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Leach JW, Eckwright D, Champaloux SW, Forsberg P, Weiss A, Jorgensen C, Gleason PP. Medically integrated dispensing (MID) clinical and cost outcomes compared to specialty pharmacies (SP). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18645] [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
e18645 Background: Oral oncolytics MID offers potential care and cost advantages compared to a centralized SP model. A pharmacy benefit manger and 3 health plans created a pilot program to enable and encourage oncology practice MID with the goal of improving care, enhancing the provider and patient experience, and reducing drug waste. This study assesses clinical outcomes and drug waste differences between MID and central SP dispensing using real-world pharmacy claims data. Methods: The MID pilot program was implemented early 2021 within 3 oncology practices across 3 plans commercially insured lives. Members were required to have continuous enrollment for the adherence and discontinuation (d/c) measures. Adherence was measured using the CMS industry standard proportion of days covered with a > / = 80% cut point. D/c was measured in new initiators defined as no claim evidence of the drug in the previous 90 days with discontinuation defined as having a > / = 45-day therapy gap within the first 180 days. Dose changes were defined as a new unit strength being dispensed for a previously filled drug. Each measure used a unique drug list: 3 CDK4/6i for adherence; 10 highly utilized oral brand and generic oncolytics for d/c; and 26 oral oncology brand drugs having multiple strengths and labeled dose change directions for dose change waste. The adherence and waste measures assessment end date was Dec 31, 2021 and for d/c was Jan 28, 2022. Statistical testing: adherence- Fischer’s exact test; d/c- chi-square; and waste– t-test. Results: For adherence, individuals were followed for an average of 243 days, range 21-333 days, without a statistical difference between MID and SP follow-up. CDK4/6i adherence was 82% (9 of 11) for MID and 73% (421 of 574) for SP, p = 0.74. D/C was 29% (15 of 52) for MID and 48% (360 of 753) for SP, p = 0.01. Waste occurred in 29% (6 of 21) of MID dose changes and 50% (315 of 627) of SP dose changes, p = 0.05; resulting in an average cost of $937 and $2,733 per dose change at the MID and SP, respectively, for an SP average dose change additional cost of $1,796. Conclusions: MID demonstrated numerically higher adherence, significantly lower d/c rate with MID having a number need to treat of 5 to prevent one less d/c event, and significantly lower waste expense with an estimated savings of $1.1 million, if all 627 individuals with a dose change at SP had used a MID. These real-world findings have resulted in a national PBM network to encourage MID use.
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Sahli B, Eckwright D, Darling E, Gleason PP, Leach JW. Chimeric antigen receptor T-cell therapy real-world assessment of total cost of care and clinical events for the treatment of relapsed or refractory lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19500] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19500 Background: Axicabtagene ciloleucel and tisagenlecleucel are FDA approved to treat relapsed or refractory B-cell lymphoma. CAR-T therapy involves a complex process of extraction, transfection, administration and management of adverse reactions such as cytokine release syndrome. Little has been established using real world evidence identifying CAR-T episode total cost of care (TCC) and post administration clinical events (CE) among the commercially insured population. Methods: Integrated pharmacy and medical claims were queried among a population of 15 million commercially insured members from Jan 2018 to June 2020 to identify members 18 years and older with a CAR-T drug claim cost of > $250,000, lymphoma dx, no leukemia dx, and continuously enrolled through a CAR-T episode of 30 days prior to and 56 days post the CAR-T administration date. The TCC and CAR-T specific costs were calculated for the episode. Inpatient (IP) days pursuant to CAR-T administration were calculated using admission and discharge dates. Post CAR-T administration date CEs defined as subsequent chemotherapy, bone marrow transplant (BMT), and death or hospice, as well as time to event (TTE) were identified. Subsequent chemotherapy post CAR-T administration was identified. Results: 74 members, 59% male and mean age 55 years (min 18, max 76), met inclusion criteria. Mean CAR-T episode TCC was $711,884 (median $610,999) with mean CAR-T drug cost $527,547 (median $411,278). Mean IP days per episode were 17.3 (standard deviation [SD]) 9.6). 29 members (39%) experienced any CE with a mean 228 (SD 217) TTE. No CE identified among 21 (28%) members who disenrolled or ceased claim activity after a mean 253 days (SD 167). 24 (32%) remained enrolled with no CEs with a mean follow-up of a 390 days (SD 264), as of Oct 2020. Non-mutually exclusive CEs include: 22 (30%) members received subsequent chemotherapy, mean TTE 263 days (SD 238); 4 (7%) had a BMT, mean TTE 245 days (SD 108); and 13 (18%) had an identified death or hospice, mean TTE 297 days (SD 143). The most common non-mutually exclusive subsequent chemotherapy observed in 22 members were: rituximab (9 members), bendamustine (8), lenalidomide (8), obinutuzumab (5), pembrolizumab (4), polatuzumab vedotin (4), cyclophosphamide (3), ibrutinib (2), and venetoclax (2). 14 additional subsequent therapies with 1 unique utilizer were also observed. Conclusions: These 74 members show substantial variation in CAR-T episode TCC and clinical experience. 29 (39%) members did not have a durable response to CAR-T with providers initiating subsequent chemotherapy in 22 of 29 cases in the absence of clear guidelines. These data inform managed care activities such as performance metrics, case rates, and value based arrangements. Additionally, these data are important in actuarial forecasting for given the potential future volume of treated patients and spend.
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Steffen McLouth LE, Zhao F, Owonikoko TK, Feliciano JL, Mohindra NA, Dahlberg SE, Wade JL, Srkalovic G, Lash BW, Leach JW, Leal TA, Aggarwal C, Cella D, Ramalingam SS, Wagner LI. Patient-reported tolerability of veliparib combined with cisplatin and etoposide for treatment of extensive stage small cell lung cancer: Neurotoxicity and adherence data from the ECOG ACRIN cancer research group E2511 phase II randomized trial. Cancer Med 2020; 9:7511-7523. [PMID: 32860331 PMCID: PMC7571824 DOI: 10.1002/cam4.3416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The ECOG-ACRIN Cancer Research Group trial E2511 recently demonstrated a potential benefit for the addition of veliparib to cisplatin-etoposide (CE) in patients with extensive stage small cell lung cancer (ES-SCLC) in a phase II randomized controlled trial. Secondary trial endpoints included comparison of the incidence and severity of neurotoxicity, hypothesized to be lower in the veliparib arm, and tolerability of the addition of veliparib to CE. Physician-rated and patient-reported neurotoxicity was also compared. MATERIALS AND METHODS Patients randomized to veliparib plus CE (n = 64) or placebo plus CE (n = 64) completed the 11-item Functional Assessment of Cancer Therapy Gynecologic Oncology Group Neurotoxicity (questionnaire pre-treatment, end of cycle 4 [ie 3 months after randomization] and 3 months post-treatment [ie 6-months]). Adherence analysis was based on treatment forms. RESULTS AND CONCLUSION No significant differences in mean or magnitude of change in neurotoxicity scores were observed between treatment arms at any time point. However, patients in the placebo arm reported worsening neurotoxicity from baseline to 3-months (M difference = -1.5, P = .045), compared to stable neurotoxicity in the veliparib arm (M difference = -0.2, P = .778). Weakness was the most common treatment-emergent (>50%) and moderate to severe (>16%) symptom reported, but did not differ between treatment arms. The proportion of adherence to oral therapy in the overall sample was 75%. Three percent of patients reported clinically significant neurotoxicity that was not captured by physician assessment. Neurotoxicity scores were not different between treatment arms. The addition of veliparib to CE appeared tolerable, though weakness should be monitored. CLINICALTRIALS. GOV IDENTIFIER NCT01642251.
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Affiliation(s)
- Laurie E. Steffen McLouth
- Department of Behavioral ScienceCenter for Health Equity TransformationUniversity of Kentucky College of MedicineLexingtonKYUSA
| | - Fengmin Zhao
- Dana‐Farber Cancer Institute & ECOG‐ACRIN Biostatistics CenterBostonMAUSA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lynne I. Wagner
- Department of Social Sciences & Health PolicyWake Forest School of MedicineWinston‐SalemNCUSA
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Hu ZI, Bendell JC, Bullock A, LoConte NK, Hatoum H, Ritch P, Hool H, Leach JW, Sanchez J, Sohal DPS, Strickler J, Patel R, Wang-Gillam A, Firdaus I, Yu KH, Kapoun AM, Holmgren E, Zhou L, Dupont J, Picozzi V, Sahai V, O'Reilly EM. A randomized phase II trial of nab-paclitaxel and gemcitabine with tarextumab or placebo in patients with untreated metastatic pancreatic cancer. Cancer Med 2019; 8:5148-5157. [PMID: 31347292 PMCID: PMC6718621 DOI: 10.1002/cam4.2425] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 03/20/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose Notch signaling dysregulation is implicated in the development of pancreatic adenocarcinoma (PDAC). Tarextumab is a fully human IgG2 antibody that inhibits Notch2/3 receptors. Patients and Methods Aphase 2, randomized, placebo‐controlled, multicenter trial evaluated the activity of tarextumab in combination with nab‐paclitaxel and gemcitabine in patients with metastatic PDAC. Patients were stratified based on ECOG performance score and Ca 19‐9 level and randomized 1:1 to nab‐paclitaxel, gemcitabine with either tarextumab or placebo. Based on preclinical and phase Ib results suggesting a positive correlation between Notch3 gene expression and tarextumab anti‐tumor activity, patients were also divided into subgroups of low, intermediate, and high Notch3 gene expression. Primary endpoint was overall survival (OS) in all and in patients with the three Notch3 gene expression subgroups (≥25th, ≥50% and ≥75% percentiles); secondary end points included progression‐free survival (PFS), 12‐month OS, overall response rate (ORR), and safety and biomarker investigation. Results Median OS was 6.4 months in the tarextumab group vs 7.9 months in the placebo group (HR = 1.34 [95% CI = 0.95, 1.89], P = .0985). No difference observed in OS in the Notch3 gene expression subgroups. PFS in the tarextumab‐treated group (3.7 months) was significantly shorter compared with the placebo group (5.5 months) (hazard ratio was 1.43 [95% CI = 1.01, 2.01]; P = .04). Grade 3 diarrhea and thrombocytopenia were more common in the tarextumab group. Conclusions The addition of tarextumab to nab‐paclitaxel and gemcitabine did not improve OS, PFS, or ORR in first‐line metastatic PDAC, and PFS was specifically statistically worse in the tarextumab‐treated patients. Clinical trial registry no NCT01647828.
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Affiliation(s)
- Zishuo Ian Hu
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Johanna C Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Andrea Bullock
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Hassan Hatoum
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paul Ritch
- Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hugo Hool
- Torrance Memorial Physician Network, Redondo Beach, California
| | | | - James Sanchez
- Comprehensive Cancer Centers of Nevada, Henderson, Nevada
| | | | | | | | | | | | - Kenneth H Yu
- Memorial Sloan Kettering Cancer Center, New York, New York.,David M. Rubenstein Center for Pancreatic Cancer Research, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann M Kapoun
- Oncomed Pharmaceuticals Inc, Redwood City, California
| | - Eric Holmgren
- Oncomed Pharmaceuticals Inc, Redwood City, California
| | - Lei Zhou
- Oncomed Pharmaceuticals Inc, Redwood City, California
| | - Jakob Dupont
- Oncomed Pharmaceuticals Inc, Redwood City, California
| | | | | | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, New York.,David M. Rubenstein Center for Pancreatic Cancer Research, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
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Lansigan F, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Shustov AR, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. Outcomes for Relapsed and Refractory Peripheral T-Cell Lymphoma Patients after Front-Line Therapy from the COMPLETE Registry. Acta Haematol 2019; 143:40-50. [PMID: 31315113 DOI: 10.1159/000500666] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outcomes for patients with peripheral T-cell lymphoma (PTCL) who fail to achieve complete response (CR) or relapse after front-line therapy are poor with lack of prospective outcomes data. OBJECTIVES COMPLETE is a prospective registry of 499 patients enrolled at academic and community sites in the United States detailing patient demographics, treatment and outcomes for patients with aggressive T cell lymphomas. We report results for patients with primary refractory and relapsed disease. METHODS Primary refractory disease was defined as an evaluable best response to initial treatment (induction ± maintenance or consolidation/transplant) other than CR, and included a partial response, progressive disease, or no response/stable disease. Relapsed disease was defined as an evaluable best response to initial treatment of CR, followed by disease progression at a later date, irrespective of time to progression. Patients were included in the analysis if initial treatment began within 30 days of enrollment and treatment duration was ≥4 days. RESULTS Of 420 evaluable patients, 97 met the definition for primary refractory and 58 with relapsed disease. In the second-line setting, relapsed patients received single-agent therapies more often than refractory patients (52 vs. 28%; p = 0.01) and were more likely to receive single-agent regimens (74 vs. 53%; p = 0.03). The objective response rate to second-line therapy was higher in relapsed patients (61 vs. 40%; p = 0.04) as was the proportion achieving a CR (41 vs. 14%; p = 0.002). Further, relapsed patients had longer overall survival (OS) compared to refractory patients, with a median OS of 29.1 versus 12.3 months. CONCLUSIONS Despite the availability of newer active single agents, refractory patients were less likely to receive these therapies and continue to have inferior outcomes compared to those with relapsed disease. PTCL in the real world remains an unmet medical need, and improvements in front-line therapies are needed.
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Affiliation(s)
| | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals Inc., Irvine, California, USA
| | - Andrei R Shustov
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | | | - Anil Tulpule
- University of Southern California, Los Angeles, California, USA
| | | | - John P Greer
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph W Leach
- Virginia Piper Cancer Institute, Minneapolis, Minnesota, USA
| | | | - Carla Casulo
- University of Rochester, Rochester, New York, USA
| | - Steven I Park
- Levine Cancer Institute, Chapel Hill, North Carolina, USA
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Park SI, Horwitz SM, Foss FM, Pinter-Brown LC, Carson KR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Shustov AR. The role of autologous stem cell transplantation in patients with nodal peripheral T-cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study. Cancer 2019; 125:1507-1517. [PMID: 30694529 DOI: 10.1002/cncr.31861] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1. METHODS Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis. RESULTS Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89). CONCLUSIONS This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc, Irvine, California
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | - Frederick Lansigan
- Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts
| | - Anil Tulpule
- University of Southern California, Los Angeles, California
| | | | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
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Owonikoko TK, Dahlberg SE, Sica GL, Wagner LI, Wade JL, Srkalovic G, Lash BW, Leach JW, Leal TB, Aggarwal C, Ramalingam SS. Randomized Phase II Trial of Cisplatin and Etoposide in Combination With Veliparib or Placebo for Extensive-Stage Small-Cell Lung Cancer: ECOG-ACRIN 2511 Study. J Clin Oncol 2018; 37:222-229. [PMID: 30523756 DOI: 10.1200/jco.18.00264] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Veliparib, a poly (ADP ribose) polymerase inhibitor, potentiated standard chemotherapy against small-cell lung cancer (SCLC) in preclinical studies. We evaluated the combination of veliparib with cisplatin and etoposide (CE; CE+V) doublet in untreated, extensive-stage SCLC (ES-SCLC). MATERIALS AND METHODS Patients with ES-SCLC, stratified by sex and serum lactate dehydrogenase levels, were randomly assigned to receive four 3-week cycles of CE (75 mg/m2 intravenously on day 1 and 100 mg/m2 on days 1 through 3) along with veliparib (100 mg orally twice per day on days 1 through 7) or placebo (CE+P). The primary end point was progression-free survival (PFS). Using an overall one-sided 0.10-level log-rank test, the study had 88% power to demonstrate a 37.5% reduction in the PFS hazard rate. RESULTS A total of 128 eligible patients received treatment on protocol. The median age was 66 years, 52% of patients were men, and Eastern Cooperative Oncology Group performance status was 0 for 29% of patients and 1 for 71%. The respective median PFS for the CE+V arm versus the CE+P arm was 6.1 versus 5.5 months (unstratified hazard ratio [HR], 0.75 [one-sided P = .06]; stratified HR, 0.63 [one-sided P = .01]), favoring CE+V. The median overall survival was 10.3 versus 8.9 months (stratified HR, 0.83; 80% CI, 0.64 to 1.07; one-sided P = .17) for the CE+V and CE+P arms, respectively. The overall response rate was 71.9% versus 65.6% (two-sided P = .57) for CE+V and CE+P, respectively. There was a significant treatment-by-strata interaction in PFS: Male patients with high lactate dehydrogenase levels derived significant benefit (PFS HR, 0.34; 80% CI, 0.22 to 0.51) but there was no evidence of benefit among patients in other strata (PFS HR, 0.81; 80% CI, 0.60 to 1.09). The following grade ≥ 3 hematology toxicities were more frequent in the CE+V arm than the CE+P arm: CD4 lymphopenia (8% v 0%; P = .06) and neutropenia (49% v 32%; P = .08), but treatment delivery was comparable. CONCLUSION The addition of veliparib to frontline chemotherapy showed signal of efficacy in patients with ES-SCLC and the study met its prespecified end point.
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Affiliation(s)
| | | | | | | | | | | | | | - Joseph W Leach
- 7 Metro Minnesota National Cancer Institute Community Oncology Research Program, Minneapolis, MN
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Rajan A, Gulley JL, Spigel DR, Iannotti N, Chandler JC, Wong DJ, Leach JW, Edenfield WJ, Wang D, Redfern CH, Grote HJ, von Heydebreck A, Ruisi MM, Munshi N, Kelly K. Avelumab (anti–PD-L1) in patients with platinum-treated advanced NSCLC: 2.5-year follow-up from the JAVELIN Solid Tumor trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James L. Gulley
- Genitourinary Malignancies Branch and Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David R. Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN
| | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port Saint Lucie, FL
| | | | - Deborah J.L. Wong
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Lillemoe TJ, Tsai ML, Swenson KK, Susnik B, Krueger J, Harris K, Rueth N, Grimm E, Leach JW. Clinicopathologic analysis of a large series of microinvasive breast cancers. Breast J 2018; 24:574-579. [DOI: 10.1111/tbj.13001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 12/23/2022]
Affiliation(s)
| | - Michaela L. Tsai
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Karen K. Swenson
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | | | - Janet Krueger
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Kendra Harris
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Natasha Rueth
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Erin Grimm
- Allina Health Laboratories; Minneapolis MN USA
| | - Joseph W. Leach
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
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Hellmann MD, Antonia SJ, Balmanoukian AS, Brahmer JR, Ou SHI, Kim SW, Ahn MJ, Kim DW, Gutierrez M, Liu SV, Schoffski P, Jaeger D, Jamal R, Leach JW, Jerusalem GHM, Lutzky J, Nemunaitis JJ, Gu Y, Abdullah SE, Segal NH. Updated overall survival and safety profile of durvalumab monotherapy in advanced NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.169] [Citation(s) in RCA: 4] [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
169 Background: Single-agent durvalumab is being evaluated in patients with advanced squamous and non-squamous NSCLC in an ongoing Phase 1/2 study (NCT01693562). Here we present updated survival and safety data in NSCLC patients. Methods: Treatment-naïve (1L) and previously treated (2L or 3L+) stage IIIB/IV NSCLC patients received durvalumab 10 mg/kg Q2W for up to 12 months. Patients were stratified by tumor PD-L1 expression (Ventana PD-L1 [SP263] Assay [PD-L1 high: ≥25% of tumor cells with membrane staining]), treatment line, and histology. Results: As of 05 September 2017, 304 NSCLC patients received durvalumab monotherapy. Median duration of follow-up was 35.6 (0.3–50.9) months. Investigator-assessed ORR ranged between 23.2% and 30.0% among PD-L1 high patients, and between 3.6% and 8.3% among PD-L1 low/negative patients. Median PFS and median OS were longer in PD-L1 high vs PD-L1 low/negative patients (Table). Any-grade treatment-related AEs (TRAEs) were reported in 57.2% of pts (including fatigue, 17.4%, decreased appetite, 9.2%, diarrhea, 8.9%); in 10.2% of pts these were Grade 3 or 4. TRAEs resulting in treatment discontinuation were reported in 17 patients (5.6%); 1 patient had a Grade 5 TRAE (pneumonia). Conclusions: In this ongoing phase 1 study, OS and safety profile appear encouraging in treatment-naïve and previously treated NSCLC patients, particularly among PD-L1 high patients. Further investigation regarding PD-L1 expression for selection of patients who most likely benefit from durvalumab is needed. Clinical trial information: NCT01693562. [Table: see text]
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Affiliation(s)
| | | | | | - Julie R. Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Sai-Hong Ignatius Ou
- Department of Medicine, Division of Hematology Oncology, University of California Irvine School of Medicine, Irvine, CA
| | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | | | | | | | - Dirk Jaeger
- Medical Oncology, National Center for Tumor Diseases, University Hospitals Heidelberg, Heidelberg, Germany
| | - Rahima Jamal
- Hôpital Notre-Dame, CHUM, University of Montréal, CHUM Research Center (CRCHUM), Montreal, QC, Canada
| | - Joseph W. Leach
- Oncology Research, Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | | | - Yu Gu
- MedImmune, Gaithersburg, MD
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Edelman MJ, Hu C, Le QT, Donington JS, D'Souza WD, Dicker AP, Loo BW, Gore EM, Videtic GMM, Evans NR, Leach JW, Diehn M, Feigenberg SJ, Chen Y, Paulus R, Bradley JD. Randomized Phase II Study of Preoperative Chemoradiotherapy ± Panitumumab Followed by Consolidation Chemotherapy in Potentially Operable Locally Advanced (Stage IIIa, N2+) Non-Small Cell Lung Cancer: NRG Oncology RTOG 0839. J Thorac Oncol 2017. [PMID: 28629896 DOI: 10.1016/j.jtho.2017.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Multimodality therapy has curative potential in locally advanced NSCLC. Mediastinal nodal sterilization (MNS) after induction chemoradiotherapy (CRT) can serve as an intermediate marker for efficacy. NRG Oncology Radiation Therapy Oncology Group (RTOG) 0229 demonstrated the feasibility and efficacy of combining full-dose radiation (61.2 Gy) with chemotherapy followed by resection and chemotherapy. On the basis of that experience and evidence that EGFR antibodies are radiosensitizing, we explored adding panitumumab to CRT followed by resection and consolidation chemotherapy in locally advanced NSCLC with a primary end point of MNS. METHODS Patients with resectable locally advanced NSCLC were eligible if deemed suitable for trimodality therapy before treatment. Surgeons were required to demonstrate expertise after CRT and adhere to specific management guidelines. Concurrent CRT consisted of weekly carboplatin (area under the curve = 2.0), paclitaxel (50 mg/m2), and 60 Gy of radiation therapy delivered in 30 fractions. There was a 2:1 randomization in favor of panitumumab at 2.5 mg/kg weekly for 6 weeks. The mediastinum was pathologically reassessed before or at the time of resection. Consolidation chemotherapy was weekly carboplatin (area under the curve = 6) and paclitaxel, 200 mg/m2 every 21 days for two courses. The study was designed to detect an improvement in MNS from 52% to 72%. With use of a 0.15 one-sided type 1 error and 80% power, 97 patients were needed. RESULTS The study was opened in November 2010 and closed in August 2015 by the Data Monitoring Committee after 71 patients had been accrued for futility and excessive toxicity in the experimental arm. A total of 60 patients were eligible: 19 patients (86%) who received CRT and 29 (76%) who received CRT plus panitumumab and underwent an operation. With regard to postoperative toxicity, there were three grade 4 adverse events (13.6%) and no grade 5 adverse events (0%) among those who received CRT versus six grade 4 (15.8%) and four grade 5 adverse events (10.5%) among those who received CRT plus panitumumab. The MNS rates were 68.2% (95% confidence interval: 45.1-86.1) and 50.0% (95% confidence interval: 33.4-66.6) for CRT and CRT plus panitumumab, respectively (p = 0.95). CONCLUSION The addition of panitumumab to CRT did not improve MNS. There was an unexpectedly high mortality rate in the panitumumab arm, although the relationship to panitumumab is unclear. The control arm had outcomes similar to those in NRG Oncology RTOG 0229.
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Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Jessica S Donington
- Laura and Isaac Perlmutter Cancer Center at New York University Langone Medical Center, New York, New York
| | | | - Adam P Dicker
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Billy W Loo
- Stanford Cancer Institute, Stanford, California
| | - Elizabeth M Gore
- Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Joseph W Leach
- Metro-Minnesota Community Clinical Oncology Program, St. Louis Park, Minnesota
| | | | | | | | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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12
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Kopetz S, Lonardi S, McDermott RS, Aglietta M, Hendlisz A, Morse M, Leach JW, Neyns B, Chan E, Chen F, Wong KYM, Lee JJ, Garcia-Alfonso P, Hill AG, Lenz HJ, Desai J, Moss RA, Cao ZA, Overman MJ, Andre T. Concordance of DNA mismatch repair deficient (dMMR)/microsatellite instability (MSI) assessment by local and central testing in patients with metastatic CRC (mCRC) receiving nivolumab (nivo) in CheckMate 142 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
3548 Background: MMR or MSI testing is recommended for mCRC pts and is often done locally by IHC or PCR testing, respectively (NCCN V1.2017) Nivo, a fully human anti-PD-1 mAb, demonstrated durable responses and a 12-mo OS rate of 73.8% in pts with mCRC locally assessed for dMMR/MSI-H status in the CheckMate 142 study (NCT02060188; Overman M, et al. 2017). Here we describe the results of local and central testing with respect to MMR/MSI status and clinical outcomes in the CheckMate 142 study. Methods: MMR/MSI status was assessed locally on archival tumor using IHC/PCR at screening and confirmed centrally by PCR (modified Bethesda panel) testing of tumor biopsy at enrollment. dMMR was defined by IHC as a loss of expression in ≥1 mismatch repair proteins. Stable microsatellite (MSS), low MSI (MSI-L), and high MSI (MSI-H), were defined as instability in 0, 1, or ≥2 markers, respectively. Pts with dMMR/MSI-H mCRC who progressed on or were intolerant of ≥1 prior line of therapy received nivo 3 mg/kg Q2W. Results: 74 pts were dMMR/MSI-H by local testing. Of these pts, 53 (72%) were centrally confirmed as MSI-H, 7 pts had insufficient tissue sample for PCR testing, and 14 pts had a central test that did not match local test results. Of the 14 pts, 3 pts with a clinical history of LS were identified locally as dMMR but centrally as MSS (Table). INV-reported ORR was 31.1% in 74 pts locally determined as dMMR/MSI-H, 35.8% in 53 pts locally and centrally confirmed as MSI-H, and 21.4% in 14 pts not centrally confirmed as MSI-H. Conclusions: The similar clinical activity between pts locally confirmed as MSI-H and pts who were centrally confirmed as MSI-H suggest local testing is appropriate for identifying the dMMR/MSI-H pts who may benefit from nivo monotherapy. Clinical trial information: NCT02060188. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Bart Neyns
- University Hospital of the Vrije, Brussels, Belgium
| | - Emily Chan
- Vanderbilt University Ingram Cancer Center, Nashville, TN
| | - Franklin Chen
- Novant Health Oncology Specialists, Winston-Salem, NC
| | | | - James J. Lee
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Andrew G Hill
- Tasman Oncology Research Pty Ltd, Queensland, Australia
| | - Heinz-Josef Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jayesh Desai
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
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13
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Andre T, Lonardi S, Wong KYM, Morse M, McDermott RS, Hill AG, Hendlisz A, Lenz HJ, Leach JW, Moss RA, Cao ZA, Ledeine JM, Chan E, Kopetz S, Overman MJ. Combination of nivolumab (nivo) + ipilimumab (ipi) in the treatment of patients (pts) with deficient DNA mismatch repair (dMMR)/high microsatellite instability (MSI-H) metastatic colorectal cancer (mCRC): CheckMate 142 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3531] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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
3531 Background: Nivo, a fully human anti-PD-1 mAb, provided an ORR of 31%, durable responses (median DOR not reached), and a 12-mo OS rate of 73.8% in pts with dMMR/MSI-H mCRC (Overman M, et al. 2017). Preliminary analysis of nivo + ipi, a humanized anti-CTLA-4 mAb, demonstrated manageable safety and promising efficacy in pts with dMMR/MSI-H mCRC (Overman M, et al . 2016). Here we report interim safety and efficacy of nivo + ipi in this pt population from the Checkmate 142 study (NCT02060188). Methods: Pts with dMMR/MSI-H mCRC who progressed on or were intolerant of ≥1 prior line of therapy received nivo 3 mg/kg + ipi 1 mg/kg q3w × 4 doses followed by nivo 3 mg/kg q2w until discontinuation due to disease progression or other reason. Primary endpoint was investigator-reported ORR by RECIST 1.1. Other endpoints included DOR, PFS, OS, safety, and tolerability. Results: 27 pts with dMMR/MSI-H mCRC treated with nivo + ipi received the first dose ≥6 mo prior to the database lock (DBL; Sept 2016). Of these pts, 93% received ≥2 prior lines of therapy. At the time of DBL, 44% of pts remained on treatment, and 14 pts had discontinued therapy due to disease progression (n=8) or TRAEs (n=6). ORR was 41% and disease control rate (DCR) was 78% (Table). The median time to response was 2.7 mo, and 82% of responses (9/11) were ongoing at 6 mo. The medians for DOR, PFS and OS had not been reached. Grade 3–4 TRAEs occurred in 10 pts (37%).TRAEs leading to discontinuation included acute kidney injury, increased transaminases, necrotizing myositis, sarcoidosis, dyspnea, and thrombocytopenia (1 each). No deaths were attributed to therapy. Conclusions: Initial analysis ofnivo + ipi in pts with ≥6-mo follow-up demonstrated a manageable safety profile and clinical activity characterized by a high DCR and encouraging survival benefit. This study is ongoing, and updated efficacy and biomarker analyses of ≈80 pts with ≥6-mo follow-up will be presented. Clinical trial information: NCT02060188. [Table: see text]
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Affiliation(s)
| | | | | | - Michael Morse
- Duke University Office of Research Administration, Durham, NC
| | | | | | | | - Heinz-Josef Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | - Emily Chan
- Vanderbilt University Ingram Cancer Center, Nashville, TN
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14
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Owonikoko TK, Dahlberg SE, Sica G, Wagner LI, Wade JL, Srkalovic G, Lash BW, Leach JW, Leal TA, Aggarwal C, Ramalingam SS. Randomized trial of cisplatin and etoposide in combination with veliparib or placebo for extensive stage small cell lung cancer: ECOG-ACRIN 2511 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8505 Background: Veliparib, a potent inhibitor of Poly (ADP) ribose polymerase (PARP) enzyme potentiates standard chemotherapy against small cell lung cancer (SCLC) in preclinical studies. We evaluated the combination of veliparib (V) with cisplatin/etoposide (CE) doublet for first-line therapy of extensive stage SCLC (ES-SCLC). Methods: Patients with ES-SCLC stratified by gender and serum LDH levels, were randomized to receive four 3-wk cycles of CE (75mg/m2 and 100 mg/m2) along with V (100mg bid on d1-7) or placebo (P). The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS). Using an overall one-sided 0.10 level logrank test, this study had 88% power to detect a 37.5% reduction in the PFS hazard rate. Results: 128 eligible pts were enrolled across 33 US sites. Median age, 66 yrs; men, 52%; PS 0/1 (29%/71%). The estimated median PFS was 6.1 m vs. 5.5 m [unstratified HR: 0.75; 1-sided p = 0.06) favoring CE+V. The median OS was 10.3 m vs. 8.9 m respectively for CE+V and CE+P [stratified HR: 0.83 (80% CI 0.64-1.07); 1-sided p = 0.17]. There was a significant treatment by strata interaction in PFS: male pts with high LDH derived benefit [PFS HR of 0.34 (80% CI: 0.22-0.51)]; among pts not in this strata: PFS HR = 0.81 (80% CI: 0.60-1.09). The best objective response rate was 71.9% vs. 65.6% (2-sided p = 0.57). Salient grade ≥3 adverse events occurring in 5% of patients are summarized in the table below. Analysis of tumor samples for predictive biomarkers is planned. Conclusions: The addition of veliparib to doublet chemotherapy was associated with improved PFS in patients with extensive stage SCLC. Clinical trial information: NCT01642251. [Table: see text]
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Affiliation(s)
| | | | - Gabriel Sica
- Emory University School of Medicine, Department of Pathology, The Atlanta VA Medical Center, Atlanta, GA
| | - Lynne I. Wagner
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - Suresh S. Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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15
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O'Reilly EM, Sahai V, Bendell JC, Bullock AJ, LoConte NK, Hatoum H, Ritch PS, Hool H, Leach JW, Sanchez J, Sohal D, Strickler JH, Patel R, Wang-Gillam A, Firdaus I, Kapoun AM, Holmgren E, Zhou L, Dupont J, Picozzi VJ. Results of a randomized phase II trial of an anti-notch 2/3, tarextumab (OMP-59R5, TRXT, anti-Notch2/3), in combination with nab-paclitaxel and gemcitabine (Nab-P+Gem) in patients (pts) with untreated metastatic pancreatic cancer (mPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
279 Background: Tarextumab (TRXT), fully human IgG2 antibody inhibits signaling of Notch2/ 3 receptors. Tumor regression seen in Notch3 (N3) expressing pt-derived pancreatic cancer xenografts when TRXT combined with Nab-P+Gem. Phase 2, randomized, placebo-controlled trial conducted to evaluate efficacy, safety of combination in mPC. Methods: Pts randomized 1:1 to TRXT or placebo (PL). TRXT given IV at 15 mg/kg q 2wks (D 1, 15), nab-P 125 mg/m2, GEM 1000mg/m2 on D1, 8, 15 q 28 days. Tissue for N3 gene expression determination was required. Primary endpoints: overall survival (OS) in all and in 3 subgroups determined by Notch 3 gene expression. Secondary: safety, progression-free survival (PFS) and overall response rate (ORR). Results: N = 177 pts randomized. Performance status (0 or 1), CA19-9 stratum (0 – ULN, > ULN – 59ULN, ≥ 59ULN) balanced. Clinical trial information: NCT01647828. . Conclusions: Addition of TRXT to Nab-P+Gem did not improve OS in 1st line mPC. A potential detrimental effect on PFS and ORR was seen in subjects with N3 < 25%ile.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Paul S. Ritch
- Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI
| | - Hugo Hool
- Cancer Care Assocs Inc, Redondo Beach, CA
| | | | | | | | | | | | | | - Irfan Firdaus
- Sarah Cannon Research Institute, Oncology Hematology Care, Inc., Cincinnati, OH
| | | | | | - Lei Zhou
- OncoMed Pharmaceutical, Inc., Redwood City, CA
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16
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Picozzi VJ, Leach JW, Seng JE, Anthony SP, Mena R, Larson T, Borazanci EH, Weiss GJ, Lin SLB, Jameson GS, Bolejack V, Stoll AC, Von Hoff DD, Ramanathan RK. Initial gemcitabine/nab-paclitaxel (GA) followed by sequential (S) mFOLFIRINOX or alternating (A) mFOLFIRI in metastatic pancreatic cancer (mPC): The SEENA-1 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
359 Background: GA, FOLFIRINOX and FOLFIRI are standard chemotherapy (CTX) regimens for mPC.The optimal introduction of these regimens following GA is not known. This phase II study evaluated 2 different approaches to this question. Methods: Eligibility criteria included 1) untreated mPC, 2) ECOG PS 0/1, 3) organ function adequate for Rx. Patients (pts) were treated according to one of 2 methods following GA given per standard dose/schedule: FOLFIRINOX (bolus 5-FU omitted) for up to 12 cycles at 24 weeks or at time of disease progression (S); or GA alternating with FOLFIRI q8 weeks up to 48 weeks total Rx (A). Results: 54 evaluable pts (28S, 26A) were enrolled . Pt characteristics included median age 65, M/F 48/52% , liver involvement 89%. 17/53 pts (31%) did not achieve disease control at 8 weeks (8 toxicity/complications , 6 disease progression, 3 declined further protocol therapy). Of the remaining 37 pts, 24/13 were treated with S/A regimens, respectively. Grade ≥ 3 treatment toxicities reported while on study with frequency ≥ 10% included anemia 21%, neutropenia 43%, thrombocytopenia 15%, and fatigue 22%. Grade ≥ 3 neuropathy occurred in 8% of pts. For all 54 pts using RECIST 1.0, CR/PR/SD/DC was 2 (4%)/20 (37%)/19 (35%)/41(76%). Ca19.9 response ≥ 90% was seen in 20/37 (54%). For all pts, median OS was 12.3 months ( 95% CI 8.6-14.5 mo); 12 and 24 mo OS was 51% and 11%, respectively. For the 37 pts with DC on GA at 8 weeks (calculated from start Rx) median OS was 13.5 mo (95% CI 10.7-15.4 mo); 12 and 24 mo OS was 55% and 16% , respectively. No statistically significant differences were seen between S and A with respect to toxicity, response or survival. Conclusions: 1) As opposed to introduction of 5FU-based CTX at the time of disease progression/prohibitive toxicity, introduction prior to that time may be at least comparable regarding both toxicity and OS. 2) This approach may further enhance OS in pts who achieve DC on GA at 8 weeks. 3) Neither S nor A method of 5FU-based CTX introduction following GA was clearly superior in this study. 4) How best to combine 5FU-based combination CTX following GA in mPC merits further study. Supported by the Seena Magowitz Foundation.
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Affiliation(s)
| | | | | | | | - Raul Mena
- Providence Heatlthcare/Disney Family Cancer Center, Burbank, CA
| | | | | | | | | | | | | | | | - Daniel D. Von Hoff
- Translational Genomics Research Institute (TGen) and HonorHealth, Phoenix and Scottsdale, AZ
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17
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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18
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Kelly K, Heery CR, Patel MR, Infante JR, Iannotti N, Leach JW, Wang D, Chandler JC, Arkenau HT, Taylor MH, Gordon MS, Wong DJL, Safran H, Kaufman H, Keilholz U, Bajars M, von Heydebreck A, Speit I, Cuillerot JM, Gulley JL. Avelumab (MSB0010718C; anti-PD-L1) in patients with advanced cancer: Safety data from 1300 patients enrolled in the phase 1b JAVELIN Solid Tumor trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Christopher Ryan Heery
- Laboratory of Tumor Immunology and Biology, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | | | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port Saint Lucie, FL
| | | | - Ding Wang
- Henry Ford Health Systems, Detroit, MI
| | | | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute UK, London and University College London Hospitals., London, United Kingdom
| | - Matthew H. Taylor
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Michael S. Gordon
- Pinnacle Oncology Hematology/HonorHealth Research Institute, Scottsdale, AZ
| | | | | | - Howard Kaufman
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ulrich Keilholz
- Department for Hemato-Oncology, Comprehensive Cancer Center, Charité-University Medicine, Berlin, Germany
| | | | | | | | | | - James L. Gulley
- Genitourinary Malignancies Branch, National Cancer Institute at the National Institutes of Health, Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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19
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Reddy SK, Parker RJ, Leach JW, Hill MJ, Burgart LJ. Tumor histopathology predicts outcomes after resection of colorectal cancer liver metastases treated with and without pre-operative chemotherapy. J Surg Oncol 2016; 113:456-62. [PMID: 27100028 DOI: 10.1002/jso.24144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/25/2015] [Accepted: 12/13/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Study objectives, included determination of: (i) associations between radiologic and pathologic responses of colorectal cancer liver metastases (CRCLM) to chemotherapy; and (ii) whether CRCLM histopathology is associated with recurrence free survival (RFS) after resection among patients not treated with pre-operative chemotherapy (untreated). METHODS Demographics, clinicopathologic characteristics, and outcomes among patients who underwent CRCLM resection from 2007 to 2014 were reviewed. Tumor regression grade (TRG) of 1-2 and 4-5 depict low and high proportions of viable tumor relative to fibrosis, respectively. RESULTS Of 138 patients, 84 (60.9%) were treated with pre-operative chemotherapy. In these patients, there was no difference in proportions with TRG 1-2 among those with verses without radiologic response (26.9% vs. 18.8%, P = 0.393). TRG 1-2 was associated with superior RFS on univariable (median 15 vs. 6 months, P < 0.001) and multivariable (P = 0.005) analyses. Radiologic response was not associated with RFS. Among untreated patients (n = 54), TRG 4-5 was associated with poor RFS on univariable (median 44 vs. 15 months, P = 0.011) and multivariable (P = 0.012) analyses. CONCLUSIONS High proportions of CRCLM fibrosis occur in 20% of patients without radiologic response to chemotherapy. Among untreated patients, high proportion of viable tumor relative to fibrosis is associated with poor RFS after resection. J. Surg. Oncol. 2016;113:456-462. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Srinevas K Reddy
- Allina Health-Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Robin J Parker
- Allina Health-Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Joseph W Leach
- Allina Health-Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Mark J Hill
- Allina Health-Virginia Piper Cancer Institute, Minneapolis, Minnesota
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Wagner LI, Zhao F, Hong F, Williams ME, Gascoyne RD, Krauss JC, Advani RH, Go RS, Habermann TM, Leach JW, O'Connor B, Schuster SJ, Cella D, Horning SJ, Kahl BS. Anxiety and health-related quality of life among patients with low-tumor burden non-Hodgkin lymphoma randomly assigned to two different rituximab dosing regimens: results from ECOG trial E4402 (RESORT). J Clin Oncol 2015; 33:740-8. [PMID: 25605841 DOI: 10.1200/jco.2014.57.6801] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study was to compare illness-related anxiety among participants in the Rituximab Extended Schedule or Retreatment Trial (RESORT) randomly assigned to maintenance rituximab (MR) versus rituximab re-treatment (RR). A secondary objective was to examine whether the superiority of MR versus RR on anxiety depended on illness-related coping style. PATIENTS AND METHODS Patients (N = 253) completed patient-reported outcome (PRO) measures at random assignment to MR or RR (baseline); at 3, 6, 12, 24, 36, and 48 months after random assignment; and at rituximab failure. PRO measures assessed illness-related anxiety and coping style, and secondary end points including general anxiety, worry and interference with emotional well-being, depression, and health-related quality of life (HRQoL). Patients were classified as using an active or avoidant illness-related coping style. Independent sample t tests and linear mixed-effects models were used to identify treatment arm differences on PRO end points and differences based on coping style. RESULTS Illness-related anxiety was comparable between treatment arms at all time points (P > .05), regardless of coping style (active or avoidant). Illness-related anxiety and general anxiety significantly decreased over time on both arms. HRQoL scores were relatively stable and did not change significantly from baseline for both arms. An avoidant coping style was associated with significantly higher anxiety (18% and 13% exceeded clinical cutoff points at baseline and 6 months, respectively) and poorer HRQoL compared with an active coping style (P < .001), regardless of treatment arm assignment. CONCLUSION Surveillance until RR at progression was not associated with increased anxiety compared with MR, regardless of coping style. Avoidant coping was associated with higher anxiety and poorer HRQoL.
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Affiliation(s)
- Lynne I Wagner
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Fengmin Zhao
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Fangxin Hong
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Michael E Williams
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - John C Krauss
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ranjana H Advani
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ronald S Go
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Thomas M Habermann
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph W Leach
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Brian O'Connor
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Stephen J Schuster
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - David Cella
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Sandra J Horning
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Brad S Kahl
- Lynne I. Wagner and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Fengmin Zhao, Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Michael E. Williams, University of Virginia, Charlottesville, VA; John C. Krauss, University of Michigan, Ann Arbor, MI; Ranjana H. Advani, Stanford University, Stanford; Sandra J. Horning, Genentech, South San Francisco, CA; Ronald S. Go, Gunderson Health System, La Crosse; Brad S. Kahl, University of Wisconsin, Madison, WI; Thomas M. Habermann, Mayo Clinic, Rochester; Joseph W. Leach, Metro Minnesota Community Clinical Oncology Program, Minneapolis, MN; Brian O'Connor, Frederick Memorial Health System, Frederick, MD; Stephen J. Schuster, University of Pennsylvania, Philadelphia, PA; and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada
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Argiris A, Lee JW, Leach JW, Schiller JH. Safety analysis of a phase II randomized trial of carboplatin (C), paclitaxel (P), bevacizumab (B) with or without cixutumumab (CX) in patients (pts) with advanced nonsquamous, non-small cell lung cancer (NSCLC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Athanassios Argiris
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
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22
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Ramanathan RK, Lee P, Seng JE, Anthony SP, Rosen PJ, Mena RR, Picozzi VJ, Sachdev JC, Larson T, Korn R, Jameson GS, Stoll AC, Von Hoff DD, Leach JW. Phase II study of induction therapy with gemcitabine and nab-paclitaxel followed by consolidation with mFOLFIRINOX in patients with metastatic pancreatic cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
224 Background: FOLFIRINOX or NabP-Gem are now standard mPC regimens.The optimal sequence is not known.This phase II study evaluated the feasibility of NabP-Gem followed by FOLFIRINOX. Methods: Eligible pts had evidence of untreated mPC, ECOG 0-1 and adequate organ function. Pts received Nab-P (125 mg/m2) and Gem (1000 mg/ m2) weekly x 3 (Induction ) every 4 weeks for upto 6 cycles. FOLFIRINOX, q2 weeks (Consolidation regimen) was initiated after 6 cycles of the Induction regimen, or earlier in case of progression, and given for a maximum of 6 months (12 cycles). mFOLFIRINOX (NEJM, 364:1817-25: 2011) has been modified with growth factor prophylaxis and omission of bolus 5FU. One endpoint is to increase 1 year survival to > 70%, (n=30, 95% CI is +/- 20%). Results: Accrual goals have been met (n=31). The M/F ratio is 55%/45%, median is 66 years. In 23 pts with elevated baseline CA19-9 levels treated with NabP-Gem, 83% had a > 90% decrease. The response rate with the NabP-Gem regimen is 43%. Selected therapy related Grade > 3 adverse events during the course of both NabP-Gem and FOLFIRINOX therapy are: neutropenia (39%), fatigue (32%), anemia (19%), thrombocytopenia (16%), thromboembolic events (3%), peripheral neuropathy (16%), leukopenia (16%), nausea (3%), vomiting (3%), diarrhea (7%), and neutropenic fever (3%). During the course of NabP-Gem, 14 dose reductions and four dose delays were seen. Two pts had early progression at cycle 4 or less and were switched to the Consolidation regimen. Seventy one % (22/31) of pts went on to receive FOLFIRINOX (4 pts still on study), 4 received FOLFIRI, and one pt received FOLFOX as Consolidation therapy. One-year survival is projected to be 50-60%. Conclusions: The induction NabP-Gem regimen shows evidence of substantial activity similar to published reports (JCO.29:4548-54: 2011). The induction-consolidation strategy is feasible in selected patients. Cumulative side effects predominantly fatigue and neuropathy will require appropriate dose reductions or treatment breaks. (Supported by the Seena Magowitz foundation). Clinical trial information: NCT01488552.
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Affiliation(s)
- Ramesh K. Ramanathan
- Translational Genomics Research Institute - Virginia G Piper Cancer Center, Scottsdale, AZ
| | - Peter Lee
- Tower Cancer Research Foundation, Beverly Hills, CA
| | | | | | | | - Raul R. Mena
- Providence Saint Joseph Medical Center, Burbank, CA
| | | | - Jasgit C. Sachdev
- Translational Genomics Research Institute - Virginia G Piper Cancer Center, Scottsdale, AZ
| | | | | | - Gayle S. Jameson
- Virginia G. Piper Cancer Center/Scottsdale Healthcare, Scottsdale, AZ
| | | | - Daniel D. Von Hoff
- Translational Genomics Research Institute - Virginia G Piper Cancer Center, Scottsdale, AZ
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23
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Leach JW, Lillemoe T, Krueger J. Clinicopathologic analysis of a large series of microinvasive breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1129] [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
1129 Background: Microinvasive breast cancer (Tmic) is defined by the AJCC as extension of cancer cells beyond the basement membrane with no single focus larger than 1 mm. The clinical behavior of this entity is unclear. Most series suggest that prognosis is similar to non-invasive cancer although the literature is mixed. Surgical management typically reflects invasive breast cancer including lymph node sampling. Published incidence of nodal involvement is also variable with some small series reporting incidence as high as 20%. We present a clinicopathologic review of a large series from a community practice setting. Methods: Using the AJCC definition of Tmic, we retrospectively identified all cases treated within Allina Health System from 2001-2011. Inclusion criteria included no prior history of breast cancer and available follow-up data. Data collected included ER/PR and HER2 status (when available), margin status and surgical and adjuvant therapy. Results: 118 eligible cases were identified with a mean follow-up of 3.65 years and mean age of 56.8 years (34-88). 39 were triple negative and 29 were HER2+. ER/PR data was available on all cases, HER2 on 60. 72 were treated with mastectomy. All patients underwent axillary staging. Lymph node metastasis was identified in 2 cases (one triple negative, one HER2+). In one case the metastasis measured 0.25 mm, in the other 0.4 mm. Complete axillary dissection performed on both cases demonstrated no additional lymph node involvement. Isolated tumor cells were also identified in 9 cases. 2 cases developed local recurrence following lumpectomy and radiation, both in the ipsilateral breast. One recurred with microinvasive disease, the second with DCIS only. There were no cases of metastatic recurrence and no breast cancer associated deaths. Conclusions: The clinical behavior of microinvasive breast cancer in this series is similar to DCIS. The incidence of lymph node metastasis was low (1.7%) and there were no cases of distant metastasis. Our data supports management of microinvasive breast cancer as a subset of DCIS and suggests that the benefit of routine lymph node sampling is questionable.
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Affiliation(s)
- Joseph W. Leach
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Minneapolis, MN
| | - Tamera Lillemoe
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Minneapolis, MN
| | - Janet Krueger
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Minneapolis, MN
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MacKenzie S, Zeh H, McCahill LE, Sielaff TD, Bahary N, Gribbin TE, Seng JE, Leach JW, Harmon J, Demeure MJ, Von Hoff DD, Moser AJ, Ramanathan RK. A pilot phase II multicenter study of nab-paclitaxel (Nab-P) and gemcitabine (G) as preoperative therapy for potentially resectable pancreatic cancer (PC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
4038 Background: Nab-P plus G is a new option for advanced PC. This combination was evaluated as a preoperative regimen for potentially resectable PC. Methods: Patients (pts, n=25) with resectable PC (NCCN criteria) were treated with 3 cycles of Nab-P (125mg/m2) & G (1000mg/m2) on day 1, 8, and 15, followed by surgical resection. The chosen endpoint was Grade III/IV histological changes (Arch Surg.127:1335-39:1992) in > 30% of resected tumor specimens. Results: Accrual is complete with 25 pts (median age 65, 10 F:15 M), 14/25 completed 3 cycles of treatment. Early drug discontinuation or drug interruption prior to the completion of 3 cycles occurred in 11 pts due to azotemia, cholangitis, pneumonia, catheter infection and pt decision. One pt had a fatal (grade 5) non-neutropenic aspergillus pneumonia. There was one episode of neutropenic fever (4%), and 3 episodes of cholangitis (12%) due to biliary stent malfunction. Other adverse events (grade 3/4) include neutropenia 64%, anemia 20%, dehydration 12%, nausea 12% and thrombocytopenia 12%. Dose reductions due to AEs were required in 5 pts, (3-neutropenia, 2-rash). Surgical resection was successful in 20/25 pts: 12- Pancreaticoduodenectomy, 8- Distal Pancreatectomy, 19/20 pts underwent an R0 resection. Surgical resection was not done in 5/25 pts due to: pre-operatively identified metastatic disease (2), blood vessel involvement at surgery (1), pt declined (1) and a pre-operative death (1).Post-operative tumor staging identified a complete response (n=1); stage IA (n=1); stage IIA (n=6); and stage IIB (n=12). Radiological partial response (PR) was documented in 4 pts prior to surgery. CA19-9 levels decreased from baseline by > 50% in 60% (n=15) of pts and by > 90% in 16% (n=4). Post-operative > 90% histological tumor response (Grade 3/4) was seen in 6 of 20 (30%) resected specimens. Conclusions: Preoperative therapy with Nab-P plus G is feasible with evidence of activity by radiological (PR in 16%), CA19-9 (decrease > 50% in 60% of pts) and pathological down staging (Grade 3/4 in 30% in resected tumor specimens). A larger study is warranted. Supported by Abraxis/Celgene Pharmaceuticals and the TGen foundation. Clinical trial information: NCT01298011.
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Affiliation(s)
- Shawn MacKenzie
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Minneapolis, MN
| | - Herbert Zeh
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Timothy D. Sielaff
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Minneapolis, MN
| | - Nathan Bahary
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | | | | - Daniel D. Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | - A Jim Moser
- Department of Surgery, Division of Surgical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ramesh K. Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
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Ramanathan RK, Lee P, Leach JW, Anthony SP, Weiss GJ, Rosen PJ, Picozzi VJ, Sachdev JC, Larson T, Korn R, Hu C, Jameson GS, Stoll AC, Von Hoff DD, Seng JE. Phase II study of induction therapy with gemcitabine and nab-paclitaxel followed by consolidation with mFOLFIRINOX in patients with metastatic pancreatic cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.233] [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
233 Background: We designed a phase II study to evaluate the efficacy, toxicity and feasibility of administering nab-paclitaxel/gemcitabine (NabP-Gem) followed by mFOLFIRINOX in MPC. Methods: Eligible patients had evidence of untreated MPC with performance status of ECOG 0-1 and adequate organ function. Induction therapy was with Nab-P (125 mg/m2) and Gem (1000 mg/ m2) weekly x 3 every 4 weeks for a maximum of 6 months (6 cycles). mFOLFIRINOX every 2 weeks (Consolidation regimen) was initiated after 6 cycles of the Induction regimen, or earlier in case of progression, and given upto 6 months (12 cycles). The FOLFIRINOX regimen (NEJM,364:1817-25: 2011) was modified to omit the bolus 5FU and requires addition of granulocyte growth factor prophylaxis. A primary endpoint is to increase 1 year survival (n=30) to >70%, (95% confidence intervals for one year survival rate is +/- 20%). Results: As of 9/1/2012, 26 of 30 subjects have been accrued. M/F ratio is 58%/42%, median is 65 years. In 20 patients treated on the induction phase, 75% have a > 90% decrease in CA 19-9 levels. The partial response rate (PR) in the first 19 patients who have completed 4 cycles is 50%. Early image analysis on 9 subjects with concurrent CT and PET showed 44% PR (RECIST 1.1) but 89% by CHOI and PET criteria. A novel approach to interrogate tumor texture composition demonstrated substantial change in lesion texture following induction therapy. To date selected Grade > 3 adverse events are neutropenia (n=8), fatigue (n=5), thromboembolic events (n=4), peripheral neuropathy (n=3), dehydration (n=2), anemia (n=3), thrombocytopenia (n=2), febrile neutropenia (n=2) and myalgias (n=2). Among 26 patients who have received at least one cycle of NabP-Gem, ten dose reductions and four dose delays were seen. To date, 11 patients have begun the Consolidation regimen with mFOLFIRINOX. Conclusions: The induction NabP-Gem regimen shows preliminary evidence of substantial activity similar to published reports (JCO.29:4548-54: 2011). Study will now evaluate the safety, efficacy and feasibilty of the Consolidation regimen with mFOLFIRINOX. Supported by the Seena Magowitz Foundation. Clinical trial information: NCT01488552.
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Affiliation(s)
| | - Peter Lee
- Providence Saint Joseph Medical Center, Burbank, CA
| | | | | | - Glen J. Weiss
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | - Vincent J. Picozzi
- Digestive Diseases and Cancer Institutes, Virginia Mason Medical Center, Seattle, WA
| | | | | | - Ronald Korn
- Scottsdale Medical Imaging, Ltd., Scottsdale, AZ
| | - Chengcheng Hu
- University of Arizona Public Health Epi/Biostats Division, Tucson, AZ
| | - Gayle S. Jameson
- Virginia G. Piper Cancer Center/Translational Genomics Research Institute, Scottsdale, AZ
| | - Amy C. Stoll
- Translational Genomics Research Institute, Scottsdale, AZ
| | - Daniel D. Von Hoff
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
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26
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Abstract
Radon is the second leading cause of lung cancer and it is recommended that all homes be tested for radon. Written surveys completed by 692 patients at two primary care clinics in the Minneapolis, MN, area revealed that only 24.7 % had ever tested their home. Testing rate was higher with greater income and education level and in homes without someone who smokes. Of participants whose homes had not been tested, 250 were enrolled in an intervention that included printed information on radon, a coupon for a discounted testing kit, and encouragement by their primary care provider to test. Follow-up indicated minimal effect of this intervention, with only 14.4 % of these participants testing during the ensuing year. Future studies should assess a stronger intervention, perhaps over multiple visits, and providing test kits on site. Targeting patients who smoke may be an effective use of resources.
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Affiliation(s)
- Mary Jo Nissen
- Oncology Research Department, Park Nicollet Institute, Minneapolis, MN, USA.
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27
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Thumbigere-Math V, Sabino MC, Gopalakrishnan R, Huckabay S, Dudek AZ, Basu S, Hughes PJ, Michalowicz BS, Leach JW, Swenson KK, Swift JQ, Adkinson C, Basi DL. Bisphosphonate-related osteonecrosis of the jaw: clinical features, risk factors, management, and treatment outcomes of 26 patients. J Oral Maxillofac Surg 2009; 67:1904-13. [PMID: 19686928 DOI: 10.1016/j.joms.2009.04.051] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 04/02/2009] [Accepted: 04/21/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the clinical features, risk factors, management, and treatment outcomes of nitrogen-containing bisphosphonate (n-BIS)-related osteonecrosis of the jaw (BRONJ). PATIENTS AND METHODS Patients with suspected BRONJ were referred to the School of Dentistry for evaluation and treatment. RESULTS A total of 26 patients (9 men and 17 women, mean age 64 years) were diagnosed with BRONJ. Of the 26 patients, 23 had received n-BIS therapy for cancer and 3 for osteoporosis. BRONJ lesions were noted more frequently in the mandible and in the posterior sextants. Of the 26 patients, 16 had developed BRONJ after dentoalveolar procedures, and 10 had developed it spontaneously. The mean interval to development of BRONJ was shorter in the patients with cancer receiving intravenous n-BIS than in the patients with osteoporosis receiving oral n-BIS (37.1 versus 77.7 months, P = .02). Using the American Association of Oral and Maxillofacial Surgeons staging system, 2 patients were diagnosed with stage I lesions, 19 with stage II, and 5 with stage III lesions. The initial management of BRONJ was nonsurgical, with debridement performed at subsequent visits, if needed. The BRONJ lesions healed completely in 4 patients, healed partially in 8, remained stable in 7, and progressed in 7. The spontaneous lesions responded favorably to BRONJ management compared with lesions that developed after dentoalveolar procedures (P = .01). No significant difference was found in response to BRONJ management between patients who had continued or discontinued n-BIS therapy after the BRONJ diagnosis (P = .54). CONCLUSIONS Long-term n-BIS therapy and recent dental procedures are consistent findings in patients with BRONJ. Spontaneous BRONJ lesions respond favorably to current BRONJ treatment strategies.
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Affiliation(s)
- Vivek Thumbigere-Math
- Division of Periodontology, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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Abstract
PURPOSE/OBJECTIVES To identify risk factors for lymphedema after breast cancer surgery. DESIGN Multisite case-control study. SETTING Lymphedema clinics in the upper midwestern region of the United States. SAMPLE 94 patients with lymphedema and 94 controls without lymphedema, matched on type of axillary surgery and surgery date. METHODS The Measure of Arm Symptom Survey, a patient-completed tool, assessed potential risk factors for lymphedema. Severity of lymphedema was measured by arm circumference, and disease and treatment factors were collected via chart review. MAIN RESEARCH VARIABLES Risk factors for lymphedema after breast cancer surgery. FINDINGS On univariate analysis, patients with lymphedema were more likely than controls to be overweight (body mass index >or= 25) (p = 0.009). They also were more likely to have had axillary radiation (p = 0.011), mastectomy (p = 0.008), chemotherapy (p = 0.033), more positive nodes (p = 0.009), fluid aspirations after surgery (p = 0.005), and active cancer status (p = 0.008). Strength training (p = 0.014) and air travel (p = 0.0005) were associated with less lymphedema occurrence. On multivariate analysis, the only factor significantly associated with lymphedema was being overweight (p = 0.022). CONCLUSIONS Being overweight is an important modifiable risk factor for lymphedema. Axillary radiation, more extensive surgery, chemotherapy, and active cancer status also were predictive of lymphedema. IMPLICATIONS FOR NURSING This study provides evidence that excess weight contributes to lymphedema; strength training and airline travel did not contribute to lymphedema.
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Abstract
Acquired pure megakaryocytic aplasia is a rare disorder defined by severe thrombocytopenia with no other hematologic abnormalities and absent, or severely decreased marrow megakaryocytes. The etiology may be immune suppression of megakaryocyte development. Two patients are described who both responded rapidly to a combination of antithymocyte globulin and cyclosporine and who remain in remission 13-20 months after discontinuation of cyclosporine. This regimen is well described for treatment of aplastic anemia and may also be effective for acquired pure megakaryocytic aplasia.
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Affiliation(s)
- J W Leach
- Department of Medicine, University of Oklahoma Health Sciences Center, Hematology-Oncology Section, Oklahoma City, USA
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30
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Leach JW, Pham T, Diamandidis D, George JN. Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) following treatment with deoxycoformycin in a patient with cutaneous T-cell lymphoma (Sezary syndrome): A case report. Am J Hematol 1999; 61:268-70. [PMID: 10440915 DOI: 10.1002/(sici)1096-8652(199908)61:4<268::aid-ajh9>3.0.co;2-o] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present a case of a patient who developed all manifestations of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) acutely following treatment of cutaneous T-cell lymphoma (CTCL, Sezary syndrome) with deoxycoformycin (pentostatin). Symptoms and signs included severe thrombocytopenia and microangiopathic hemolytic anemia; hallucinations, confusion and disorientation; oliguric acute renal failure requiring hemodialysis; and fever. No other etiology for these symptoms and signs was present. Complete recovery followed treatment for one month with plasma exchange and glucocorticoids. During the succeeding 20 months she has remained well and her CTCL remains stable on no further treatment. This case and two previously published cases suggest that acute and severe TTP-HUS may be a dose-dependent toxicity of deoxycoformycin (pentostatin).
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Affiliation(s)
- J W Leach
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA
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31
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Abstract
OBJECTIVE Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre-admission management of children admitted with acute gastroenteritis to a major children's hospital. METHODOLOGY Information was obtained from parental questionnaires and the medical notes for 164 children. RESULTS Parents were poorly informed regarding appropriate home management. Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%, and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%), antidiarrhoeals (1.2%) and anti-emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance. CONCLUSIONS Oral rehydration therapy is utilized rarely and medications are over-utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management. The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.
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Affiliation(s)
- E J Elliott
- Department of Paediatrics and Child Health, University of Sydney, New South Wales, Australia
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