 12:9185. [PMID: 35655072 PMCID: PMC9163074 DOI: 10.1038/s41598-022-13101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/20/2022] [Indexed: 01/09/2023] Open
Abstract
Emerging evidence shows that tumor cells secrete extracellular vesicles (EVs) that carry bioactive cell surface markers, such as programmed death-ligand 1 (PD-L1), which can modulate immune responses and inhibit anti-tumor responses, potentially playing a role in lymphomagenesis and in promoting the growth of these cancers. In this study, we investigated the role of EVs expressing cell surface molecules associated with B cell activation and immune regulation. We measured levels of EVs derived from plasma from 57 subjects with AIDS-related non-Hodgkin lymphoma (AIDS-NHL) enrolled in the AIDS Malignancies Consortium (AMC) 034 clinical trial at baseline and post-treatment with rituximab plus concurrent infusional EPOCH chemotherapy. We found that plasma levels of EVs expressing PD-L1, CD40, CD40L or TNF-RII were significantly reduced after cancer treatment. AIDS-NHL patients with the diffuse large B cell lymphoma (DLBCL) tumor subtype had decreased plasma levels of EVs bearing PD-L1, compared to those with Burkitt's lymphoma. CD40, CD40L and TNF-RII-expressing EVs showed a significant positive correlation with plasma levels of IL-10, CXCL13, sCD25, sTNF-RII and IL-18. Our results suggest that patients with AIDS-NHL have higher levels of EVs expressing PD-L1, CD40, CD40L or TNF-RII in circulation before cancer treatment and that levels of these EVs are associated with levels of biomarkers of microbial translocation and inflammation.
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Affiliation(s)
- Laura E Martínez
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Biomedical Sciences Research Building Room 173, Los Angeles, CA, 90095, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Di Chang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Larry I Magpantay
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Biomedical Sciences Research Building Room 173, Los Angeles, CA, 90095, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ronald Mitsuyasu
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Biomedical Sciences Research Building Room 173, Los Angeles, CA, 90095, USA
| | - Richard F Ambinder
- Division of Hematologic Malignancies, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD, USA
| | | | - Otoniel Martínez-Maza
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Biomedical Sciences Research Building Room 173, Los Angeles, CA, 90095, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Marta Epeldegui
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Biomedical Sciences Research Building Room 173, Los Angeles, CA, 90095, USA.
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
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Zhao F, Peipert J, Stearns V, Chang VTS, Jegede O, Ip E, Lee JW, O'Connell NS, Graham N, Henry NL, Loprinzi CL, Flynn PJ, Fisch MJ, Gareen IF, Carlos RC, Smith ML, Cella D, Sparano JA, Gray RJ, Wagner LI. Predictive value of baseline patient-rated treatment bother for early anastrozole discontinuation in a racially diverse cohort: Results from ECOG-ACRIN E1Z11. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12094 Background: The Functional Assessment of Cancer Therapy patient-reported outcomes (PRO) item GP5 (“I am bothered by side effects of treatment”) estimates treatment tolerability. We aimed to extend our previous finding that GP5 predicts early aromatase inhibitor (AI) discontinuation (E1Z03, 96% White) in the racially diverse E1Z11 trial cohort. Methods: E1Z11 was coordinated by the ECOG-ACRIN NCI Community Oncology Research Program (NCORP) Research Base. Postmenopausal women initiating anastrozole per clinical care for ER+ stage I-III breast cancer with a pain score 0-3/10 and no rheumatologic comorbidities were eligible. Accrual of a racially diverse cohort of 1,000 women, including Black and Asian women, was planned. GP5 was administered prior to initiating anastrozole (trial baseline) and at 3, 6, 9 and 12 months. GP5 was scored on a 5-point Likert scale from 0 (not at all) to 4 (very much) and dichotomized as no/little treatment bother (0/1) or moderate/high treatment bother (2-4), consistent with previous analyses. A univariate Cox proportional hazards model estimated baseline GP5’s association with treatment duration via hazard ratio (HR). Early treatment discontinuation status was defined as treatment duration < 12 months with discontinuation not attributed to disease progression or death (n = 4), consistent with previous analyses. Results: 1,046 women enrolled from 6/2013-10/2018 (640 White, 201 Black, 205 Asian), including 590 (56%) from NCORP Community or Minority/Underserved Sites. Approximately 10% (100/987 with GP5 data) reported moderate/high treatment bother prior to initiating anastrozole. Anastrozole discontinuation rate at 1-year was 26.2% overall; it was lower among women with no/little treatment bother (25.7%, GP5 = 0-1) compared to moderate/high treatment bother prior to initiating anastrozole (34.7%, GP5 = 2-4; HR = 1.50, 95% confidence interval [CI]:1.04-2.15, p = 0.027). Subgroup analyses by racial cohort showed a similar predictive effect of GP5 in the White (n = 606, HR = 1.76, 95% CI: 1.12-2.77, p = 0.014) and Black (n = 184, HR = 1.85, 95% CI: 0.92-3.71, p = 0.079) cohorts, but not in the Asian cohort (n = 197, HR = 0.40, 95% CI: 0.10-1.62, p = 0.20). Conclusions: Moderate/high treatment bother prior to starting anastrozole was observed in 10% of patients and associated with a higher risk of early discontinuation, except in Asian patients. Our findings support the presence of a treatment tolerability threshold which can be compromised by pre-treatment burden. Treatment tolerability may also be influenced by cultural and genetic factors, which will be explored in further analysis of genetic and PRO data. Clinical trial information: NCT01824836.
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Affiliation(s)
| | - John Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Victor Tsu-Shih Chang
- Section of Hematology/Oncology, Veterans Administration New Jersey Health Care System, East Orange, NJ
| | | | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | | | | | - Patrick J. Flynn
- NSABP/NRG Oncology, and Metro-Minnesota Community Oncology Research Consotrium (MMCORC), Minneapolis, MN
| | | | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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Patel R, Hovstadius M, Kier MW, Moshier E, Zimmerman BS, Cascetta KP, Jaffer S, Sparano JA, Tiersten A. Correlation of Ki67 working group prognostic risk categories with oncotype DX recurrence score (RS) in early breast cancer (EBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
553 Background: The 21-gene RS (Oncotype DX) provides prognostic information for distant recurrence risk and is predictive of adjuvant chemotherapy benefit in hormone receptor (HR)-positive, HER-2 negative EBC. Ki67 protein expression is a proliferation marker that is determined by immunohistochemistry (IHC). The International Ki67 Working Group (IKWG) has provided guidelines for clinical use of Ki67 for prognostic classification (PMID: 33369635). The objectives of this study were to determine the correlation between IHC-measured Ki67 with the 21-gene RS, and evaluate their association with other anatomic and biologic tumor features. Methods: We performed a retrospective chart review of women with HR-positive, HER-2 negative EBC with 0-3 positive lymph nodes who had both Ki67 (via IHC using MIB-1 antibody on surgical specimen at our institutional pathology CLIA laboratory) and 21-gene RS between 2013 to 2021. Patients were categorized into Ki67 low (≤ 5%), intermediate (6-29%), and high (≥30%) based on IKWG recommendations. Overall and risk stratified agreement between Ki67 and RS were assessed using the proportion of agreement and Kappa statistic. Linear regression was used to test for associations between tumor features of ER%, PR%, and tumor size and log transformed Ki67 and RS. A t-test was used to compare average log transformed Ki67 and RS by tumor differentiation and nodal status. Results: We identified 461 patients with HR-positive BC of whom 26.7% were ≤ 50 years at diagnosis, 30% pre-menopausal and 10% node-positive. Overall, 29% (n = 137) of patients had low Ki67, 49% (n = 227) intermediate, and 21% (n = 97) high Ki67. 18% (n = 85) had RS 0-10, 67% (n = 311) had RS 11-25 and 14% (n = 65) had RS ≥ 26. There was no significant agreement (kappa < 0) between Ki67 and RS (Kappa = -0.0035, p = 0.5406) in the overall population and fair agreement (kappa 0.21-0.40) between high Ki67 and RS (Kappa = 0.2510, p < 0.0001). Higher ER% was significantly associated with lower RS (p < 0.0001) and lower Ki67 (p = 0.0042). High tumor grade was associated with higher RS and higher Ki67 (p < 0.0001). Higher PR% was associated with lower RS (p > 0.0001) but not lower Ki67. Positive nodal status and larger tumor size were associated with higher Ki67 (p = 0.0081, p < 0.0001) but not RS. Among the 49% of patients with intermediate Ki67 of 6-29%, the distribution of low, intermediate, and high RS was 24%, 65%, and 11%, respectively. Conclusions: In this group of patients selected to have a 21-gene RS, there was no correlation between Ki67 and RS in the overall population, and fair agreement between high Ki67 and high RS. Among the approximately one-half with an intermediate Ki67 of 6-29%, 89% would be spared chemotherapy based on a low-intermediate RS. In patients with high Ki67, 68% might be spared chemotherapy based on the RS. In the low Ki67 group, 6% had a high RS. Ki67 has limited utility in identifying patients with high or low RS.
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Affiliation(s)
- Rima Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, New York, NY
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20
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Kantor O, King TA, Freedman RA, Mayer EL, Chavez Mac Gregor M, Korde LA, Sparano JA, Mittendorf EA. Racial/ethnic disparities in locoregional recurrence in hormone-receptor positive node-negative breast cancer patients enrolled in the TAILORx trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
515 Background: Whether racial/ethnic disparities in locoregional recurrence (LRR) exist in patients (pts) with similar access to care treated on clinical trials is uncertain. We examined racial/ethnic differences in LRR in hormone-receptor positive HER2-negative (HR+HER2-) node-negative pts enrolled in the TAILORx trial. Methods: 10,273 pts age 18-75 were enrolled in TAILORx, which assigned pts with an OncotypeDx Recurrence Score (RS) <11 to endocrine therapy (ET) alone, those with RS >25 to chemotherapy + ET (CET), and randomized pts with RS 11-25 to ET or CET. Pts with unknown race/ethnicity (n=323) or incomplete treatment adherence information (n=1,168) were excluded from this analysis. Race/ethnicity was self-reported. LRR was defined as ipsilateral invasive in-breast, chest wall, or regional nodal recurrence without distant recurrence. Kaplan-Meier curves were used to estimate 8-year LRR. Cox proportional hazards analysis adjusted for clinical and treatment factors was used to determine factors associated with LRR. Results: 8,782 pts with T1-2N0 HR+HER2- breast cancer were included. Race/ethnicity was non-Hispanic White (NHW) in 6,932 (78.9%), non-Hispanic Black (NHB) in 629 (7.2%), Hispanic in 818 (9.3%), and Asian in 403 (4.6%). Treatment adherence was high across groups over time, with a 9.1% crossover in treatment arms. Average duration of ET was 63.8 +/- 0.3 months. Radiation therapy was planned in 96.0% of pts after breast conservation and 12.7% after mastectomy. At a median follow-up of 8 years, LRR rates were 1.9% in NHW, 4.2% in in NHB, 3.2% in Hispanic, and 3.9% in Asian pts (p<0.01). LRR rates broken down by RS are shown in the Table. On adjusted analyses, NHB and Asian (vs. NHW) pts were more likely to have LRR (HR 1.94 for NHB, HR 2.04 for Asian, p<0.05 for both). Additional statistically significant factors associated with LRR included age <50 (HR 1.85), T2 tumors (HR 1.43), higher grade (HR 2.30 for grade 3), and high RS (HR 3.13 for RS>25). Treatment receipt (chemotherapy, ET duration, and radiation) was not associated with LRR in this population. Conclusions: Racial/ethnic differences in LRR were seen in T1-2N0 HR+HER2- breast cancer pts enrolled in the TAILORx trial despite high rates of treatment adherence in this clinical trial population, with highest LRR rates in NHB and Asian pts. Further study in needed to understand racial/ethnic patterns in LRR by breast cancer subtype and if failure to rescue after LRR may contribute to differences in breast cancer mortality.[Table: see text]
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Affiliation(s)
- Olga Kantor
- Dana-Farber Brigham Cancer Center, Boston, MA
| | - Tari A. King
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
| | | | | | | | - Larissa A. Korde
- Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
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21
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Schreier A, Munoz-Arcos L, Alvarez A, Sparano JA, Anampa JD. Racial disparities in neutrophil counts among patients with metastatic breast cancer during treatment with CDK4/6 inhibitors. Breast Cancer Res Treat 2022; 194:337-351. [PMID: 35633421 DOI: 10.1007/s10549-022-06574-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/19/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The three CDK4/6 inhibitors (CDK4/6i) approved for use in HR-positive/HER2-negative metastatic breast cancer (MBC), palbociclib, ribociclib, and abemaciclib, are generally well tolerated; however, neutropenia is a common toxicity. Within the general population, neutropenia has been shown to be more common in individuals of African descent. The landmark CDK4/6i trials in MBC lacked racial diversity in their patient populations. We aimed to assess the toxicity profiles of CDK4/6is in a racially diverse population. METHODS We conducted a retrospective study at Montefiore Medical Center in patients with HR-positive/HER2-negative MBC prescribed CDK4/6i as first or subsequent line therapy between January 2015 and April 2020. Baseline characteristics and laboratory data at various treatment timepoints were collected. RESULTS The final analysis included 182 patients, of whom 46% were Black. Baseline absolute neutrophil count (ANC) was lower in the Black vs. Non-Black cohort (p = 0.001) but the change in ANC from baseline (delta-ANC) was smaller in the Black cohort, and the ANC at different treatment timepoints was similar between groups. There was no difference in the rate of infection or number of dose delays/reductions between racial groups. We did not find any difference in PFS between Black and Non-Black groups, regardless of the presence of CDK4/6i-induced neutropenia. CONCLUSION We analyzed toxicity profiles of 182 patients with HR-positive/HER2-negative MBC treated with CDK4/6i. Despite the lower baseline ANC seen in our Black cohort, treatment toxicities were similar between racial groups. Long-term outcomes with CDK4/6i therapy, measured by PFS, were similar between Black vs. Non-Black patients.
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Affiliation(s)
- Ashley Schreier
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Laura Munoz-Arcos
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alvaro Alvarez
- Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Joseph A Sparano
- Department of Medical Oncology, Mount Sinai Health System, New York, NY, USA
| | - Jesus D Anampa
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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22
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Kim G, Pastoriza JM, Qin J, Lin J, Karagiannis GS, Condeelis JS, Yothers G, Anderson S, Julian T, Entenberg D, Rohan TE, Xue X, Sparano JA, Oktay MH. Racial disparity in distant recurrence-free survival in patients with localized breast cancer: A pooled analysis of National Surgical Adjuvant Breast and Bowel Project trials. Cancer 2022; 128:2728-2735. [PMID: 35578919 DOI: 10.1002/cncr.34241] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Black race is associated with worse outcome in patients with breast cancer. The distant relapse-free survival (DRFS) between Black and White women with localized breast cancer who participated in National Cancer Institute-sponsored clinical trial was evaluated. METHODS Pooled data were analyzed from 8 National Surgical Adjuvant Breast and Bowel Project (NSABP) trials including 9702 women with localized breast cancer treated with adjuvant chemotherapy (AC, n = 7485) or neoadjuvant chemotherapy (NAC, n = 2217), who self-reported as Black (n = 1070) or White (n = 8632) race. The association between race and DRFS was analyzed using log-rank tests and multivariate Cox regression. RESULTS After adjustment for covariates including age, tumor size, nodal status, body mass index and taxane use, and treatment (AC vs NAC), Black race was associated with an inferior DRFS in estrogen receptor-positive (ER+; hazard ratio [HR], 1.24; 95% CI, 1.05-1.46; P = .01), but not in ER- disease (HR, 0.97; 95% CI, 0.83-1.14; P = .73), and significant interaction between race and ER status was observed (P = .03). There was no racial disparity in DRFS among patients with pathologic complete response (pCR) (log-rank P = .8). For patients without pCR, Black race was associated with worse DRFS in ER+ (HR, 1.67; 95% CI, 1.14-2.45; P = .01), but not in ER- disease (HR, 0.91; 95% CI, 0.65-1.28; P = .59). CONCLUSIONS Black race was associated with significantly inferior DRFS in ER+ localized breast cancer treated with AC or NAC, but not in ER- disease. In the NAC group, racial disparity was also observed in patients with residual ER+ breast cancer at surgery, but not in those who had pCR. LAY SUMMARY Black women with breast cancer have worse outcomes compared with White women. We investigated if this held true in the context of clinical trials that provide controlled treatment setting. Black women with cancer expressing estrogen receptors (ERs) had worse outcome than White women. If breast cancers did not express ERs, there was no racial disparity in outcome. We also observed racial disparity in women who received chemotherapy before their cancer was removed, but only if they had cancer expressing ERs and residual disease on completion of treatment. If the cancer disappeared with presurgical chemotherapy, there was no racial disparity.
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Affiliation(s)
- Gina Kim
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jessica M Pastoriza
- Department of Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jiyue Qin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - George S Karagiannis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - John S Condeelis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Greg Yothers
- Department of Biostatistics, Graduate School of Public, Health at University of Pittsburgh, Pittsburgh, Pennsylvania
- NRG Oncology, Philadelphia, Pennsylvania
| | - Stewart Anderson
- Department of Biostatistics, Graduate School of Public, Health at University of Pittsburgh, Pittsburgh, Pennsylvania
- NRG Oncology, Philadelphia, Pennsylvania
| | - Thomas Julian
- NRG Oncology, Philadelphia, Pennsylvania
- Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - David Entenberg
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Joseph A Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York
| | - Maja H Oktay
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York
- Integrated Imaging Program, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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23
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Fazeli S, Snyder BS, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis CA, Corsetti RL, Rahbar H, Spell DW, Blankstein KB, Han LK, Sabol JL, Bumberry JR, Miller KD, Sparano JA, Comstock CE, Wagner LI, Carlos RC. Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open 2022; 5:e2210331. [PMID: 35536580 PMCID: PMC9092204 DOI: 10.1001/jamanetworkopen.2022.10331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. Objective To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. Design, Setting, and Participants A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Exposures Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Main Outcomes and Measures Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Results Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P < .001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P < .001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P < .001). Conclusions and Relevance In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California San Diego, San Diego
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Seema A. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine A. Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ralph L. Corsetti
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle
| | | | | | - Linda K. Han
- Department of Surgery, Indiana University, Indianapolis
| | - Jennifer L. Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - John R. Bumberry
- Department of Surgery, Mercy Hospital Springfield, Springfield, Missouri
| | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Joseph A. Sparano
- Department of Hematology-Oncology, Mount Sinai Health System, New York, New York
| | | | - Lynne I. Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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24
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Sadigh G, Gray RJ, Sparano JA, Yanez B, Garcia SF, Timsina LR, Obeng-Gyasi S, Gareen I, Sledge GW, Whelan TJ, Cella D, Wagner LI, Carlos RC. Assessment of Racial Disparity in Survival Outcomes for Early Hormone Receptor-Positive Breast Cancer After Adjusting for Insurance Status and Neighborhood Deprivation: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Oncol 2022; 8:579-586. [PMID: 35175284 PMCID: PMC8855314 DOI: 10.1001/jamaoncol.2021.7656] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Racial disparities in survival outcomes among Black women with hormone receptor-positive breast cancer have been reported. However, the association between individual-level and neighborhood-level social determinants of health on such disparities has not been well studied. OBJECTIVE To evaluate the association between race and clinical outcomes (ie, relapse-free interval and overall survival) adjusting for individual insurance coverage and neighborhood deprivation index (NDI), measured using zip code of residence, in women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of 9719 women with breast cancer in the Trial Assigning Individualized Options for Treatment, a randomized clinical trial conducted from April 7, 2006, to October 6, 2010. All participants received a diagnosis of hormone receptor-positive, ERBB2-negative, axillary node-negative breast cancer. The present data analysis was conducted from April 1 to October 22, 2021. MAIN OUTCOMES AND MEASURES A multivariate model was developed to evaluate the association between race and relapse-free interval and overall survival adjusting for insurance and NDI level at study entry, early discontinuation of endocrine therapy 4 years after initiation, and clinicopathologic characteristics of cancer. Median follow-up for clinical outcomes was 96 months. RESULTS A total of 9719 women (4.2% [n = 405] Asian; 7.1% [n = 693] Black; 84.3% [n = 8189] White; 4.4% [n = 403] others/not specified) were included; 9.1% of included women [n = 889] were Hispanic or Latino. Median (SD) age was 56 (9.2) years. In multivariate models, Black race compared with White race was associated with statistically significant shorter relapse-free interval (hazard ratio [HR], 1.39; 95% CI, 1.05-1.84; P = .02) and overall survival (HR, 1.49; 95% CI, 1.10-2.99; P = .009), adjusting for insurance and NDI level at study entry and other factors. Although uninsured status was not associated with clinical outcomes, patients with Medicare (HR, 1.30; 95% CI, 1.01-1.68; P = .04) and Medicaid (HR, 1.44; 95% CI, 1.01-2.05; P = .05) had shorter overall survival compared with those with private insurance. Participants living in neighborhoods in the highest NDI quartile experienced shorter overall survival compared with those in the lowest quartile (HR, 1.34; 95% CI, 1.01-1.77; P = .04), regardless of self-identified race. CONCLUSIONS AND RELEVANCE The findings of this post hoc analysis of a randomized clinical trial suggest that Black women with breast cancer have significantly shorter relapse-free interval and overall survival compared with White women. Early discontinuation of endocrine therapy, clinicopathologic characteristics, insurance coverage, and NDI do not fully explain the observed disparity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00310180.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Robert J. Gray
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Joseph A. Sparano
- Department of Hematology and Oncology, The Mount Sinai Hospital, New York, New York
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lava R. Timsina
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus
| | - Ilana Gareen
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | | | - Timothy J. Whelan
- Canadian Cancer Trials Group, McMaster University, Hamilton, Ontario, Canada
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynne I. Wagner
- Wake Forest University Health Sciences, Winston Salem, North Carolina
| | - Ruth C. Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor
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Khan SA, Zhao F, Goldstein LJ, Cella D, Basik M, Golshan M, Julian TB, Pockaj BA, Lee CA, Razaq W, Sparano JA, Babiera GV, Dy IA, Jain S, Silverman P, Fisher CS, Tevaarwerk AJ, Wagner LI, Sledge GW. Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (EA2108). J Clin Oncol 2022; 40:978-987. [PMID: 34995128 PMCID: PMC8937009 DOI: 10.1200/jco.21.02006] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/01/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Distant metastases are present in 6% or more of patients with newly diagnosed breast cancer. In this context, locoregional therapy for the intact primary tumor has been hypothesized to improve overall survival (OS), but clinical trials have reported conflicting results. METHODS Women presenting with metastatic breast cancer and an intact primary tumor received systemic therapy for 4-8 months; if no disease progression occurred, they were randomly assigned to locoregional therapy for the primary site (surgery and radiotherapy per standards for nonmetastatic disease) or continuing sysmetic therapy. The primary end point was OS; locoregional control and quality of life were secondary end points. The trial design provided 85% power to detect a 19.3% absolute difference in the 3-year OS rate in randomly assigned patients. The stratified log-rank test and Cox proportional hazards model were used to compare OS between arms. Cumulative incidence of locoregional progression was compared using Gray's test. Quality-of-life assessment used standard instruments. RESULTS Of 390 participants enrolled, 256 were randomly assigned: 131 to continued systemic therapy and 125 to early locoregional therapy. The 3-year OS was 67.9% without and 68.4% with early locoregional therapy (hazard ratio = 1.11; 90% CI, 0.82 to 1.52; P = .57). The median OS was 53.1 months (95% CI, 47.9 to not estimable) in the systemic therapy arm and 54.9 months (95% CI, 46.7 to not estimable) in the locoregional therapy arm. Locoregional progression was less frequent in those randomly assigned to locoregional therapy (3-year rate: 16.3% v 39.8%; P < .001). Quality-of-life measures were largely similar between arms. CONCLUSION Early locoregional therapy for the primary site did not improve survival in patients presenting with metastatic breast cancer. Although it was associated with improved locoregional control, this had no overall impact on quality of life.
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Affiliation(s)
| | - Fengmin Zhao
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Mark Basik
- Jewish General Hospital Lady Davis Institute, McGill University, Montréal, QC, Canada
| | - Mehra Golshan
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | | | | | | | - Wajeeha Razaq
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Irene A. Dy
- Eisenhower Medical Center, Rancho Mirage, CA
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Kantor O, Burstein HJ, King T, Shak S, Russell C, Giuliano AE, Hortobagyi GN, Winer EP, Korde LA, Sparano JA, Mittendorf EA. Abstract PD9-01: Expanding downstaging criteria in AJCC pathologic prognostic staging using OncotypeDx Recurrence Score® assay in T1-2N0 hormone-receptor positive patients enrolled in the TAILORx trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd9-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The AJCC 8th edition pathologic prognostic staging (PPS) system, which incorporates both anatomic and biologic factors, was developed using data from patients captured in the National Cancer Database diagnosed 2010-2012 in whom complete anatomic (T, N and M category) as well as biologic data (grade, ER, PR, HER2) were available. The clinical endpoint was 3-year overall survival. In addition, the use of genomic assays was incorporated based on the initial report from the TAILORx trial, with patients with T1-2N0 hormone-receptor positive, HER2 negative (HR+,HER2-) breast cancer and an Oncotype DX Recurrence Score® (RS) result <11 being staged as PPS IA. Given availability of long-term prospective followup data from TAILORx, we undertook this study to examine if the RS criteria for downstaging to PPS IA can be expanded using the patients enrolled on this trial. Methods: TAILORx assigned T1-2N0 HR+HER2- breast cancer patients with RS <11 to endocrine therapy (ET) alone and RS >25 to chemotherapy followed by ET (CET). Those with RS 11-25 were randomized to ET or CET. 10,273 patients were enrolled. Patients with incomplete HR status or grade and those with T3 disease were excluded for this analysis. Recurrence-free survival (RFS) in patients with RS <11 were compared between patients that did and did not fall into current AJCC PPS IA category using the Kaplan-Meier method. Results: 9,535 patients were included for analysis. The majority were > 50 years old (n=6893, 72.3%), had T1 tumors (n=6561, 68.8%), grade 2 disease (n=5291, 55.5%), and underwent lumpectomy (n=6855, 71.9%). RS breakdown was <11 in 1539 (16.1%), 11-17 in 3423 (35.9%), 18-25 in 3088 (32.4%) and >25 in 1485 (15.6%). 8,698 (91.2%) patients were AJCC PPS IA (including all T1N0 patients regardless of RS), and 837 (8.8%) were not PPS IA. Median follow-up time was 95 months. PPS IA patients had 8-yr RFS of 94.2% which was statistically similar to patients with RS 11-17 that were not PPS IA (91.7%, p=0.07) and better than patients with RS >18 that were not PPS IA (85.4% for RS 18-25, 76.0% for RS >25, p<0.01). For patients with a RS 11-17 that were not PPS IA receiving ET alone, 8-yr RFS was 93.3% which was statistically similar to PPS IA patients receiving ET alone (94.9%, p=0.24). There was no RFS benefit with CET for patients with RS 11-17 not PPS IA (Table). Conclusions: Patients with T1-2N0 HR+HER2- breast cancer and RS<18 have similar RFS to patients staged as PPS IA by the current AJCC staging system, regardless of treatment, suggesting that consideration could be given to expanding the criteria for pathologic prognostic stage IA to include RS<18.
Comparison of RFS in patients with Stage IA and not Stage IA by AJCC PPS, n=9535Stage IANot stage IA, RS 11-17Not stage IA, RS 18-25Not stage IA, RS >25All Patients, n=9535n=8698n=169n=269n=3998yr RFS % (95% CI)94.2 (93.6-94.8)91.7 (87.0-96.4)85.4 (80.3-90.5)76.0 (69.1-82.9)P-value*Ref0.07<0.01<0.01ET, n=5370n=5123n=88n=135n=248yr RFS % (95% CI)94.9 (94.1-95.7)93.3 (87.6-99.9)85.1 (77.8-92.4)58.3 (77.8-92.4)P-value*Ref0.24<0.01<0.01CET, n=4165n=3575n=81n=134n=3758yr RFS % (95% CI)93.2 (92.2-94.2)90.0 (82.4-97.6)85.8 (78.7-92.9)76.9 (69.8-84.0)P-value*Ref0.019<0.01<0.01ET endocrine therapy; CET chemoendocrine therapy*compared to T1-2N0 patients with PPS IA
Citation Format: Olga Kantor, Harold J Burstein, Tari King, Steven Shak, Christy Russell, Armando E Giuliano, Gabriel N Hortobagyi, Eric P Winer, Larissa A Korde, Joseph A Sparano, Elizabeth A Mittendorf. Expanding downstaging criteria in AJCC pathologic prognostic staging using OncotypeDx Recurrence Score® assay in T1-2N0 hormone-receptor positive patients enrolled in the TAILORx trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD9-01.
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Affiliation(s)
| | | | - Tari King
- Brigham and Women's Hospital, Boston, MA
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Klar N, Gray RJ, Adams S, Sparano JA, Goldstein LJ, DeMichele AM, Wolff AC, Davidson NE, Sledge GW, Badve SS. Abstract P1-08-35: Stromal tumor infiltrating lymphocytes analysis by race and ethnicity in triple negative breast cancers from 2 phase III randomized adjuvant breast cancer trials: ECOG-ACRIN E2197 and E1199. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-08-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Black patients with triple negative breast cancer (TNBC) have worse survival outcomes, even after adjusting for stage at diagnosis, income, insurance status and other socioeconomic factors. Little is known regarding anti-tumor immune responses in Black patients and how these differences affect responses to treatment in TNBC. Limited data exists regarding the stromal tumor infiltrating lymphocytes (sTILs, which are strongly prognostic in TNBC) distribution based on race and ethnicity. Here we evaluate the prevalence, distribution, and prognostic impact of sTILs in TNBC by race/ethnicity from 2 prospective clinical trials of adjuvant anthracycline/taxane-based chemotherapy (E2197 and E1199). Methods: Full-face hematoxylin and eosin-stained sections of 481 tumors from ECOG-ACRIN trials E2197 and E1199 were previously evaluated for density of sTILs and shown to be associated with disease-free survival (DFS), distant recurrence-free interval (DRFI), and overall survival (OS) (Adams, et al JCO 2014). Further analyses were undertaken to evaluate the impact of race/ethnicity. Results: The majority of the 481 TNBC were from White patients (82.3%, n=403); with 12.3% (n=59) Black patients, 1.6% (n=14) other (9 Hispanic, 3 Asian, 2 Other), and 0.5% (n=5) unknown race. Age distribution (mean 49.2 for White and 49.2 for Black) and node negative disease (White 68/403 (42%), Black 24/59 (41%)) were similar. However, tumor size ≤2cm was seen more commonly in White patients (34%, 137/403) compared with Black patients (20%, 12/59). Black patients had a higher proportion of high sTILs (≥30%) with 23.7% (14/59) compared to White patients (11.4%, 46/403). The association of continuous stromal TILs with DFS (hazard ratio for a 10-point difference) was 0.84 (95% CI 0.72, 0.98) for White patients and 0.94 (95% CI 0.73, 1.20) for Black patients [159 DFS events for Whites, 26 DFS events for Blacks]. Conclusions: This is the first dataset from prospective clinical trials evaluating sTILs in TNBC in Black patients. Prevalence of high sTILs was greater in Black patients compared to White patients. The association between increasing sTILs and improved invasive disease-free survival across racial/ethnic groups must be investigated in larger datasets.
Table 1.Race/EthnicityTotal (n=481)White (n=403)Black (n=59)Other (n=19)Mean age49.049.249.245.6T1 (tumor <=2cm)157(32.6%)137 (34.0%)12 (20.3%)8 (42.1%)T2 (tumor >2 and <=5cm)283(58.8%)232 (57.6%)41 (69.5%)10 (52.6%)T3 and T441 (8.5%)34 (8.4%)6 (10.2%)1 (5.3%)Node negative197 (41.0%)168 (41.7%)24 (40.7%)5 (26.3%)Median sTILs (Quartiles)10 (10, 20)10 (10, 20)10 (10,20)20 (10, 30)sTILs = 095 (19.8%)83 (20.6%)10 (16.9%)2 (10.5%)sTILs 10-29%319 (66.3%)274 (68.0%)35 (59.3%)10 (52.6%)sTILs ≥30%67 (13.9%)46 (11.4%)14 (23.7%)7 (36.8%)—sTIL 30-49%,46 (9.6%)32 (7.9%)11 (18.6%)3 (15.8%)—sTIL 50-74%,17 (3.5%)11 (2.7%)3 (5.1%)3 (15.8%)—sTIL 75-100%4 (0.8%)3 (0.7%)01 (5.2%)iDFS (HR for 10% sTIL increase)0.86 (95% CI 0.76, 0.98)0.84 (95% CI 0.72, 0.98)0.94 (95% CI 0.73, 1.20)0.97 (95% CI 0.68, 1.40)DRFI (HR for 10% sTIL increase)0.82 (95% CI 0.68, 0.99)0.79 (95% CI 0.63, 1.00)1.08 (95% CI 0.82, 1.44)0.54 (95% CI 0.32, 0.90)OS (HR for 10% sTIL increase)0.81 (95% CI 0.69, 0.95)0.76 (95% CI 0.62, 0.94)1.01 (95% CI 0.76, 1.35)0.83 (95% CI 0.54, 1.29)
Citation Format: Natalie Klar, Robert J Gray, Sylvia Adams, Joseph A Sparano, Lori J Goldstein, Angela M DeMichele, Antonio C Wolff, Nancy E Davidson, George W Sledge, Sunil S Badve. Stromal tumor infiltrating lymphocytes analysis by race and ethnicity in triple negative breast cancers from 2 phase III randomized adjuvant breast cancer trials: ECOG-ACRIN E2197 and E1199 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-35.
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Affiliation(s)
- Natalie Klar
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Grossman School of Medicine, New York, NY
| | - Robert J Gray
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Sylvia Adams
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Grossman School of Medicine, New York, NY
| | | | | | | | - Antonio C Wolff
- Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD
| | - Nancy E Davidson
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
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Smith KL, Zhao F, Mayer IA, Tevaarwerk AJ, Garcia SF, Arteaga CL, Symmans WF, Park BH, Burnette BL, Makower DF, Block M, Morley KA, Jani CR, Mescher C, Dewani SJ, Brown-Glaberman U, Flaum LE, Mayer EL, Sikov WM, Rodler ET, DeMichele AM, Sparano JA, Wolff AC, Miller KD, Wagner LI. Abstract P4-10-02: Patient-reported outcomes in EA1131: A randomized phase III trial of platinum vs. capecitabine in patients with residual triple-negative breast cancer after neoadjuvant chemotherapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Understanding health-related quality of life (HRQOL), including side effects, is critical to guide supportive care during chemotherapy. The EA1131 trial demonstrated that Platinum (Plat) was unlikely to improve outcomes compared to capecitabine (Cape) in patients with stage II-III triple-negative breast cancer (TNBC) of basal subtype and ≥1 cm residual disease after neoadjuvant chemotherapy (NAC), supporting Cape as the continued standard of care. Patient-reported outcomes (PRO) were administered as a sub-study to understand HRQOL and symptoms from the patient’s perspective. Methods: EA1131 was amended in 9/2017 to add PRO endpoints and all patients enrolled after this amendment were eligible for the PRO sub-study. The Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (FBSI) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity Subscale (NtxS; Plat arm only) were administered at baseline (BL), cycle 3 day 1 (C3D1), and following treatment at 6 and 15 months. Due to early trial termination, the PRO sub-study target accrual (n=362) was not reached. It was hypothesized that HRQOL, assessed by the FBSI-Treatment Side Effect (TSE) subscale (range 0-16, higher score = less side effects, better HRQOL), would indicate fewer post-treatment side effects at 6 and 15 months following Plat compared to Cape. The Wilcoxon rank sum test was used to compare FBSI-TSE subscale scores and total FBSI scores (range 0-64, higher score = better overall HRQOL) between arms at BL, C3D1, 6 months and 15 months. Two-sample t-tests were used to compare change in FBSI-TSE subscale scores and total FBSI scores from BL to C3D1 between arms. Change in NtxS scores (range 0-44, higher score = less neurotoxicity) from BL to C3D1 was evaluated with the paired t-test. Analyses were exploratory and p-values <0.05 considered significant without multiple comparisons adjustment. Results: Of 331 patients eligible for the PRO sub-study (156 Plat arm, 175 Cape arm), 296 (89.4%) completed ≥1 PRO. Mean FBSI-TSE subscale scores were better for Cape at BL (Cape 14.5, Plat 13.9, p-value 0.02), for Plat at C3D1 (Cape 13.5, Plat 14.0, p-value 0.04), and did not differ at 6 months (Cape 14.6, Plat 14.7, p-value 0.70) or 15 months (Cape 14.9, Plat 14.5, p-value 0.44). FBSI-TSE subscale scores worsened from BL to C3D1 for Cape but not for Plat (mean change Cape -0.72, mean change Plat 0.15, p-value 0.003). FBSI-TSE subscale change scores from BL to C3D1 exceeded the threshold for clinically meaningful worsening (> 1.5 points) in 27% of patients on Cape and 23% of patients on Plat (p-value 0.51). Mean total FBSI scores did not differ between arms at any time (BL: Cape 50.6, Plat 49.7; C3D1: Cape 48.1, Plat 48.0; 6 months: Cape 49.9, Plat 51.1; 15 months: Cape 53.3, Plat 50.3; all p > 0.05). Mean change in total FBSI scores from BL to C3D1 did not differ between arms (Cape -2.20, Plat -1.83, p = 0.75). Mean (standard deviation) NtxS scores for the Plat arm were 38 (6.3), 36.1 (7.8), 36 (7.1) and 34.5 (7.9) at BL, C3D1, 6 months and 15 months, respectively. Mean NtxS score decreased (indicating worsening neurotoxicity) from BL to C3D1 (p-value 0.006). Conclusions: Despite more frequent severe toxicity by CTCAE criteria for Plat than Cape, patient-reported side effects worsened during treatment with Cape but not Plat. Overall, changes in HRQOL were small for both arms and resolved after therapy. However approximately one-fourth of patients had clinically meaningful worsening side effects on both arms. PRO-assessed neurotoxicity increased in the Plat arm. This PRO sub-study demonstrates that PROs capture toxicities beyond CTCAE criteria and provides novel data about patients’ experience during adjuvant chemotherapy following NAC for TNBC.
Citation Format: Karen L Smith, Fengmin Zhao, Ingrid A Mayer, Amye J Tevaarwerk, Sofia F Garcia, Carlos L Arteaga, William F Symmans, Ben H Park, Brian L Burnette, Della F Makower, Margaret Block, Kimberly A Morley, Chirag R Jani, Craig Mescher, Shabana J Dewani, Ursa Brown-Glaberman, Lisa E Flaum, Erica L Mayer, William M Sikov, Eve T Rodler, Angela M DeMichele, Joseph A Sparano, Antonio C Wolff, Kathy D Miller, Lynne I Wagner. Patient-reported outcomes in EA1131: A randomized phase III trial of platinum vs. capecitabine in patients with residual triple-negative breast cancer after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-02.
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Affiliation(s)
- Karen L Smith
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Fengmin Zhao
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Ingrid A Mayer
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | | | | | | | - Ben H Park
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Brian L Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI
| | | | | | | | | | - Craig Mescher
- Metro-Minnesota Community Oncology Research Consortium, St. Louis Park, MN
| | | | | | | | | | | | | | | | | | - Antonio C Wolff
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, NC
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Sparano JA, O’Neill A, Graham N, Northfelt DW, Dang CT, Wolff AC, Sledge GW, Miller KD. Inflammatory cytokines and distant recurrence in HER2-negative early breast cancer. NPJ Breast Cancer 2022; 8:16. [PMID: 35136076 PMCID: PMC8825796 DOI: 10.1038/s41523-021-00376-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 12/07/2021] [Indexed: 01/14/2023] Open
Abstract
Systemic inflammation is believed to contribute to the distant recurrence of breast cancer. We evaluated serum samples obtained at diagnosis from 249 case:control pairs with stage II-III Her2-negative breast cancer with or without subsequent distant recurrence. Conditional logistic regression analysis, with models fit via maximum likelihood, were used to estimate hazard ratios (HRs) and test for associations of cytokines with distant recurrence risk. The only biomarker associated with a significantly increased distant recurrence risk when adjusted for multiple testing was the proinflammatory cytokine IL-6 (HR 1.37, 95% confidence intervals [CI] 1.15, 1.65, p = 0.0006). This prospective-retrospective study provides evidence indicating that higher levels of the cytokine IL-6 at diagnosis are associated with a significantly higher distant recurrence risk.
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Affiliation(s)
- Joseph A. Sparano
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY USA
| | - Anne O’Neill
- grid.65499.370000 0001 2106 9910Dana Farber Cancer Institute ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | - Noah Graham
- grid.65499.370000 0001 2106 9910Dana Farber Cancer Institute ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | | | - Chau T. Dang
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Antonio C. Wolff
- grid.280502.d0000 0000 8741 3625Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD USA
| | - George W. Sledge
- grid.168010.e0000000419368956Stanford Cancer Center, Palo Alto, CA USA
| | - Kathy D. Miller
- grid.257413.60000 0001 2287 3919Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN USA
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Garcia SF, Gray RJ, Sparano JA, Tevaarwerk AJ, Carlos RC, Yanez B, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Fatigue and endocrine symptoms among women with early breast cancer randomized to endocrine versus chemoendocrine therapy: Results from the TAILORx patient-reported outcomes substudy. Cancer 2022; 128:536-546. [PMID: 34614209 PMCID: PMC8776586 DOI: 10.1002/cncr.33939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/01/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND TAILORx (Trial Assigning Individualized Options for Treatment) prospectively assessed fatigue and endocrine symptoms among women with early-stage hormone receptor-positive breast cancer and a midrange risk of recurrence who were randomized to endocrine therapy (E) or chemotherapy followed by endocrine therapy (CT+E). METHODS Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue, the Patient-Reported Outcomes Measurement Information System-Fatigue Short Form, and the Functional Assessment of Cancer Therapy-Endocrine Symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Linear regression was used to model outcomes on baseline symptoms, treatment, and other factors. RESULTS Participants (n = 458) in both treatment arms reported greater fatigue and endocrine symptoms at early follow-up in comparison with the baseline. The magnitude of change in fatigue was significantly greater for the CT+E arm than the E arm at 3 and 6 months but not at 12, 24, or 36 months. The CT+E arm reported significantly greater changes in endocrine symptoms from the baseline to 3 months in comparison with the E arm; change scores were not significantly different at later time points. Endocrine symptom trajectories by treatment differed by menopausal status, with the effect larger and increasing for postmenopausal patients. CONCLUSIONS Adjuvant CT+E was associated with greater increases in fatigue and endocrine symptoms at early time points in comparison with E. These differences lessened over time, and this demonstrated early chemotherapy effects more than long-term ones. Treatment arm differences in endocrine symptoms were more evident in postmenopausal patients. LAY SUMMARY Participants in TAILORx (Trial Assigning Individualized Options for Treatment) with early-stage hormone receptor-positive breast cancer and an intermediate risk of recurrence were randomly assigned to endocrine or chemoendocrine therapy. Four hundred fifty-eight women reported fatigue and endocrine symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Both groups reported greater symptoms at early follow-up versus the baseline. Increases in fatigue were greater for the chemoendocrine group than the endocrine group at 3 and 6 months but not later. The chemoendocrine group reported greater changes in endocrine symptoms in comparison with the endocrine group at 3 months but not later.
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Affiliation(s)
| | - Robert J. Gray
- Dana Farber Cancer Institute
- ECOG-ACRIN Biostatistics Center
| | | | | | | | | | - Ilana F. Gareen
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
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Kessler AJ, Sparano JA. Systemic therapy for triple-negative breast cancer: A changing landscape. Crit Rev Oncol Hematol 2022; 171:103608. [PMID: 35093499 DOI: 10.1016/j.critrevonc.2022.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alaina J Kessler
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, United States.
| | - Joseph A Sparano
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, United States
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Makower D, Qin J, Lin J, Xue X, Sparano JA. The 21-gene recurrence score in early non-ductal breast cancer: a National Cancer Database analysis. NPJ Breast Cancer 2022; 8:4. [PMID: 35027533 PMCID: PMC8758772 DOI: 10.1038/s41523-021-00368-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
The 21-gene recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit in early estrogen receptor-positive (ER +) HER2-negative (HER2-) breast cancer (BCA). We evaluated clinicopathologic characteristics, RS and chemotherapy benefit in invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and carcinomas of mixed histologies (ductal + lobular (DLC), ductal + other (DOC), lobular + other (LOC)). Women diagnosed between 1/1/2010 and 1/1/2014 with ER + HER2- BCA, measuring <5 cm, with 0–3 involved axillary nodes, surgery as first treatment, and available RS, were identified from the NCDB. Associations between categorical variables were examined using chi-square test. Cox proportional hazards model was used to examine overall survival (OS) differences among histology subtypes. IDC was associated with smaller size, high grade, and RS > 26. ILC was associated with larger size, and least likely to be high grade (p < 0.0001). Lobular histology was associated with lower incidence of RS > 26. IDC patients (pts) were more likely to receive chemotherapy than pts with other histologies (p < 0.0001). OS for IDC, ILC and DOC were similar. DLC was associated with improved OS (HR 0.82, p = 0.02). Adjuvant chemotherapy was associated with improved OS in IDC (HR = 0.76, p < 0.0001) but not in ILC (HR = 0.99, p = 0.93), DLC (HR = 1.04, p = 0.86), DOC (HR = 0.87, p = 0.71), or LOC (HR = 2.91, p = 0.10). Lobular and mixed BCA histologies have distinct clinicopathologic features compared with IDC, and are less likely to have high RS. OS is similar for IDC and ILC. Although chemotherapy benefit was seen only in IDC, benefit for ILC with RS > 26 cannot be excluded.
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Affiliation(s)
- Della Makower
- Montefiore Einstein Center for Cancer Care, New York, NY, USA.
| | - Jiyue Qin
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Juan Lin
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Xiaonan Xue
- Albert Einstein Cancer Center, Bronx, NY, USA
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Ip EH, Saldana S, Miller KD, Carlos RC, Gareen IF, Sparano JA, Graham N, Zhao F, Lee JW, O’Connell NS, Cella D, Peipert JD, Gray RJ, Wagner LI. Tolerability of bevacizumab and chemotherapy in a phase 3 clinical trial with human epidermal growth factor receptor 2-negative breast cancer: A trajectory analysis of adverse events. Cancer 2021; 127:4546-4556. [PMID: 34726788 PMCID: PMC8887554 DOI: 10.1002/cncr.33992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND E5103 was a study designed to evaluate the efficacy and safety of bevacizumab. It was a negative trial for the end points of invasive disease-free survival and overall survival. The current work examines the tolerability of bevacizumab and other medication exposures with respect to clinical outcomes and patient-reported outcomes (PROs). METHODS Adverse events (AEs) collected from the Common Terminology Criteria for Adverse Events were summarized to form an AE profile at each treatment cycle. All-grade and high-grade events were separately analyzed. The change in the AE profile over the treatment cycle was delineated as distinct AE trajectory clusters. AE-related and any-reason early treatment discontinuations were treated as clinical outcome measures. PROs were measured with the Functional Assessment of Cancer Therapy-Breast + Lymphedema. The relationships between the AE trajectory and early treatment discontinuation as well as PROs were analyzed. RESULTS More than half of all AEs (57.5%) were low-grade. A cluster of patients with broad and mixed AE (all-grade) trajectory grades was significantly associated with any-reason early treatment discontinuation (odds ratio [OR], 2.87; P = .01) as well as AE-related discontinuation (OR, 4.14; P = .001). This cluster had the highest count of all-grade AEs per cycle in comparison with other clusters. Another cluster of patients with primary neuropathic AEs in their trajectories had poorer physical well-being in comparison with a trajectory of no or few AEs (P < .01). A high-grade AE trajectory did not predict discontinuations. CONCLUSIONS A sustained and cumulative burden of across-the-board toxicities, which were not necessarily all recognized as high-grade AEs, contributed to early treatment discontinuation. Patients with neuropathic all-grade AEs may require additional attention for preventing deterioration in their physical well-being.
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Affiliation(s)
- Edward H. Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Santiago Saldana
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathy D. Miller
- Hematology/Oncology Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Ilana F. Gareen
- Department of Epidemiology and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Joseph A. Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Noah Graham
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Fengmin Zhao
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biostatics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ju-Whei Lee
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nathaniel S. O’Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert J. Gray
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biostatics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lynne I. Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Mayer IA, Zhao F, Arteaga CL, Symmans WF, Park BH, Burnette BL, Tevaarwerk AJ, Garcia SF, Smith KL, Makower DF, Block M, Morley KA, Jani CR, Mescher C, Dewani SJ, Tawfik B, Flaum LE, Mayer EL, Sikov WM, Rodler ET, Wagner LI, DeMichele AM, Sparano JA, Wolff AC, Miller KD. Reply to T. Shimoi et al and Y. Shimanuki et al. J Clin Oncol 2021; 39:3522-3524. [PMID: 34554848 PMCID: PMC8547907 DOI: 10.1200/jco.21.01905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2024] Open
Affiliation(s)
- Ingrid A. Mayer
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Fengmin Zhao
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Carlos L. Arteaga
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - William F. Symmans
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Ben H. Park
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Brian L. Burnette
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Amye J. Tevaarwerk
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Sofia F. Garcia
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Karen L. Smith
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Della F. Makower
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Margaret Block
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Kimberly A. Morley
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Chirag R. Jani
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Craig Mescher
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Shabana J. Dewani
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Bernard Tawfik
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Lisa E. Flaum
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Erica L. Mayer
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - William M. Sikov
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Eve T. Rodler
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Lynne I. Wagner
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Angela M. DeMichele
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Joseph A. Sparano
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Antonio C. Wolff
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Kathy D. Miller
- Ingrid A. Mayer, MD, MSCI, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Fengmin Zhao, PhD, Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Carlos L. Arteaga, MD, UT Southwestern Simmons Cancer Center, Dallas, TX; William F. Symmans, MD, MD Anderson Cancer Center, Houston, TX; Ben H. Park, MD, PhD, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN; Brian L. Burnette, MD, Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI; Amye J. Tevaarwerk, MD, University of Wisconsin Carbone Cancer Center, Madison, WI; Sofia F. Garcia, PhD, Northwestern University, Evanston, IL; Karen L. Smith, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; Della F. Makower, MD, Montefiore Medical Center, Bronx, NY; Margaret Block, MD, Alegent Health Bergan Mercy Medical Center, Omaha, NE; Kimberly A. Morley, MD, Saint Joseph Mercy Hospital, Ann Arbor, MI; Chirag R. Jani, MD, Phoebe Putney Memorial Hospital, Albany, GA; Craig Mescher, MD, Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN; Shabana J. Dewani, MD, Columbus Oncology and Hematology Associates Inc, Columbus, OH; Bernard Tawfik, MD, University of New Mexico Cancer Center, Albuquerque, NM; Lisa E. Flaum, MD, Northwestern University, Evanston, IL; Erica L. Mayer, MD, Dana-Farber Cancer Institute, Boston, MA; William M. Sikov, MD, Women and Infants Hospital of Rhode Island, Providence, RI; Eve T. Rodler, MD, University of California, Davis, Davis, CA; Lynne I. Wagner, PhD, Wake Forest University Health Sciences, Winston-Salem, NC; Angela M. DeMichele, MD, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA; Joseph A. Sparano, MD, Montefiore Medical Center, Bronx, NY; Antonio C. Wolff, MD, Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD; and Kathy D. Miller, MD, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
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Fazeli S, Snyder BS, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis CA, Miller KD, Sparano JA, Comstock CE, Wagner LI, Carlos RC. Patient-Reported Testing Burden of Breast Magnetic Resonance Imaging Among Women With Ductal Carcinoma In Situ: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open 2021; 4:e2129697. [PMID: 34726748 PMCID: PMC8564581 DOI: 10.1001/jamanetworkopen.2021.29697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE The use of magnetic resonance imaging (MRI) in pretreatment planning of ductal carcinoma in situ (DCIS) remains controversial. Understanding changes in short-term health-related quality of life associated with breast MRI would allow for a more complete comparative effectiveness assessment. OBJECTIVE To assess whether there are changes in patient-reported quality of life associated with breast MRI among women diagnosed with DCIS. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a substudy of a nonrandomized clinical trial conducted at 75 participating US institutions from March 2015 to April 2016. Women recently diagnosed with unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. A total of 355 women met the eligibility criteria and underwent the study MRI. Data analysis was performed from June 3, 2020, to July 1, 2021. EXPOSURES Participants underwent bilateral breast MRI within 30 days of study registration and before surgery. Information on patient-reported testing burden for breast MRI was collected after MRI and before surgery. MAIN OUTCOMES AND MEASURES The primary outcome of this substudy was the patient-reported testing burden of breast MRI, measured by the Testing Morbidities Index (TMI) summated scale score. The TMI is a 7-item instrument that evaluates the temporary changes in quality of life associated with imaging before, during, and after the test (0 represents the worst possible, 100 the hypothetical ideal test experience). RESULTS Of the 355 women who met the eligibility criteria, 244 (69%) completed both questionnaires and were included in this analysis. The median age was 59 years (range, 34-85 years). The mean MRI TMI summated scale score was 85.9 (95% CI, 84.6-87.3). Of the 244 women, 142 (58%) experienced at least some fear and anxiety before the examination, and 120 women (49%) experienced fear and anxiety during the examination. A total of 156 women (64%) experienced pain or discomfort during the examination. In multivariable analyses, greater test-related burden was associated with higher levels of cancer worry (regression coefficient, -2.75; SE, 0.94; P = .004). CONCLUSIONS AND RELEVANCE In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anxiety/psychology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/psychology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/psychology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/psychology
- Clinical Trials as Topic
- Fear/psychology
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Magnetic Resonance Imaging/psychology
- Middle Aged
- Quality of Life/psychology
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California, San Diego
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Seema A. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine A. Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Joseph A. Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Lynne I. Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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Rohan TE, Ginsberg M, Wang Y, Couch FJ, Feigelson HS, Greenlee RT, Honda S, Stark A, Chitale D, Wang T, Xue X, Oktay MH, Sparano JA, Loudig O. Molecular markers of risk of subsequent invasive breast cancer in women with ductal carcinoma in situ: protocol for a population-based cohort study. BMJ Open 2021; 11:e053397. [PMID: 34702732 PMCID: PMC8549665 DOI: 10.1136/bmjopen-2021-053397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) of the breast is a non-obligate precursor of invasive breast cancer (IBC). Many DCIS patients are either undertreated or overtreated. The overarching goal of the study described here is to facilitate detection of patients with DCIS at risk of IBC development. Here, we propose to use risk factor data and formalin-fixed paraffin-embedded (FFPE) DCIS tissue from a large, ethnically diverse, population-based cohort of 8175 women with a first diagnosis of DCIS and followed for subsequent IBC to: identify/validate miRNA expression changes in DCIS tissue associated with risk of subsequent IBC; evaluate ipsilateral IBC risk in association with two previously identified marker sets (triple immunopositivity for p16, COX-2, Ki67; Oncotype DX Breast DCIS score); examine the association of risk factor data with IBC risk. METHODS AND ANALYSIS We are conducting a series of case-control studies nested within the cohort. Cases are women with DCIS who developed subsequent IBC; controls (2/case) are matched to cases on calendar year of and age at DCIS diagnosis. We project 485 cases/970 controls in the aim focused on risk factors. We estimate obtaining FFPE tissue for 320 cases/640 controls for the aim focused on miRNAs; of these, 173 cases/346 controls will be included in the aim focused on p16, COX-2 and Ki67 immunopositivity, and of the latter, 156 case-control pairs will be included in the aim focused on the Oncotype DX Breast DCIS score®. Multivariate conditional logistic regression will be used for statistical analyses. ETHICS AND DISSEMINATION Ethics approval was obtained from the Institutional Review Boards of Albert Einstein College of Medicine (IRB 2014-3611), Kaiser Permanente Colorado, Kaiser Permanente Hawaii, Henry Ford Health System, Mayo Clinic, Marshfield Clinic Research Institute and Hackensack Meridian Health, and from Lifespan Research Protection Office. The study results will be presented at meetings and published in peer-reviewed journals.
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Affiliation(s)
- Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mindy Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert T Greenlee
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Stacey Honda
- Center for Integrated Healthcare, Kaiser Permanente, Hawaii Permanente Medical Group, Honolulu, Hawaii, USA
| | - Azadeh Stark
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
- Breast Oncology Program and Department of Pathology, Henry Ford Health System, Detroit, Michigan, USA
| | - Dhananjay Chitale
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
- Breast Oncology Program and Department of Pathology, Henry Ford Health System, Detroit, Michigan, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Maja H Oktay
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Joseph A Sparano
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
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Connolly RM, Zhao F, Miller KD, Lee MJ, Piekarz RL, Smith KL, Brown-Glaberman UA, Winn JS, Faller BA, Onitilo AA, Burkard ME, Budd GT, Levine EG, Royce ME, Kaufman PA, Thomas A, Trepel JB, Wolff AC, Sparano JA. E2112: Randomized Phase III Trial of Endocrine Therapy Plus Entinostat or Placebo in Hormone Receptor-Positive Advanced Breast Cancer. A Trial of the ECOG-ACRIN Cancer Research Group. J Clin Oncol 2021; 39:3171-3181. [PMID: 34357781 PMCID: PMC8478386 DOI: 10.1200/jco.21.00944] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Endocrine therapy resistance in advanced breast cancer remains a significant clinical problem that may be overcome with the use of histone deacetylase inhibitors such as entinostat. The ENCORE301 phase II study reported improvement in progression-free survival (PFS) and overall survival (OS) with the addition of entinostat to the steroidal aromatase inhibitor (AI) exemestane in advanced hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. PATIENTS AND METHODS E2112 is a multicenter, randomized, double-blind, placebo-controlled phase III study that enrolled men or women with advanced HR-positive, HER2-negative breast cancer whose disease progressed after nonsteroidal AI. Participants were randomly assigned to exemestane 25 mg by mouth once daily and entinostat (EE) or placebo (EP) 5 mg by mouth once weekly. Primary end points were PFS by central review and OS. Secondary end points included safety, objective response rate, and lysine acetylation change in peripheral blood mononuclear cells between baseline and cycle 1 day 15. RESULTS Six hundred eight patients were randomly assigned during March 2014-October 2018. Median age was 63 years (range 29-91), 60% had visceral disease, and 84% had progressed after nonsteroidal AI in metastatic setting. Previous treatments included chemotherapy (60%), fulvestrant (30%), and cyclin-dependent kinase inhibitor (35%). Most common grade 3 and 4 adverse events in the EE arm included neutropenia (20%), hypophosphatemia (14%), anemia (8%), leukopenia (6%), fatigue (4%), diarrhea (4%), and thrombocytopenia (3%). Median PFS was 3.3 months (EE) versus 3.1 months (EP; hazard ratio = 0.87; 95% CI, 0.67 to 1.13; P = .30). Median OS was 23.4 months (EE) versus 21.7 months (EP; hazard ratio = 0.99; 95% CI, 0.82 to 1.21; P = .94). Objective response rate was 5.8% (EE) and 5.6% (EP). Pharmacodynamic analysis confirmed target inhibition in entinostat-treated patients. CONCLUSION The combination of exemestane and entinostat did not improve survival in AI-resistant advanced HR-positive, HER2-negative breast cancer.
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Affiliation(s)
- Roisin M. Connolly
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Cancer Research at UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | | | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Min-Jung Lee
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Richard L. Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Karen L. Smith
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | - Bryan A. Faller
- Heartland NCORP, Missouri Baptist Medical Centre, Saint Louis, MO
| | | | | | | | | | | | | | | | - Jane B. Trepel
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Antonio C. Wolff
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Chou SHS, Romanoff J, Lehman CD, Khan SA, Carlos R, Badve SS, Xiao J, Corsetti RL, Javid SH, Spell DW, Han LK, Sabol JL, Bumberry JR, Gareen IF, Snyder BS, Gatsonis C, Wagner LI, Wolff AC, Miller KD, Sparano JA, Comstock CE, Rahbar H. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology 2021; 301:E381. [PMID: 34543146 DOI: 10.1148/radiol.2021219016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Barbi M, Makower D, Sparano JA. The clinical utility of gene expression assays in breast cancer patients with 0-3 involved lymph nodes. Ther Adv Med Oncol 2021; 13:17588359211038467. [PMID: 34408795 PMCID: PMC8366126 DOI: 10.1177/17588359211038467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Multigene expression assays are prognostic for recurrence in hormone-receptor positive 2 (HER-2) negative breast cancer, and, in some cases, predictive of benefit from chemotherapy or extended endocrine therapy. The results of these assays may be used to guide treatment recommendations for early HER-2 negative breast cancer. We review the results of trials establishing the clinical utility of several commercially available gene expression assays.
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Affiliation(s)
- Mali Barbi
- Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | - Della Makower
- Department of Oncology, Montefiore Medical Center, 1695 Eastchester Rd, Bronx, NY 10461, USA
| | - Joseph A Sparano
- Division of Hematology/Oncology, Mt. Sinai School of Medicine, New York, NY, USA
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Martínez LE, Lensing S, Chang D, Magpantay LI, Mitsuyasu R, Ambinder RF, Sparano JA, Martínez-Maza O, Epeldegui M. Immune Activation and Microbial Translocation as Prognostic Biomarkers for AIDS-Related Non-Hodgkin Lymphoma in the AMC-034 Study. Clin Cancer Res 2021; 27:4642-4651. [PMID: 34131000 PMCID: PMC8364886 DOI: 10.1158/1078-0432.ccr-20-4167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE AIDS-related non-Hodgkin lymphoma (ARL) is the most common cancer in HIV-infected individuals in the United States and other countries in which HIV-positive persons have access to effective combination antiretroviral therapy (cART). Our prior work showed that pretreatment/postdiagnosis plasma levels of some cytokines, such as IL6, IL10, and CXCL13, have the potential to serve as indicators of clinical response to treatment and survival in ARL. The aims of this study were to identify novel prognostic biomarkers for response to treatment and/or survival in persons with ARL, including biomarkers of microbial translocation and inflammation. EXPERIMENTAL DESIGN We quantified plasma levels of several biomarkers (sCD14, LBP, FABP2, EndoCab IgM, IL18, CCL2/MCP-1, sCD163, IP-10/CXCL10, TARC/CCL17, TNFα, BAFF/BLyS, sTNFRII, sCD44, and sIL2Rα/sCD25) by multiplexed immunometric assays (Luminex) or ELISA in plasma specimens obtained from ARL patients enrolled in the AMC-034 trial, which compared infusional combination chemotherapy (EPOCH: etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) with concurrent or sequential rituximab. Plasma was collected prior to the initiation of therapy (n = 57) and after treatment initiation (n = 55). RESULTS We found that several biomarkers decreased significantly after treatment, including TNFα, sCD25, LBP, and TARC (CCL17). Moreover, pretreatment plasma levels of BAFF, sCD14, sTNFRII, and CCL2/MCP-1 were univariately associated with overall survival, and pretreatment levels of BAFF, sTNFRII, and CCL2/MCP-1 were also associated with progression-free survival. CONCLUSIONS Our results suggest that patients with ARL who responded to therapy had lower pretreatment levels of inflammation and microbial translocation as compared with those who did not respond optimally.
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Affiliation(s)
- Laura E Martínez
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Di Chang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Larry I Magpantay
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ronald Mitsuyasu
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
| | - Richard F Ambinder
- Division of Hematologic Malignancies, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Otoniel Martínez-Maza
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Marta Epeldegui
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California.
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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Mo A, Chung J, Eichler J, Yukelis S, Feldman S, Fox J, Garg M, Kalnicki S, Ohri N, Sparano JA, Klein J. Breast cancer survivorship care during the COVID-19 pandemic within an urban New York Hospital System. Breast 2021; 59:301-307. [PMID: 34385028 PMCID: PMC8334511 DOI: 10.1016/j.breast.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine clinicodemographic determinants associated with breast cancer survivorship follow-up during COVID-19. Methods We performed a retrospective, population-based cohort study including early stage (Stage I-II) breast cancer patients who underwent resection between 2006 and 2018 in a New York City hospital system. The primary outcome was oncologic follow-up prior to and during the COVID-19 pandemic. Secondary analyses compared differences in follow-up by COVID-19 case rates stratified by ZIP code. Results A total of 2942 patients with early-stage breast cancer were available for analysis. 1588 (54%) of patients had attended follow-up in the year prior to the COVID-19 period but failed to continue to follow-up during the pandemic, either in-person or via telemedicine. 1242 (42%) patients attended a follow-up appointment during the COVID-19 pandemic. Compared with patients who did not present for follow-up during COVID-19, patients who continued their oncologic follow-up during the pandemic were younger (p = 0.049) more likely to have received adjuvant radiation therapy (p = 0.025), and have lower household income (p = 0.031) on multivariate modeling. When patients who live in Bronx, New York, were stratified by ZIP code, there was a modest negative association (r = −0.56) between COVID-19 cases and proportion of patients who continued to follow-up during the COVID-19 period. Conclusion We observed a dramatic disruption in routine breast cancer follow-up during the COVID-19 pandemic. Providers and health systems should emphasize reintegrating patients who missed appointments during COVID-19 back into regular surveillance programs to avoid significant morbidity and mortality from missed breast cancer recurrences. A dramatic disruption in routine oncologic follow-up was observed during the COVID-19 period. Over half of patients with breast cancer at our center did not attend routine oncologic follow-up during COVID-19. Patients who were younger, had lower SES, and who received radiotherapy were more likely to follow-up during the pandemic. A modest negative association was observed between local ZIP code COVID-19 infection rates and follow-up attendance rate.
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Affiliation(s)
- Allen Mo
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Julie Chung
- Health Information Management, Cancer Registry, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeremy Eichler
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sarah Yukelis
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sheldon Feldman
- Department of Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jana Fox
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Madhur Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Joseph A Sparano
- Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
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Chou SHS, Romanoff J, Lehman CD, Khan SA, Carlos R, Badve SS, Xiao J, Corsetti RL, Javid SH, Spell DW, Han LK, Sabol JL, Bumberry JR, Gareen IF, Snyder BS, Gatsonis C, Wagner LI, Wolff AC, Miller KD, Sparano JA, Comstock CE, Rahbar H. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology 2021; 301:66-77. [PMID: 34342501 DOI: 10.1148/radiol.2021204743] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There are limited data from clinical trials describing preoperative MRI features and performance in the evaluation of mammographically detected ductal carcinoma in situ (DCIS). Purpose To report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial. Materials and Methods Secondary analyses of a multicenter prospective clinical trial from the ECOG-ACRIN Cancer Research Group included women with DCIS diagnosed with conventional imaging techniques (mammography and US), confirmed via core-needle biopsy (CNB), and enrolled between March 2015 and April 2016 who were candidates for wide local excision (WLE) based on conventional imaging and clinical examination results. DCIS MRI features and pathologic features from CNB and excision were recorded. Each woman without invasive upgrade of the index DCIS at WLE received a 12-gene DCIS score. MRI performance metrics were calculated. Associations of imaging features with invasive upgrade, dichotomized DCIS score (<39 vs ≥39), and single WLE success were estimated in uni- and multivariable analyses. Results Among 339 women (median age, 60 years; interquartile range, 51-66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm; P < .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P = .05 to P = .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P < .001). Conclusion Preoperative MRI depicted ductal carcinoma in situ (DCIS) diagnosed with conventional imaging most commonly as nonmass enhancement, with larger median span than mammography, and additional cancer detection rate of 6.2%. MRI features of this subset of DCIS did not enable prediction of pathologic or genomic outcomes. Clinical trial registration no. NCT02352883 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Kuhl in this issue.
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Affiliation(s)
- Shinn-Huey S Chou
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Justin Romanoff
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Constance D Lehman
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Seema A Khan
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ruth Carlos
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Sunil S Badve
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Jennifer Xiao
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ralph L Corsetti
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Sara H Javid
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Derrick W Spell
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Linda K Han
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Jennifer L Sabol
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - John R Bumberry
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ilana F Gareen
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Bradley S Snyder
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Constantine Gatsonis
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Lynne I Wagner
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Antonio C Wolff
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Kathy D Miller
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Joseph A Sparano
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Christopher E Comstock
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Habib Rahbar
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
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Lin LL, Lakomy DS, Chiao EY, Strother RM, Wirth M, Cesarman E, Borok M, Busakhala N, Chibwesha CJ, Chinula L, Ndlovu N, Orem J, Phipps W, Sewram V, Vogt SL, Sparano JA, Mitsuyasu RT, Krown SE, Gopal S. Clinical Trials for Treatment and Prevention of HIV-Associated Malignancies in Sub-Saharan Africa: Building Capacity and Overcoming Barriers. JCO Glob Oncol 2021; 6:1134-1146. [PMID: 32697667 PMCID: PMC7392698 DOI: 10.1200/go.20.00153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to review the current status of clinical trials for HIV-associated malignancies in people living with HIV in sub-Saharan Africa (SSA) and efforts made by the AIDS Malignancy Consortium (AMC) to build capacity in SSA for HIV malignancy research. METHODS All malignancy-related clinical trials in 49 SSA countries on ClinicalTrials.gov were reviewed and evaluated for inclusion and exclusion criteria pertaining to HIV status. Additional studies by AMC in SSA were compiled from Web-based resources, and narrative summaries were prepared to highlight AMC capacity building and training initiatives. RESULTS Of 96 cancer trials identified in SSA, only 11 focused specifically on people living with HIV, including studies in Kaposi sarcoma, cervical dysplasia and cancer, non-Hodgkin lymphoma, and ocular surface squamous neoplasia. Recognizing the increasing cancer burden in the region, AMC expanded its clinical trial activities to SSA in 2010, with 4 trials completed to date and 6 others in progress or development, and has made ongoing investments in developing research infrastructure in the region. CONCLUSION As the HIV-associated malignancy burden in SSA evolves, research into this domain has been limited. AMC, the only global HIV malignancy-focused research consortium, not only conducts vital HIV-associated malignancies research in SSA, but also develops pathology, personnel, and community-based infrastructure to meet these challenges in SSA. Nonetheless, there is an ongoing need to build on these efforts to improve HIV-associated malignancies outcomes in SSA.
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Affiliation(s)
- Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.,Dartmouth Geisel School of Medicine, Hanover, NH
| | - Elizabeth Y Chiao
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert M Strother
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Margaret Borok
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Naftali Busakhala
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Carla J Chibwesha
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC.,Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.,Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lameck Chinula
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.,UNC Project-Malawi, Lilongwe, Malawi
| | - Ntokozo Ndlovu
- Department of Radiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Warren Phipps
- Uganda Cancer Institute, Kampala, Uganda.,Department of Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Vikash Sewram
- African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Samantha L Vogt
- Department of Medical Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Joseph A Sparano
- Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY
| | - Ronald T Mitsuyasu
- Center for Clinical AIDS Research and Education, University of California, Los Angeles, Los Angeles, CA
| | | | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
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Jayasekera J, Sparano JA, O'Neill S, Chandler Y, Isaacs C, Kurian AW, Kushi L, Schechter CB, Mandelblatt J. Development and Validation of a Simulation Model-Based Clinical Decision Tool: Identifying Patients Where 21-Gene Recurrence Score Testing May Change Decisions. J Clin Oncol 2021; 39:2893-2902. [PMID: 34251881 PMCID: PMC8425835 DOI: 10.1200/jco.21.00651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There is a need for industry-independent decision tools that integrate clinicopathologic features, comorbidities, and genomic information for women with node-negative, invasive, hormone receptor–positive, human epidermal growth factor receptor-2–negative (early-stage) breast cancer.
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Affiliation(s)
- Jinani Jayasekera
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Joseph A Sparano
- Department of Oncology at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Young Chandler
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Claudine Isaacs
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Allison W Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Lawrence Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Clyde B Schechter
- Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
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Kim G, Pastoriza JM, Qin J, Lin J, Karagiannis GS, Condeelis JS, Yothers G, Julian TB, Anderson SJ, Entenberg D, Rohan TE, Sparano JA, Xue X, Oktay MH. Abstract 35: Racial disparity in localized breast cancer: Pooled analysis of NSABP trials. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The purpose of this study was to evaluate whether there are differences in distant recurrence rates between Black and White women with localized breast cancer who participated in NCI-sponsored clinical trials, and thus had access to state of the art oncologic care and lacked major comorbidities.
Methods: We analyzed pooled data from 10 NSABP trials including 10,364 patients with localized breast cancer treated with adjuvant chemotherapy (AC, n=8147) or neoadjuvant chemotherapy (NAC, n=2217), limited to those with self-reported race that was either Black (n=1006, 10.3%) or White (n=9358, 89.7%). AC/NAC included doxorubicin and cyclophosphamide, with or without a taxane. The association between race (Black vs. White) and distant relapse-free survival (DRFS) was analyzed in the overall population and stratified by AC or NAC use. Log rank tests were used to test for differences in DRFS. Multivariate Cox regression was performed to estimate risk of distant recurrence adjusted for other prognostic covariates including age (continuous), tumor size (> 2 cm vs. < 2 cm), ER expression (positive vs. negative), and nodal status (pathologically positive for AC cohort or clinically positive for NAC cohort vs. negative).
Results: In the AC cohort, 7,419 (91%) patients were White and 728 (9%) Black. In the NAC cohort, 1,939 (88%) were White and 278 (12%) Black. Black race was associated with an inferior DRFS in the combined AC/NAC cohort (Logrank p<.0001), and in both the AC and NAC cohorts (Logrank p=0.0008 and p=0.01, respectively). After adjustment for other covariates in multivariate analysis, Black race remained significantly associated with an inferior DRFS in the combined AC/NAC cohort (HR 1.17, [95% CI 1.05-1.31], p=0.004), with similar trends noted in the AC (HR 1.17 [95% CI 1.02-1.33], p=0.03) and NAC cohort (HR 1.21 [95% CI 0.98-1.45], p=0.08). When the AC cohort was analyzed by ER status, Black race was associated with worse DRFS in ER-positive disease (HR 1.32 [95% CI 1.06-1.63], p=0.02), but not ER-negative disease (HR 1.06, [95% CI 0.87-1.30], p=0.57), although there was no statistically significant interaction with ER status (p=0.15). In the NAC cohort, Black women had a higher pathologic complete response (pCR) rate (22% vs 17%, Chi-squared test p=0.03). Black race was associated with a significantly worse DRFS in patients who did not achieve pCR (HR 1.34 [95% CI 1.06-1.63], p=0.01), but not in those who had a pCR (HR 0.89 [95% CI 0.49, 1.61], p=0.71).
Conclusion: We observed that Black women with localized breast cancer had higher distant recurrence rates than White women. This and other reports suggest that factors other than social determinants of health may be contributing to racial disparities in breast cancer outcome/progression, most notably in ER-positive disease and patients with residual disease after NAC. Future research is needed to help delineate the biological differences that contribute to these observations.
Citation Format: Gina Kim, Jessica M. Pastoriza, Jiyue Qin, Juan Lin, George S. Karagiannis, John S. Condeelis, Greg Yothers, Thomas B. Julian, Stewart J. Anderson, David Entenberg, Thomas E. Rohan, Joseph A. Sparano, Xiaonan Xue, Maja H. Oktay. Racial disparity in localized breast cancer: Pooled analysis of NSABP trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 35.
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Affiliation(s)
- Gina Kim
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Jiyue Qin
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Juan Lin
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - John S. Condeelis
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - David Entenberg
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Thomas E. Rohan
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Joseph A. Sparano
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Xiaonan Xue
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Maja H. Oktay
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Yanez B, Gray RJ, Sparano JA, Carlos RC, Sadigh G, Garcia SF, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Association of Modifiable Risk Factors With Early Discontinuation of Adjuvant Endocrine Therapy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Oncol 2021; 7:2780917. [PMID: 34137783 PMCID: PMC8377561 DOI: 10.1001/jamaoncol.2021.1693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Early discontinuation of adjuvant endocrine therapy (ET) is problematic among breast cancer survivors, with previous studies suggesting that up to 50% of women do not adhere to the recommended full 5 years of ET treatment. OBJECTIVE To identify the association between early discontinuation of ET in the Trial Assigning Individualized Options for Treatment (TAILORx) and modifiable risk factors, polypharmacy, and types of additional medications such as antidepressants and opioids. DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis includes a subgroup of 954 patients with breast cancer in TAILORx, a randomized clinical trial conducted from April 7, 2006, to October 6, 2010. All participants received a diagnosis of hormone receptor-positive, ERBB2-negative, axillary node-negative breast cancer and started ET within a year of study entry. Analyses were conducted in the intent-to-treat population. Statistical analysis took place from January 15, 2020, to April 6, 2021. MAIN OUTCOMES AND MEASURES Participants completed measures on cancer-related health-related quality of life including physical well-being and social well-being prior to initiating ET. Early discontinuation of ET was defined as discontinuation less than 4 years from initiation for reasons other than death or recurrence. Kaplan-Meier estimates were used to calculate discontinuation, and Cox proportional hazards regression joint prediction models were used to analyze the association between rates of adherence to ET with patient-level factors. RESULTS A total of 954 women (mean [SD] age, 56.6 [8.9] years) were included in this analysis. In a joint model, receipt of chemoendocrine therapy (vs receipt of ET only; hazard ratio [HR], 0.57; 95% CI, 0.35-0.92; P = .02) and age older than 40 years (vs ≤40 years; HR for 41-50 years, 0.39; 95% CI, 0.18-0.85; P = .02; HR for 51-60 years, 0.28; 95% CI, 0.13-0.60; P = .001; HR for 61-70 years, 0.40; 95% CI, 0.18-0.86; P = .02; and HR for >70 years, 0.23; 95% CI, 0.07-0.77; P = .02) were associated with a lower probability of early discontinuation of ET. Adjusted for these factors, a history of depression compared with no history of depression (HR, 1.82; 95% CI, 1.19-2.77; P = .005), worse physical well-being compared with better physical well-being (HR, 2.12; 95% CI, 1.30-3.45; P = .002), and worse social well-being compared with better social well-being (HR, 1.94; 95% CI, 1.20-3.13; P = .006) were individually and significantly associated with a higher probability of early discontinuation of ET. Only antidepressant use at study baseline was associated with early discontinuation (HR, 1.87; 95% CI, 1.23-2.84; P = .003). CONCLUSIONS AND RELEVANCE In this post hoc analysis of a randomized clinical trial, baseline patient-reported health-related quality of life components, such as poor social well-being, poor physical well-being, and comorbid depression, were significant risk factors for early discontinuation of endocrine therapies. These results support systematic screening for patient-reported outcomes and depressive symptoms to identify women at risk for discontinuation of ET. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00310180.
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Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J. Gray
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Biostatistics Center, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Joseph A. Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan Comprehensive Cancer Center, Ann Arbor
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Timothy J. Whelan
- Canadian Cancer Trials Group, McMaster University, Hamilton, Ontario, Canada
| | - George W. Sledge
- Department of Medicine, Stanford Cancer Center Palo Alto, Stanford, California
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynne I. Wagner
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston Salem, North Carolina
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Abstract
Introduction Approximately 10% of all breast cancer cases occur in individuals who have germline pathogenic variants of the BRCA 1, BRCA 2, and other genes associated with impaired DNA damage repair that is associated with an increased risk of breast, ovarian, and other cancers. Inhibitors of poly-ADP ribose polymerase (PARP) induce synthetic lethality in cancer cells harboring such pathogenic variants.Area covered In this review, the authors review the mechanisms of action, antitumor activity, and adverse events associated with PARP inhibitors for the treatment of advanced breast cancer. The authors then summarize the area and provide their expert perspectives on the area.Expert opinion Two PARP inhibitors are approved in metastatic breast cancer, including olaparib and talozaparib. Both agents were approved based on phase III trials demonstrating that they were associated with improved progression-free survival compared with treatment of physician's choice in patients receiving second-third line therapy for locally advanced, inoperable, or metastatic breast cancer in patients with germline pathogenic BRCA 1 or BRCA2 variants.
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Affiliation(s)
- Sun Young Oh
- Department of Hematology and Oncology, Montefiore-Einstein center for cancer care, Albert Einstein College of Medicine, Bronx, NY
| | - Shafia Rahman
- Department of Hematology and Oncology, Montefiore-Einstein center for cancer care, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph A Sparano
- Department of Hematology and Oncology, Montefiore-Einstein center for cancer care, Albert Einstein College of Medicine, Bronx, NY
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Mayer IA, Zhao F, Arteaga CL, Symmans WF, Park BH, Burnette BL, Tevaarwerk AJ, Garcia SF, Smith KL, Makower DF, Block M, Morley KA, Jani CR, Mescher C, Dewani SJ, Tawfik B, Flaum LE, Mayer EL, Sikov WM, Rodler ET, Wagner LI, DeMichele AM, Sparano JA, Wolff AC, Miller KD. Randomized Phase III Postoperative Trial of Platinum-Based Chemotherapy Versus Capecitabine in Patients With Residual Triple-Negative Breast Cancer Following Neoadjuvant Chemotherapy: ECOG-ACRIN EA1131. J Clin Oncol 2021; 39:2539-2551. [PMID: 34092112 DOI: 10.1200/jco.21.00976] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with triple-negative breast cancer (TNBC) and residual invasive disease (RD) after completion of neoadjuvant chemotherapy (NAC) have a high-risk for recurrence, which is reduced by adjuvant capecitabine. Preclinical models support the use of platinum agents in the TNBC basal subtype. The EA1131 trial hypothesized that invasive disease-free survival (iDFS) would not be inferior but improved in patients with basal subtype TNBC treated with adjuvant platinum compared with capecitabine. PATIENTS AND METHODS Patients with clinical stage II or III TNBC with ≥ 1 cm RD in the breast post-NAC were randomly assigned to receive platinum (carboplatin or cisplatin) once every 3 weeks for four cycles or capecitabine 14 out of 21 days every 3 weeks for six cycles. TNBC subtype (basal v nonbasal) was determined by PAM50 in the residual disease. A noninferiority design with superiority alternative was chosen, assuming a 4-year iDFS of 67% with capecitabine. RESULTS Four hundred ten of planned 775 participants were randomly assigned to platinum or capecitabine between 2015 and 2021. After median follow-up of 20 months and 120 iDFS events (61% of full information) in the 308 (78%) patients with basal subtype TNBC, the 3-year iDFS for platinum was 42% (95% CI, 30 to 53) versus 49% (95% CI, 39 to 59) for capecitabine. Grade 3 and 4 toxicities were more common with platinum agents. The Data and Safety Monitoring Committee recommended stopping the trial as it was unlikely that further follow-up would show noninferiority or superiority of platinum. CONCLUSION Platinum agents do not improve outcomes in patients with basal subtype TNBC RD post-NAC and are associated with more severe toxicity when compared with capecitabine. Participants had a lower than expected 3-year iDFS regardless of study treatment, highlighting the need for better therapies in this high-risk population.
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Affiliation(s)
- Ingrid A Mayer
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | - Ben H Park
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Brian L Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI
| | | | | | - Karen L Smith
- Johns Hopkins University, Sidney Kimmel Cancer Center, Baltimore, MD
| | | | | | | | | | - Craig Mescher
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park, MN
| | | | | | | | | | | | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, NC
| | | | | | - Antonio C Wolff
- Johns Hopkins University, Sidney Kimmel Cancer Center, Baltimore, MD
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
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Mayer IA, Zhao F, Arteaga CL, Symmans WF, Park BH, Burnette BL, Tevaarwerk AJ, Garcia SF, Smith KL, Mayer EL, Sikov WM, Rodler ET, Wagner LI, DeMichele A, Sparano JA, Wolff AC, Miller K. A randomized phase III post-operative trial of platinum-based chemotherapy (P) versus capecitabine (C) in patients (pts) with residual triple-negative breast cancer (TNBC) following neoadjuvant chemotherapy (NAC): ECOG-ACRIN EA1131. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.605] [Citation(s) in RCA: 2] [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
605 Background: Pts with TNBC who have residual invasive disease (RD) after completion of NAC have a very high risk for recurrence, which is reduced by adjuvant capecitabine (C). Pre-clinical models support the use of platinum agents (P) in the TNBC basal subtype. EA1131 tested the hypothesis that invasive disease-free survival (iDFS) would not be inferior but improved in pts with basal subtype TNBC after NAC with the adjuvant use of a P instead of C (primary objective). Methods: Pts with clinical stage II/III TNBC post neoadjuvant taxane +/- anthracycline-based chemotherapy with at least 1 cm RD in the surgical specimen were randomized (1:1) to receive P (carboplatin or cisplatin once every 3 weeks for 4 cycles) or C (14/7d every 3 weeks for 6 cycles). TNBC subtype (basal vs. non-basal) was analyzed in the surgical specimen by PAM50. A non-inferiority design (non-inferiority margin of hazard ratio [HR] of 1.154) with superiority alternative (alternative HR of 0.754) was chosen, assuming a 4-year iDFS of 67% for the C arm. Non-inferiority was tested first. If non-inferiority was shown, a formal test for superiority of P compared to C would be conducted. Results: 401 participants were randomized to P or C between 2015 and 2020 (recruitment goal, 775), 310 (77%) had TNBC basal subtype disease (primary analysis population). Pts’ median age was 52 years, 71% were White and 19% Black. At diagnosis, most tumors were high grade (78%), T2 (59%), 47% N0, and 40% N1. Residual tumors were 37% ypT1, 44% ypT2, and 47% ypN0. Overall incidence of any toxicity was similar (83% with P, 80% with C), but grade 3 and 4 toxicities (no grade 5) were more common with P (25% vs 15%). After median follow-up of 18 months, 113 iDFS events (58% of full information) had occurred. 3-year iDFS for P arm was 40% (95%CI, 29%-51%) and 44% (95%CI, 32%-55%) for C arm. The HR for arms P/C was 1.09 (95% Repeated Confidence Interval, 0.62-1.90) and the probability of eventually rejecting the null of inferiority (i.e., conditional power) was 6%. The Data Safety and Monitoring Committee recommended stopping the trial at the 5th interim analysis in March 2021 since it was unlikely that the trial would be able to show non-inferiority or superiority of the P arm. Conclusions: Participants with TNBC with RD after NAC had a lower than expected 3-year iDFS regardless of study treatment. Available data show that it is very unlikely that the study would be able to establish non-inferiority of P to C. In addition, severe toxicities were more common with P. In pts with TNBC, particularly basal subtype, with at least 1 cm RD after NAC and high-risk of recurrence, adjuvant P use does not improve outcomes. Correlative analyses of RD tissue (NGS), circulating markers (ctDNA and CTC pre/post treatment), and patient-reported outcomes (PRO) questionnaires will now occur. Clinical trial information: NCT02445391.
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Affiliation(s)
| | | | | | | | - Ben Ho Park
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | | | - Sofia F. Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karen L. Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | - Angela DeMichele
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | - Antonio C. Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Kathy Miller
- Indiana University Simon Cancer Center Indianapolis, Indianapolis, IN
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Jayasekera J, Sparano JA, Chandler Y, Isaacs C, Kurian AW, Kushi LH, O'Neill SC, Schechter CB, Mandelblatt JS. A simulation model-based clinical decision tool to guide personalized treatment based on individual characteristics: Does 21-gene recurrence score assay testing change decisions? J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12507 Background: There is a need for web-based decision tools that integrate clinicopathologic features and genomic information to guide breast cancer therapy for women with node-negative, hormone receptor positive, HER2 negative (“early-stage”) breast cancer. We developed a novel simulation model-based clinical decision tool that provides prognostic estimates of treatment outcomes based on age, tumor size, grade, and comorbidities with and without 21-gene recurrence scores (RS). Methods: We adapted an extant breast cancer simulation model developed within the NCI-funded Cancer Intervention and Surveillance Modeling Network (CISNET) to derive estimates for the 10-year risks of distant recurrence, breast cancer-specific mortality, other cause mortality and life-years gained with endocrine vs. chemo-endocrine therapy for individual women based on their age, tumor size, grade, and comorbidity-level with and without RS test results. The model used an empiric Bayesian analytical approach to combine information from clinical trials, registry and claims data to provide individual estimates. External validation of the model was performed by comparing model-based breast cancer mortality rates and observed rates in the Surveillance Epidemiology and End Results (SEER) registry. Results: Several exemplar profiles were selected to illustrate the clinical utility of the decision tool. For example, the absolute chemotherapy benefit for 10-year distant recurrence risk and life-years gained, without RS testing, and the outcomes if a woman got tested and had a RS 16-20 are provided below for a 40-44-year-old woman and a 65–69-year-old woman diagnosed with a small (≤2cm), intermediate grade tumor and mild comorbidities. Conclusions: Simulation modeling is useful for creating clinical decision tools to support shared decision making for early-stage breast cancer treatment.[Table: see text]
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Affiliation(s)
- Jinani Jayasekera
- Lombardi Cancer Center MedStar Georgetown University Hospital, Washington, DC
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | - Lawrence H. Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Suzanne C. O'Neill
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Clyde B. Schechter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
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