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Wickenheisser NE, Dillon M, Broadwater G, Zacherl K, Bixel K, Levine M, Newton M, Thel H, Tucker K, Gehrig P, Khetan VU, Brunette-Masi LL, Matsuo K, Khouri OR, Duhon A, Gowthaman D, Cowan M, Mojdehbakhsh R, Rose S, Olawaiye A, Davidson BA, Moss HA, Havrilesky LJ. Radical hysterectomy case volume and cervical cancer treatment in the era of COVID-19: A multi-site analysis of National Cancer Institute-designated Comprehensive Cancer Centers. Gynecol Oncol 2023; 179:70-78. [PMID: 37944328 DOI: 10.1016/j.ygyno.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic. METHODS In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018-2/28/2020; (2) Pandemic & Recovery: 4/1/2020-12/31/2021. The primary outcome was total monthly radical hysterectomy case volume. Secondary outcomes were stage at diagnosis and diagnosis-to-treatment time. Statistical analyses used chi-squared and two sample t-tests. RESULTS Between 3/1/2018-12/31/2021, 561 patients were diagnosed with cervical cancer. The Pre-Pandemic and Pandemic & Recovery cohorts had similar age, race, ethnicity, smoking status, and Body Mass Index (BMI). During Pandemic & Recovery, the mean monthly radical hysterectomy case volume decreased from 7[SD 2.8] to 5[SD 2.0] (p = 0.001), the proportion of patients diagnosed with Stage I disease dropped from 278/561 (49.5%) to 155/381 (40.7%), and diagnosis of stage II-IV disease increased from 281/561 (50.1%) to 224/381 (58.8%). Primary surgical management was less frequent (38.3% Pandemic & Recovery versus 46.7% Pre-Pandemic, p = 0.013) and fewer surgically-treated patients received surgery within 6 weeks of diagnosis (27.4% versus 38.9%; p = 0.025). CONCLUSIONS Lower radical hysterectomy case volume, a shift to higher cervical cancer stage, and delay in surgical therapy were observed across the United States following the COVID-19 outbreak. Decreased surgical volume may result from lower detection of early-stage disease or other factors.
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Affiliation(s)
- Natalie E Wickenheisser
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Mairead Dillon
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Gloria Broadwater
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Kathleen Zacherl
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Monica Levine
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Meredith Newton
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Hannah Thel
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Katherine Tucker
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Paola Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Varun U Khetan
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Laurie L Brunette-Masi
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Koji Matsuo
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Olivia R Khouri
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Ashley Duhon
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Divya Gowthaman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Matthew Cowan
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Rachel Mojdehbakhsh
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Stephen Rose
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Alexander Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America.
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Morton M, Haight PJ, Khadraoui W, Backes F, Bixel K, O'Malley DM, Nagel C, Chambers LM. "More than a song and dance": Exploration of patient perspectives and educational quality of gynecologic cancer content on TikTok. Gynecol Oncol 2023; 175:81-87. [PMID: 37329872 DOI: 10.1016/j.ygyno.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/05/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To investigate themes, quality, and reliability of gynecologic cancer-related content on the social media application TikTok. METHODS TikTok was systematically searched for the 100 most popular posts for ovarian cancer (OC), endometrial cancer (EC), cervical cancer (CC), vulvar cancer (VC), and gestational trophoblastic disease (GTD) in August 2022. Data was collected for demographics, tone, and themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale. Relationships between content demographics, disease sites, and themes were assessed. RESULTS As of August 2022, the top five hashtags for each gynecologic cancer on TikTok had 466.7 million views. 430 of the top 500 posts were eligible for inclusion (OC: n = 86, CC: n = 93, EC: n = 98, GTD: n = 63, VC: n = 90). The majority of creators (n = 323, 75.1%) were White, 33 (7.7%) were Black, 20 (4.6%) were Asian/Pacific Islander (API), 10 (2.3%) were South Asian, 20 (4.7%) were Hispanic/Latino/a, 24 (5.5%) were unable to determine. Eleven central themes were identified, with significant differences when analyzed by disease site and race. The median DISCERN score for all posts was 1.0, indicating poor educational quality and reliability. When compared by race, South Asian/API posters received the highest scores (3, IQR 2.5) versus Black (2: IQR 3), Hispanic/Latino/a (2: IQR 0), and White posters (1, IQR 2) (p = 0.0013). CONCLUSION(S) Gynecologic cancer-related content on TikTok is of poor educational quality, and racial disparities in gynecologic cancer extend to social media. Opportunities exist to create more diverse content to support racial and cultural experiences in gynecologic cancer treatment.
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Affiliation(s)
- Molly Morton
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA.
| | - Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Wafa Khadraoui
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Floor Backes
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Kristin Bixel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Christa Nagel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
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Thomson CA, Crane TE, Miller A, Gold MA, Powell M, Bixel K, Van Le L, DiSilvestro P, Ratner E, Lele S, Guntupalli S, Huh W, Robertson SE, Modesitt S, Casey AC, Basen-Engquist K, Skiba M, Walker J, Kachnic L, Alberts DS. Lifestyle intervention in ovarian cancer enhanced survival (LIVES) study (NRG/GOG0225): Recruitment, retention and baseline characteristics of a randomized trial of diet and physical activity in ovarian cancer survivors. Gynecol Oncol 2023; 170:11-18. [PMID: 36608382 PMCID: PMC10023359 DOI: 10.1016/j.ygyno.2022.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants. METHODS The LIVES study (NRG Oncology/GOG 0225) is a Phase III diet plus physical activity intervention trial testing the hypothesis that ovarian cancer survivors in the lifestyle intervention will demonstrate better progression-free survival than those in the control condition. Study interventions were delivered via centralized telephone-based health coaching. Baseline descriptive statistics were computed for demographic, clinical, and lifestyle behavior characteristics. RESULTS The LIVES study exceeded its recruitment goals, enrolling 1205 ovarian cancer survivors from 195 NRG/NCORP-affiliated oncology practices across 49 states from 2012 to 2018. The mean age of enrollees was 59.6 years; the majority (69.4%) with stage III disease; 89% White, 5.5% Hispanic; 64% overweight/obese. Baseline self-reported diet showed a mean daily intake of 6.6 servings of fruit and vegetables, 62.7 fat grams, and 21.7 g of fiber. Physical activity averaged 13.0 MET-hours/week of moderate to vigorous physical activity; 50.9 h/week of sedentary time. Retention rates exceeded 88%. CONCLUSION The LIVES study demonstrates efficiency in recruiting and retaining ovarian cancer survivors in a 24-month study of diet and physical activity intervention with a primary endpoint of progression free survival that will be reported. TRIAL REGISTRATION ClinicalTrials.govNCT00719303.
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Affiliation(s)
- Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Tracy E Crane
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; Division of Medical Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Austin Miller
- NRG Oncology, Clinical Trials Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Michael A Gold
- Oklahoma Cancer Specialists and Research Institute, Tulsa, OK, USA.
| | - Matthew Powell
- Washington University School of Medicine, St. Louis, MO, USA.
| | - Kristin Bixel
- Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
| | - Linda Van Le
- University of North Carolina School of Medicine, UNC Hospitals, 101 Manning Dr, Chapel Hill, NC, USA.
| | | | - Elena Ratner
- Yale University School of Medicine, New Haven, CT, USA.
| | | | - Saketh Guntupalli
- University of Colorado Cancer Center - Anschutz Cancer Pavilion, Aurora, CO, USA.
| | - Warner Huh
- University of Alabama at Birmingham Hospital, Birmingham, AL, USA.
| | | | - Susan Modesitt
- University of Virginia, Emily Couric Clinical Cancer Center, Charlottesville, VA, USA.
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, Director of the Center for Energy Balance in Cancer Prevention & Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Meghan Skiba
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Joan Walker
- University of Oklahoma, Oklahoma City, OK, USA.
| | - Lisa Kachnic
- Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
| | - David S Alberts
- Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, Emeritus, University of Arizona Cancer Center, Tucson, AZ, 85719, USA.
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Ahmed K, Quick A, Bixel K, Kim Y, Lemerond E, Chon H, Chern J, Fernandez D, Hoffman M, Kim S, Lam C, Montejo M, Shahzad M, Wenham R. Atezolizumab and Stereotactic Body Radiation Therapy in Metastatic, Recurrent or Persistent Cervical Cancer: Interim Results from a Non-Randomized, Open-Label Phase II Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Calo C, Barrington DA, Mclaughlin EM, Bixel K. Help wanted: low provider density is associated with advanced stage cervical cancer. Int J Gynecol Cancer 2022; 32:ijgc-2022-003779. [PMID: 36170995 DOI: 10.1136/ijgc-2022-003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients in rural areas have a higher incidence of cervical cancer with increased rates of metastatic disease than their urban counterparts. OBJECTIVE To evaluate whether medical provider density, acting as a surrogate for screening availability, is associated with the incidence of cervical cancer or proportion diagnosed with advanced stage disease. METHODS Cervical cancer cases by county from 2015 were retrieved from the SEER database. The numbers of primary obstetric-gynecologists (OB-GYN), family practice, and internal medicine providers were obtained from the Area Health Resource File, and population estimates for each county were used to calculate provider to resident ratios. Spearman rank correlations were used to compare the number of providers per 100 000 residents with the overall incidence of cervical cancer as well as the proportion diagnosed at an advanced stage. Multivariable logistic regression was performed to assess factors independently associated with advanced stage disease, accounting for county of residence. Mortality was compared across different OB-GYN provider density categories. RESULTS A total of 3505 cases of cervical cancer from 405 counties were included. Spearman correlation demonstrated a significant inverse association between the number of OB-GYN providers per 100 000 residents and the incidence of cervical cancer (p<0.0001) as well as the proportion diagnosed at an advanced stage (p=0.003). Compared with those living in counties with ≤5 OB-GYN providers per 100 000 residents, those living in counties with >10 providers had a 29% reduction in the odds of presenting with advanced stage disease (OR=0.71; 95% CI 0.55 to 0.91). An inverse association between cervical cancer-related mortality and OB-GYN provider density was also noted. CONCLUSION A significant inverse correlation between provider density and incidence of cervical cancer, proportion with advanced stage disease, and cervical cancer-related mortality was observed. Increasing provider density in these underserved, high-risk areas may improve timely cancer detection.
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Affiliation(s)
- Corinne Calo
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Eric M Mclaughlin
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Kristin Bixel
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Calo CA, Barrington DA, Brown M, Gonzalez L, Baek J, Huffman A, Benedict J, Backes F, Chambers L, Cohn D, Copeland L, Cosgrove C, Nagel C, O'Malley D, Bixel K. High pre-treatment neutrophil-to-lymphocyte ratio as a prognostic marker for worse survival in patients with recurrent/metastatic cervical cancer treated with immune checkpoint inhibitors. Gynecol Oncol Rep 2022; 42:101040. [PMID: 35855965 PMCID: PMC9287632 DOI: 10.1016/j.gore.2022.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio was predictive of OS in cervical cancer patients treated with PD-1/PD-L1 inhibitors. For those with a NLR < 8 the probability of survival at one year was 57% compared to 26% for those with NLR ≥ 8. No significant association between NLR and progression free survival or response to treatment was noted. Assessment of ORR was limited due to 5/14 patients in the NLR ≥ 8 group passing before assessment of disease response. NLR holds promise as a predictive marker for survival in this population and warrants further evaluation.
Objective To evaluate the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and survival outcomes among patients with recurrent/metastatic cervical cancer treated with PD-1/PD-L1 inhibitors. Methods A retrospective analysis of patients with recurrent/metastatic cervical cancer treated with PD-1/PD-L1 inhibitors from 2016 to 2021 was conducted. Progression free survival (PFS) and overall survival (OS) outcomes were assessed for patients stratified by NLR (<8 vs ≥ 8) utilizing Kaplan-Meier method. Univariable analysis was performed to compare baseline characteristics between the two groups. Results A total of 49 patients were included in analysis. A majority of patients had squamous cell histology (57%), were PD-L1 positive (55%), received ≤ 1 prior lines of systemic therapy (57%), and had distant metastatic disease at the time of treatment (69%). The groups were well-balanced with respect to age, race, histology, smoking status, PD-L1 positivity, prior lines of treatment (≤1 vs > 1), prior radiation therapy, ECOG performance status, and disease distribution for patients with a NLR < 8 (n = 35) compared to those with a NLR ≥ 8 (n = 14). A pre-treatment NLR of < 8 was associated with improved survival (p < 0.01), with 57% (95% CI: 41%, 78%) probability of survival at one year compared to 26% (95% CI: 10%, 66%) for those with NLR ≥ 8. No statistically significant differences in probability of PFS at 1 year were seen between NLR < 8 compared to those with NLR ≥ 8 (p = 0.70). Conclusions Pre-treatment NLR may hold prognostic value for patients with metastatic/recurrent cervical cancer treated with PD-1/PD-L1 inhibitors, with NLR < 8 associated with improved survival.
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Affiliation(s)
- Corinne A. Calo
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
- Corresponding author at: 320 W 10th Ave, M210 Starling Loving Hall, Columbus, OH 43210, United States.
| | - David A. Barrington
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Morgan Brown
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
| | - Lynette Gonzalez
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Jae Baek
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Allison Huffman
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Jason Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Floor Backes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Laura Chambers
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - David Cohn
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Larry Copeland
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Casey Cosgrove
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Christa Nagel
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - David O'Malley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Kristin Bixel
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
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Wagner V, Piver R, Levine M, Backes F, Cohn D, Copeland L, Cosgrove C, Fowler J, Nagel C, O’Malley D, Bixel K. Using machine learning to predict venous thromboembolism in patients with uterine cancer (081). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barrington DA, Calo C, Baek J, Brown M, Wagner V, Gonzalez L, Huffman A, Benedict J, Bixel K. Beyond mismatch repair deficiency? Pre-treatment neutrophil-to-lymphocyte ratio is associated with improved overall survival in patients with recurrent endometrial cancer treated with immunotherapy. Gynecol Oncol 2022; 166:522-529. [PMID: 35907683 DOI: 10.1016/j.ygyno.2022.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association of pre-treatment neutrophil-to-lymphocyte ratio (NLR) with progression-free survival (PFS) and overall survival (OS) for patients with recurrent endometrial cancer (EC) treated with immunotherapy. METHODS Recurrent EC patients treated with immunotherapy alone or in combination from 2016 to 2021 were included. Demographics, pre-treatment laboratory results, pathologic data, response at first radiographic assessment, and cancer outcomes were obtained from the medical record. Kaplan-Meier curves were generated to compare PFS and OS stratified by NLR. RESULTS The 106 patients included in the study were stratified by NLR <6 (n = 77, 72.6%) or NLR ≥6 (n = 29, 27.3%). Most had endometrioid pathology (59%), widely metastatic disease, and 36.8% had received ≥2 treatment lines before initiating immunotherapy. Mismatch repair deficiency (dMMR) was noted in 52 (49.1%) tumors. Most dMMR patients (94.3%) were treated with single-agent pembrolizumab, and most MMR proficient patients (78.7%) were treated with lenvatinb plus pembrolizumab. In the overall cohort, 40.2% (partial response (PR) 29.9%, complete response (CR) 10.4%) of patients with a NLR <6 responded at first radiographic assessment, compared to 31% (PR 27.5%, CR 3.4%) of patients with NLR ≥6 (p 0.691). Kaplan-Meier curves stratified by NLR <6 vs. ≥6 showed no difference in PFS. However, NLR <6 was associated with improved OS (p < 0.05). In the NLR < 6 group, the probability of survival at one year was 69% (95% CI: 58%, 82%), compared to 41% (95% CI: 26%, 67%) for the NLR > 6 group. CONCLUSIONS Pre-treatment NLR <6 was associated with improved OS for recurrent EC patients treated with immunotherapy. NLR holds promise as a predictive biomarker for survival after immunotherapy treatment for patients with recurrent EC.
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Affiliation(s)
- David A Barrington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| | - Corinne Calo
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Jae Baek
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Morgan Brown
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Vincent Wagner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Lynette Gonzalez
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Allison Huffman
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jason Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Kristin Bixel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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Bixel K, Barrington DA, Vetter MH, Suarez AA, Felix AS. Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma. J Minim Invasive Gynecol 2022; 29:219-230. [PMID: 34348183 PMCID: PMC8803987 DOI: 10.1016/j.jmig.2021.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). DESIGN Retrospective cohort. SETTING The National Cancer Database, 2010 to 2015. PATIENTS A total of 140 470 patients with histologically confirmed EC who underwent hysterectomy. INTERVENTIONS Patients were grouped according to surgical approach. MEASUREMENTS AND MAIN RESULTS A total of 140 470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%), followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, and the percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in ZIP codes with lower proportions of individuals who did not graduate from high school, and those treated at noncommunity cancer programs were less likely to undergo laparotomy than RAL, and non-white women, those diagnosed with high-grade histology, and those with advanced-stage EC were more likely to undergo laparotomy than RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: hazard ratio 1.21; 95% confidence interval, 1.18-1.25; traditional laparoscopy: hazard ratio 1.06; 95% confidence interval, 1.02-1.09). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed. CONCLUSION RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management.
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Affiliation(s)
- Kristin Bixel
- Division of Gynecologic Oncology (Drs. Bixel and Barrington).
| | | | - Monica H Vetter
- Division of Gynecologic Oncology, Baptist Health Medicine Group, Lexington, Kentucky (Dr. Vetter)
| | - Adrian A Suarez
- Division of Surgical Pathology (Dr. Suarez), College of Medicine
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health (Dr. Felix), The Ohio State University, Columbus, Ohio
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10
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duPont NC, Enserro D, Brady MF, Moxley K, Walker JL, Cosgrove C, Bixel K, Tewari KS, Thaker P, Wahner Hendrickson AE, Rubin S, Fujiwara K, Casey AC, Soper J, Burger RA, Monk BJ. Prognostic significance of ethnicity and age in advanced stage epithelial ovarian cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2022; 164:398-405. [PMID: 34857397 PMCID: PMC9400113 DOI: 10.1016/j.ygyno.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Age and ethnicity are among several factors that influence overall survival (OS) in ovarian cancer. The study objective was to determine whether ethnicity and age were of prognostic significance in women enrolled in a clinical trial evaluating the addition of bevacizumab to front-line therapy. METHODS Women with advanced stage ovarian, primary peritoneal, or fallopian tube cancer were enrolled in a phase III clinical trial. All women had surgical staging and received adjuvant chemotherapy with one of three regimens. Cox proportional hazards models were used to evaluate the relationship between OS with age and race/ethnicity among the study participants. RESULTS One-thousand-eight-hundred-seventy-three women were enrolled in the study. There were 280 minority women and 328 women over the age of 70. Women age 70 and older had a 34% increase risk for death when compared to women under 60 (HR = 1.34; 95% CI 1.16-1.54). Non-Hispanic Black women had a 54% decreased risk of death with the addition of maintenance bevacizumab (HR = 0.46, 95% CI:0.26-0.83). Women of Asian descent had more hematologic grade 3 or greater adverse events and a 27% decrease risk of death when compared to non-Hispanic Whites (HR = 0.73; 95% CI: 0.59-0.90). CONCLUSIONS Non-Hispanic Black women showed a decreased risk of death with the addition of bevacizumab and patients of Asian ancestry had a lower death rate than all other minority groups, but despite these clinically meaningful improvements there was no statistically significant difference in OS among the groups.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Black or African American/statistics & numerical data
- Age Factors
- Aged
- Aged, 80 and over
- Angiogenesis Inhibitors/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian/statistics & numerical data
- Bevacizumab/therapeutic use
- Carboplatin/administration & dosage
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/pathology
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/pathology
- Chemotherapy, Adjuvant/methods
- Ethnicity/statistics & numerical data
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/pathology
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Middle Aged
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/pathology
- Prognosis
- Proportional Hazards Models
- Survival Rate
- White People/statistics & numerical data
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Affiliation(s)
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Mark F Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Katherine Moxley
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | - Joan L Walker
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | | | | | | | | | | | - Stephen Rubin
- Abramson Cancer Center at University of Pennsylvania, Philadelphia, PA 19111, USA.
| | - Keiichi Fujiwara
- Saitama Medical University/International Medical Center, Saitama, JP 350-1298, Japan.
| | | | - John Soper
- University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Robert A Burger
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), Phoenix, AZ, USA.
| | - Bradley J Monk
- University of Arizona College of Medicine, Phoenix Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ, USA.
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11
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Wagner V, Piver R, Levine M, Bixel K. Postoperative venous thromboembolism risk stratification in patients with uterine cancer. Gynecol Oncol 2022. [DOI: 10.1016/j.ygyno.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Barrington D, Calhoun C, Haight P, Tubbs C, Cohn D, Bixel K. Lenvatinib plus pembrolizumab in advanced recurrent endometrial cancer: a cost-effectiveness analysis. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Bixel K, Barrington D, Vetter M, Suarez A, Felix A. Determinants of surgical approach and survival among women with endometrial carcinoma. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00883-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Castaneda A, Graves S, Suarez A, Cohn D, O'Malley D, Copeland L, Fowler J, Backes F, Bixel K, Cosgrove C. Incidence of ovarian metastasis in neuroendocrine tumors of the cervix. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Lightfoot M, Benedict J, Smrz S, Henderson A, Bishop E, Boyles G, Bixel K. Rate of fracture among women undergoing treatment for gynecologic malignancies. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Backes FJ, Wei L, Chen M, Hill K, Dzwigalski K, Poi M, Phelps M, Salani R, Copeland LJ, Fowler JM, Cohn DE, Bixel K, Cosgrove C, Hays J, O'Malley D. Phase I evaluation of lenvatinib and weekly paclitaxel in patients with recurrent endometrial, ovarian, fallopian tube, or primary peritoneal Cancer. Gynecol Oncol 2021; 162:619-625. [PMID: 34272090 DOI: 10.1016/j.ygyno.2021.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the maximally tolerated dose (MTD) and describe toxicities associated with lenvatinib and weekly paclitaxel in patients with recurrent endometrial and platinum resistant epithelial ovarian cancer. METHODS Using a 3 + 3 design patients were given weekly paclitaxel 80 mg/m2 IV day 1, 8, 15 and oral levantinib daily on a 28-day cycle. Lenvatinib dose levels were 8 mg, 12 mg, 16 mg, 20 mg. Toxicities were recorded using CTCAE v4.03 and response was determined with imaging after cycle 2, then every 3rd cycle, using RECIST 1.1 criteria. RESULTS 26 patients were enrolled; 19 with ovarian cancer (14 high grade serous, 1 low grade serous, 2 clear cell, 1 endometrioid, and 1 carcinosarcoma), and 7 with endometrial cancer (3 serous, and 4 endometrioid). The MTD was established at lenvatinib 16 mg and weekly paclitaxel 80 mg/m2. Toxicities (all grades) occurring in ≥25% of patients included anemia, neutropenia, lymphopenia, mucositis, nausea, diarrhea, anorexia, hypertension, fatigue, proteinuria, epistaxis, hoarseness. Twenty-three patients were evaluable for response and PFS; 15 (65%) had a partial response, 7 (30%) stable, 1 (4%) progressive disease with an objective response rate of 65%; 71% in ovarian and 50% in endometrial cancer. Median progression free survival (PFS) is 12.4 months; 14.0 months in endometrial cancer, 7.2 months in ovarian cancer; 54% had a PFS > 6 months. The median duration of response for PR patients (n = 15) was 10.9 months. CONCLUSIONS The regimen was tolerable with manageable side effects. Encouraging activity was observed in endometrial and ovarian cancer, and warrants further development.
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Affiliation(s)
- Floor J Backes
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States.
| | - Lai Wei
- Center of Biostatistics, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Min Chen
- Division of Pharmaceutics and Pharmacology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Kasey Hill
- Comprehensive Cancer Canter, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Kyle Dzwigalski
- Comprehensive Cancer Canter, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Ming Poi
- Division of Pharmaceutics and Pharmacology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Mitch Phelps
- Division of Pharmaceutics and Pharmacology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States; David Geffen School of Medicine at UCLA, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Larry J Copeland
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Jeffrey M Fowler
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Kristin Bixel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - Casey Cosgrove
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - John Hays
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - David O'Malley
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
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17
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Henderson A, Smrz S, Lightfoot M, Benedict J, Bishop E, Boyles G, Stiles A, Bixel K. EPR21-036: Osteoporosis Screening and Referral is Underutilized in a High Risk Population of Patients With Gynecologic Malignancies. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Haight P, Savage J, Bixel K. The poor prognosis of sarcomatoid carcinoma arising from low grade serous ovarian cancer: A case report and review of the literature. Gynecol Oncol Rep 2021; 36:100735. [PMID: 33718564 PMCID: PMC7933262 DOI: 10.1016/j.gore.2021.100735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
Sarcomatoid or anaplastic carcinomas arising within serous ovarian neoplasms are rare. Despite small size, sarcomatoid carcinomas are aggressive spindle cell nodules. Clinician communication with the pathologist is critical when inconsistency exists.
Sarcomatoid or anaplastic carcinomas arising within epithelial ovarian neoplasms are rare, particularly within serous tumors of the ovary, and carry a poor prognosis. Here we present the case of a patient initially diagnosed with low grade serous ovarian carcinoma arising within a serous borderline tumor (atypical proliferative serous tumor). She underwent rapid progression of disease and was found to have anaplastic/sarcomatoid carcinoma on biopsy of recurrence. These findings prompted pathologic re-review of the original neoplasm, which demonstrated a microscopic focus of sarcomatoid/anaplastic carcinoma.
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Affiliation(s)
- Paulina Haight
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States
- Corresponding author at: Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States.
| | - Johanna Savage
- Division of Pathology, The Ohio State University Wexner Medical Center, S305E Rhodes Hall, 410 W 10 Avenue, Columbus, OH 43210, United States
| | - Kristin Bixel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States
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19
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Vetter M, Smrz S, Gehrig P, Peng K, Matsuo K, Davidson B, Cisa M, Lees B, Brunette L, Tucker K, Stuart Staley A, Gotlieb W, Holloway R, Essel K, Holman L, Goldfeld E, Olawaiye A, Rose S, Uppal S, Bixel K. Pathologic and clinical tumor size discordance in early-stage cervical cancer: Does it matter? Gynecol Oncol 2020; 159:354-358. [DOI: 10.1016/j.ygyno.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023]
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20
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Vetter MH, Bixel K, Felix AS. Management of stage II endometrial cancer and subsequent oncologic outcomes: a National Cancer Database study. J Gynecol Oncol 2020; 31:e84. [PMID: 33078593 PMCID: PMC7593216 DOI: 10.3802/jgo.2020.31.e84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/17/2020] [Accepted: 07/12/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The management of stage II endometrial cancer (EC) is challenging due to the wide variation in surgical practice and adjuvant treatment recommendations. We sought to describe the treatment patterns for patients with stage II EC and to evaluate the association between surgical management and adjuvant therapy on survival outcomes in a large cohort of patients with stage II EC. Methods Using data from the National Cancer Database, we identified 9,690 women with stage II EC. We used logistic regression to identify association of sociodemographic and tumor characteristics with surgery type and receipt of adjuvant therapy. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between adjuvant therapy, hysterectomy type, and overall survival. Results Almost 11% of the cohort underwent radical hysterectomy; however, there was no difference in survival between surgical types even when adjusted for adjuvant therapy (HR=0.94; 95% CI=0.82–1.07). Compared to no adjuvant treatment, radiation only (HR=0.66; 95% CI=0.61–0.73) and combination radiation and chemotherapy (HR=0.53; 95% CI=0.45–0.62) were associated with lower risk of death. There was no survival benefit of chemotherapy alone even when separated by histologic subtype (HR range, 0.55–1.46). Conclusions Women with stage II EC do not appear to benefit from routine radical hysterectomy though all patients appear to benefit from receipt of radiation therapy (RT), regardless of modality. Additionally, there may be an added survival benefit with the combination of computed tomography and RT in patients with non-endometrioid, high-risk histologies.
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Affiliation(s)
- Monica Hagan Vetter
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
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21
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Kim CH, Lefkowits C, Holschneider C, Bixel K, Pothuri B. Managing opioid use in the acute surgical setting: A society of gynecologic oncology clinical practice statement. Gynecol Oncol 2020; 157:563-569. [DOI: 10.1016/j.ygyno.2020.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
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22
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Abstract
PURPOSE OF REVIEW Conventional and novel applications of Poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors (PARPi) are reviewed in the context of recently published clinical trials and preclinical data supporting rapidly expanding uses of this class of chemotherapy. RECENT FINDINGS PARPi block a pathway of DNA repair and target defects in homologous recombination repair (HRR), a pathway responsible for high-fidelity repair of double-strand breaks in DNA. BRCA1/2 proteins are essential to this pathway. Approximately 15-30% of women with ovarian cancer will have a germline or somatic BRCA mutation, and PARPi have shown promise in this population in a variety of settings. With growing understanding of the HRR pathway and its role in gynecologic malignancies, the potential applications of PARPi continue to expand. While the role of PARPi in gynecologic malignancies is most established in ovarian cancer, there are also promising applications in uterine and cervical cancer. We review current indications for PARPi use and promising applications of these medications in gynecologic malignancies.
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Affiliation(s)
- Michelle Lightfoot
- Ohio State Wexner Medical Center, M210 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH-43210, USA
| | - Lauren Montemorano
- Ohio State Wexner Medical Center, M210 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH-43210, USA
| | - Kristin Bixel
- Ohio State Wexner Medical Center, M210 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH-43210, USA.
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Bixel K, Vetter M, Davidson B, Berchuck A, Cohn D, Copeland L, Fowler JM, Havrilesky L, Lee PS, O'Malley DM, Salani R, Valea F, Alvarez Secord A, Backes F. Intraperitoneal chemotherapy following neoadjuvant chemotherapy and optimal interval tumor reductive surgery for advanced ovarian cancer. Gynecol Oncol 2020; 156:530-534. [PMID: 31937450 DOI: 10.1016/j.ygyno.2019.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intraperitoneal (IP) chemotherapy following neoadjuvant chemotherapy (NACT) and interval tumor reductive surgery (TRS) for advanced ovarian cancer is feasible, however, the impact on disease outcomes remains unclear. We compare outcomes of patients treated with IP chemotherapy versus intravenous (IV) chemotherapy following NACT and interval TRS. METHODS In this retrospective review, patients with advanced ovarian cancer were included if they received NACT followed by optimal interval TRS between 1/2004 and 4/2017. Patients were excluded if they had an ECOG PS >1, received >6 cycles of NACT or postoperative chemotherapy, and/or received bevacizumab during primary therapy. Primary outcomes were progression free survival (PFS) and overall survival (OS). RESULTS There were 134 patients included in this study, 37 (28%) received IP and 97 (72%) received IV chemotherapy postoperatively. Patients in the IV group were older (median 66.3 vs 59.7 years, p = 0.0039) though there were no differences in BMI, race, BRCA status, stage, or histology. Median PFS was 3 months longer in the IP group (14.5 versus 11.5 months, p = 0.028) however there was no significant difference in OS. On univariate analysis, increasing number of NACT cycles (HR 1.914, 95% CI 1.024-3.497) and residual disease at completion of TRS (HR 1.541, 95% CI 1.042-2.248) were associated with decreased PFS; IP chemotherapy was associated with increased PFS (HR 0.633, 95% CI 0.414-0.944). These associations remained on multivariate analysis. Toxicity was comparable between the groups. CONCLUSIONS IP after NACT and optimal interval TRS was associated with in improved PFS compared to IV chemotherapy without significant differences in toxicity.
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Affiliation(s)
- K Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America.
| | - M Vetter
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - B Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - A Berchuck
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - D Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - L Copeland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - J M Fowler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - L Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - P S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - D M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - R Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - F Valea
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - A Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - F Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
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Vetter MH, Smith B, Benedict J, Hade EM, Bixel K, Copeland LJ, Cohn DE, Fowler JM, O'Malley D, Salani R, Backes FJ. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol 2020; 222:60.e1-60.e7. [PMID: 31401259 PMCID: PMC7201377 DOI: 10.1016/j.ajog.2019.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/05/2019] [Accepted: 08/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endometrial intraepithelial neoplasia, also known as complex atypical hyperplasia, is a precancerous lesion of the endometrium associated with a 40% risk of concurrent endometrial cancer at the time of hysterectomy. Although a majority of endometrial cancers diagnosed at the time of hysterectomy for endometrial intraepithelial neoplasia are low risk and low stage, approximately 10% of patients ultimately diagnosed with endometrial cancers will have high-risk disease that would warrant lymph node assessment to guide adjuvant therapy decisions. Given these risks, some physicians choose to refer patients to a gynecologic oncologist for definitive management. Currently, few data exist regarding preoperative factors that can predict the presence of concurrent endometrial cancer in patients with endometrial intraepithelial neoplasia. Identification of these factors may assist in the preoperative triaging of patients to general gynecology or gynecologic oncology. OBJECTIVE To determine whether preoperative factors can predict the presence of concurrent endometrial cancer at the time of hysterectomy in patients with endometrial intraepithelial neoplasia; and to describe the ability of preoperative characteristics to predict which patients may be at a higher risk for lymph node involvement requiring lymph node assessment at the time of hysterectomy. MATERIALS AND METHODS We conducted a retrospective cohort study of women undergoing hysterectomy for pathologically confirmed endometrial intraepithelial neoplasia from January 2004 to December 2015. Patient demographics, imaging, pathology, and outcomes were recorded. The "Mayo criteria" were used to determine patients requiring lymphadenectomy. Unadjusted associations between covariates and progression to endometrial cancer were estimated by 2-sample t-tests for continuous covariates and by logistic regression for categorical covariates. A multivariable model for endometrial cancer at the time of hysterectomy was developed using logistic regression with 5-fold cross-validation. RESULTS Of the 1055 charts reviewed, 169 patients were eligible and included. Of these patients, 87 (51.5%) had a final diagnosis of endometrial intraepithelial neoplasia/other benign disease, whereas 82 (48.5%) were ultimately diagnosed with endometrial cancer. No medical comorbidities were found to be strongly associated with concurrent endometrial cancer. Patients with endometrial cancer had a thicker average endometrial stripe compared to the patients with no endometrial cancer at the time of hysterectomy (15.7 mm; standard deviation, 9.5) versus 12.5 mm; standard deviation, 6.4; P = .01). An endometrial stripe of ≥2 cm was associated with 4.0 times the odds of concurrent endometrial cancer (95% confidence interval, 1.5-10.0), controlling for age. In all, 87% of endometrial cancer cases were stage T1a (Nx or N0). Approximately 44% of patients diagnosed with endometrial cancer and an endometrial stripe of ≥2 cm met the "Mayo criteria" for indicated lymphadenectomy compared to 22% of endometrial cancer patients with an endometrial stripe of <2 cm. CONCLUSION Endometrial stripe thickness and age were the strongest predictors of concurrent endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia. Referral to a gynecologic oncologist may be especially warranted in endometrial intraepithelial neoplasia patients with an endometrial stripe of ≥2 cm given the increased rate of concurrent cancer and potential need for lymph node assessment.
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Affiliation(s)
- Monica Hagan Vetter
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Blair Smith
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Jason Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | - Erinn M Hade
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Larry J Copeland
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Jeffrey M Fowler
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - David O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH.
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Montemorano L, Lightfoot MDS, Bixel K. Role of Olaparib as Maintenance Treatment for Ovarian Cancer: The Evidence to Date. Onco Targets Ther 2019; 12:11497-11506. [PMID: 31920338 PMCID: PMC6938196 DOI: 10.2147/ott.s195552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
PARP inhibitors have shown significant promise in the treatment of ovarian cancer. Olaparib is a PARP inhibitor that has been approved for maintenance for BRCA-mutated ovarian cancer in the recurrent and front-line setting as well as for treatment of BRCA-mutated ovarian cancer in patients who have received multiple prior lines of chemotherapy. In this review, we focus on the use of olaparib in the maintenance setting including the evidence to date, ongoing research, and future directions.
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Affiliation(s)
- Lauren Montemorano
- The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, Columbus, OH43210, USA
| | - Michelle DS Lightfoot
- The Ohio State University Wexner Medical Center, James Cancer Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbus, OH43210, USA
| | - Kristin Bixel
- The Ohio State University Wexner Medical Center, James Cancer Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbus, OH43210, USA
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Vetter M, Khan A, Backes F, Bixel K, Cohn D, Copeland L, Fowler J, Salani R, O'Malley D. Outpatient desensitization is an effective and safe management option for platinum hypersensitivity reactions: A single institution experience. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Smrz S, Vetter M, Bixel K. Pathologic upstaging due to tumor size is associated with worse oncologic outcomes in patients with stage 1B1 cervical cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vetter M, Bixel K, Felix A. Use of adjuvant therapy and overall survival in stage II low-grade versus high-grade endometrioid endometrial carcinomas: A National Cancer Database study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Smrz S, Vetter M, Bixel K. Pathologic upstaging due to tumor size is associated with worse oncologic outcomes in patients with stage IB1 cervical cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vetter M, Bixel K, Felix A. Patterns of adjuvant therapy and outcomes in the treatment of stage II endometrial cancer: A National Cancer Database study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bixel K, Cobb MC. Exercise in Pregnancy. Lifestyle Medicine 2019. [DOI: 10.1201/9781315201108-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Davidson BA, Broadwater G, Crim A, Boccacio R, Bixel K, Backes F, Previs RA, Salinaro J, Salani R, Moore K, Secord AA. Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol 2019; 152:554-559. [DOI: 10.1016/j.ygyno.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
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Saini U, Suarez AA, Naidu S, Wallbillich JJ, Bixel K, Wanner RA, Bice J, Kladney RD, Lester J, Karlan BY, Goodfellow PJ, Cohn DE, Selvendiran K. STAT3/PIAS3 Levels Serve as "Early Signature" Genes in the Development of High-Grade Serous Carcinoma from the Fallopian Tube. Cancer Res 2018; 78:1739-1750. [PMID: 29339537 DOI: 10.1158/0008-5472.can-17-1671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 01/23/2023]
Abstract
The initial molecular events that lead to malignant transformation of the fimbria of the fallopian tube (FT) through high-grade serous ovarian carcinoma (HGSC) remain poorly understood. In this study, we report that increased expression of signal transducer and activator of transcription 3 (pSTAT3 Tyr705) and suppression or loss of protein inhibitor of activated STAT3 (PIAS3) in FT likely drive HGSC. We evaluated human tissues-benign normal FT, tubal-peritoneal junction (TPJ), p53 signature FT tissue, tubal intraepithelial lesion in transition (TILT), serous tubal intraepithelial carcinoma (STIC) without ovarian cancer, and HGSC for expression of STAT3/PIAS3 (compared with their known TP53 signature) and their target proliferation genes. We observed constitutive activation of STAT3 and low levels or loss of PIAS3 in the TPJ, p53 signature, TILT, and STIC through advanced stage IV (HGSC) tissues. Elevated expression of pSTAT3 Tyr705 and decreased levels of PIAS3 appeared as early as TPJ and the trend continued until very advanced stage HGSC (compared with high PIAS3 and low pSTAT3 expression in normal benign FT). Exogenous expression of STAT3 in FT cells mediated translocation of pSTAT3 and c-Myc into the nucleus. In vivo experiments demonstrated that overexpression of STAT3 in FT secretory epithelial cells promoted tumor progression and metastasis, mimicking the clinical disease observed in patients with HGSC. Thus, we conclude that the STAT3 pathway plays a role in the development and progression of HGSC from its earliest premalignant states.Significance: Concomitant gain of pSTAT3 Tyr705 and loss of PIAS3 appear critical for initiation and development of high-grade serous carcinoma. Cancer Res; 78(7); 1739-50. ©2018 AACR.
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Affiliation(s)
- Uksha Saini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adrian A Suarez
- Department of Pathology, Gynecological Pathology and Cytopathology Unit, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shan Naidu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John J Wallbillich
- Division of Gynecologic Oncology, Department of OB/GYN, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ross A Wanner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jason Bice
- Pathology Core Lab, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raleigh D Kladney
- Pathology Core Lab, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jenny Lester
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Beth Y Karlan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Karuppaiyah Selvendiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio.
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Meyer LA, Cronin AM, Sun CC, Bixel K, Bookman MA, Cristea MC, Griggs JJ, Levenback CF, Burger RA, Mantia-Smaldone G, Matulonis UA, Niland JC, O'Malley DM, Wright AA. Use and Effectiveness of Neoadjuvant Chemotherapy for Treatment of Ovarian Cancer. J Clin Oncol 2017; 34:3854-3863. [PMID: 27601552 DOI: 10.1200/jco.2016.68.1239] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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
Purpose In 2010, a randomized clinical trial demonstrated noninferior survival for patients with advanced ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) compared with primary cytoreductive surgery (PCS). We examined the use and effectiveness of NACT in clinical practice. Patients and Methods A multi-institutional observational study of 1,538 women with stages IIIC to IV ovarian cancer who were treated at six National Cancer Institute-designated cancer centers. We examined NACT use in patients who were diagnosed between 2003 and 2012 (N = 1,538) and compared overall survival (OS), morbidity, and postoperative residual disease in a propensity-score matched sample of patients (N = 594). Results NACT use increased from 16% during 2003 to 2010 to 34% during 2011 to 2012 in stage IIIC disease ( Ptrend < .001), and from 41% to 62% in stage IV disease ( Ptrend < .001). Adoption of NACT varied by institution, from 8% to 30% for stage IIIC disease (P < .001) and from 27% to 61% ( P = .007) for stage IV disease during this time period. In the matched sample, NACT was associated with shorter OS in stage IIIC disease (median OS: 33 v 43 months; hazard ratio [HR], 1.40; 95% CI, 1.11 to 1.77) compared with PCS, but not stage IV disease (median OS: 31 v 36 months; HR, 1.16; 95% CI, 0.89 to 1.52). Patients with stages IIIC and IV disease who received NACT were less likely to have ≥ 1 cm postoperative residual disease, an intensive care unit admission, or a rehospitalization (all P ≤ .04) compared with those who received PCS treatment. However, among women with stage IIIC disease who achieved microscopic or ≤ 1 cm postoperative residual disease, NACT was associated with decreased OS (HR, 1.49; 95% CI, 1.01 to 2.18; P = .04). Conclusion Use of NACT increased significantly between 2003 and 2012. In this observational study, PCS was associated with increased survival in stage IIIC, but not stage IV disease. Future studies should prospectively consider the efficacy of NACT by extent of residual disease in unselected patients.
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Affiliation(s)
- Larissa A Meyer
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Angel M Cronin
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Charlotte C Sun
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Kristin Bixel
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael A Bookman
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Mihaela C Cristea
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Jennifer J Griggs
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Charles F Levenback
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert A Burger
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Gina Mantia-Smaldone
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Ursula A Matulonis
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Joyce C Niland
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - David M O'Malley
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Alexi A Wright
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
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Bixel K, Saini U, Kumar Bid H, Fowler J, Riley M, Wanner R, Deepa Priya Dorayappan K, Rajendran S, Konishi I, Matsumura N, Cohn DE, Selvendiran K. Targeting STAT3 by HO3867 induces apoptosis in ovarian clear cell carcinoma. Int J Cancer 2017. [PMID: 28646535 DOI: 10.1002/ijc.30847] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advanced ovarian clear cell carcinoma (OCCC) carries a very poor prognosis in large part secondary to the extremely high rate of resistance to standard platinum and taxane chemotherapy. Signal transducer and activator of transcription 3(STAT3) expression and activation has been shown to regulate tumor progression in various human cancers, though has not been well studied in OCCC. Preliminary work in our lab has demonstrated constitutive activation of STAT3 (pSTAT3Tyr705 or pSTAT3727) in OCCC cell lines as well as human OCCC tumor tissue samples. Significantly, pSTAT3 is expressed in the absence of other forms of activated STAT (pSTAT1, 2, 6). Therefore, this work was planned to investigate the role of STAT3 and examine the efficacy of a novel anti-cancer compound -HO-3867, which is an inhibitor of STAT3, using known OCCC cell lines. Results demonstrate that treatment with HO-3867 decreased expression of pSTAT3 Tyr705 as well pSTAT3 Ser727, while total STAT3 remained constant. STAT3 overexpression increased the migration capability in OVTOKO cells in vitro and led to an increased tumor size when injected in vivo. The inhibitory effect of HO-3867 on cell proliferation and cell survival was accompanied by increased apoptosis, within 24 h post treatment. Treatment with HO-3867 resulted in a decrease in Bcl-2 and increase of cleavage of caspase 3, caspase 7, and PARP, confirming induction of apoptosis after treatment with HO-3867. In addition, HO-3867 significantly inhibited formation of human umbilical vein endothelial cells capillary-like structures and invasion at both 5 and 10 µM concentrations. STAT3 expression plays an important role in the spread of OCCC in vitro as well as in vivo. Thus, we can exploit the STAT3 pathway for targeted drug therapy. Inhibition of pSTAT3 using HO-3867in OCCC cell lines appears to be a promising therapy. This is of utmost importance given the poor response of OCCC to standard chemotherapy regimens.
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Affiliation(s)
- Kristin Bixel
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Uksha Saini
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hemant Kumar Bid
- Cancer Therapeutics, Life Sciences Institute University of Michigan campus, Ann Arbor, MI
| | - John Fowler
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Maria Riley
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ross Wanner
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kalpana Deepa Priya Dorayappan
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sneha Rajendran
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ikuo Konishi
- Division of GYN/ONC, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriomi Matsumura
- Division of GYN/ONC, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - David E Cohn
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Karuppaiyah Selvendiran
- Division of Gynecologic Oncology, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
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Bixel K, Vetter M, Cohn D, Fowler J, Copeland L, O'Malley D, Salani R, Backes F. Intraperitoneal chemotherapy following neoadjuvant chemotherapy and optimal cytoreductive surgery. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Esselen KM, Cronin AM, Bixel K, Bookman MA, Burger RA, Cohn DE, Cristea M, Griggs JJ, Levenback CF, Mantia-Smaldone G, Meyer LA, Matulonis UA, Niland JC, Sun C, O'Malley DM, Wright AA. Use of CA-125 Tests and Computed Tomographic Scans for Surveillance in Ovarian Cancer. JAMA Oncol 2017; 2:1427-1433. [PMID: 27442965 DOI: 10.1001/jamaoncol.2016.1842] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A 2009 randomized clinical trial demonstrated that using cancer antigen 125 (CA-125) tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patients' quality of life without improving survival, compared with clinical observation. The Society of Gynecologic Oncology guidelines categorize CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance. To date, few studies have examined the use of CA-125 tests in clinical practice. Objectives To examine the use of CA-125 tests and computed tomographic (CT) scans in clinical practice before and after the 2009 randomized clinical trial and to estimate the economic effect of surveillance testing. Design, Setting, and Participants A prospective cohort of 1241 women with ovarian cancer in clinical remission after completion of primary cytoreductive surgery and chemotherapy at 6 National Cancer Institute-designated cancer centers between January 1, 2004, and December 31, 2011, was followed up through December 31, 2012, to study the use of CA-125 tests and CT scans before and after 2009. Data analysis was conducted from April 9, 2014, to March 28, 2016. Main Outcomes and Measures The use of CA-125 tests and CT scans before and after 2009. Secondary outcomes included the time from CA-125 markers doubling to retreatment among women who experienced a rise in CA-125 markers before and after 2009, and the costs associated with surveillance testing using 2015 Medicare reimbursement rates. Results Among 1241 women (mean [SD] age 59 [12] years; 1112 white [89.6%]), the use of CA-125 testing and CT scans was similar during the study period. During 12 months of surveillance, the cumulative incidence of patients undergoing 3 or more CA-125 tests was 86% in 2004-2009 vs 91% in 2010-2012 (P = .95), and the cumulative incidence of patients undergoing more than 1 CT scan was 81% in 2004-2009 vs 78% in 2010-2012 (P = .50). Among women whose CA-125 markers doubled (n = 511), there was no significant difference in the time to retreatment with chemotherapy before and after 2009 (median, 2.8 vs 3.5 months; P = .40). During a 12-month period, there was a mean of 4.6 CA-125 tests and 1.7 CT scans performed per patient, resulting in a US population surveillance cost estimate of $1 999 029 per year for CA-125 tests alone and $16 194 647 per year with CT scans added. Conclusions and Relevance CA-125 tests and CT scans are still routinely used for surveillance testing in patients with ovarian cancer, although their benefit has not been proven and their use may have significant implications for patients' quality of life as well as costs.
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Affiliation(s)
- Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Angel M Cronin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | | | - Robert A Burger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor8Division of Hematology and Oncology, Department of Health Management and Policy, University of Michigan Comprehensive Cancer Center, Ann Arbor
| | - Charles F Levenback
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Gina Mantia-Smaldone
- Division of Gynecologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Larissa A Meyer
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Joyce C Niland
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Charlotte Sun
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Crafton SM, Bixel K, Hays JL. PARP inhibition and gynecologic malignancies: A review of current literature and on-going trials. Gynecol Oncol 2016; 142:588-96. [PMID: 27168003 DOI: 10.1016/j.ygyno.2016.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 01/05/2023]
Abstract
The poly (ADP-ribose) polymerase (PARP) family of enzymes is important in several DNA repair pathways. Drugs that inhibit these enzymes have been investigated in many types of cancer, but their application in the treatment of gynecologic malignancies has rapidly evolved - as manifested by the 2014 FDA approval for olaparib in the treatment of recurrent ovarian cancer associated with a germline BRCA mutation (gBRCA). In efforts to broaden their efficacy, current clinical trials have demonstrated benefit of olaparib, and other PARP inhibitors (PARPi), as single agents and in combination with cytotoxic chemotherapy and biologic agents, in wide ranging populations. Although the majority of data for PARPi in gynecologic malignancies has been specifically regarding ovarian cancer, their role in the treatment of uterine and cervical cancer is currently being investigated. This review will serve as a synopsis of seminal trials to date, summarize the breadth of clinical application in on-going studies, query how these results may change future practice, and reflect on questions yet to be answered.
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Affiliation(s)
- S M Crafton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, United States.
| | - K Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, United States
| | - J L Hays
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, United States; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
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Saini U, Naidu S, ElNaggar AC, Bid HK, Wallbillich J, Wanner R, Bixel K, Riley M, Bolyard C, Suarez AA, Kaur B, Kuppusamy P, Hays J, Goodfellow P, Cohn DE, Selvendiran K. Abstract LB-036: Elevated STAT3 expression in ovarian tumor ascites regulates invasion and metastasis: a promising therapeutic target. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: Although, the ovarian cancer patient ascites is a recognized source of metastasis, the expression of oncogenic proteins in ascites and their effects on the tumor metastatic microenvironment still remain poorly understood. In this study, we investigate the role of STAT3 in primary ovarian cancer ascites and STAT3 as a potential target for ovarian tumor therapy in a preclinical animal model using our novel and safe STAT3 inhibitor of HO-3867.
Methods: We start with culturing the primary cancer cell lines from various human ascites and confirming the status of STAT3 signaling. The exact role that STAT3 plays in ovarian cancer was addressed using STAT3 knocked down and STAT3 overexpression cell lines. These were further used to develop an orthotopic mouse model of ovarian cancer. In vivo antitumor activity of STAT3 inhibitor of HO-3867 assessment was done by oral administration of HO-3867 in orthotopic tumor mice. using histopathological analysis, RPPA, TUNEL and angiogenesis assays. In vivo bio-absorption of HO-3867 compounds in tumors by EPR and LCMS analysis.
Results: We have found that pSTAT3 Tyr705 is constitutively expressed in the patient ascites derived cancer cells (ADCCs) and the range of expression could be very high to low. Subsequent in vivo transplantation of ADCCs with higher pSTAT3 expression injected into mice resulted in a large primary tumor and widespread metastases; while the mice with cells with STAT3 Knocked out had a smaller tumor and no metastases. We further demonstrate that the cytokines secreted into the culture medium can activate the JAK/STAT pathway in the STAT3 Ko cells thereby making up for the absence of inherent STAT3 in the cells. Once we proved the importance of STAT3 in ovarian cancer progression and metastases, we moved on to targeting STAT3 using our novel STAT3 inhibitor and pre-clinical orthotopic tumor model. Treatment with HO-3867 (100 ppm) significantly suppressed ovarian tumor growth and metastasis. A substantial amount of HO-3867 was detected in the ovarian tumor tissues. Suppression of STAT3 and its downstream target proteins were confirmed with reverse phase protein array. In vivo Matrigel assay showed that HO-3867 treated samples had significantly reduced vessel formation (∼4 times) when compared to untreated control. HO-3867 was also found to have cytotoxic effects in ex vivo culture of freshly collected human tumor samples, including patients with chemotherapy-resistant disease.
Conclusions: Our study has concluded that constitutive expression of STAT3 in patient ascites is a significant contributor in ovarian tumor invasion and metastasis. STAT3-selective targeting agent HO-3867 in orthotopic ovarian tumor and ex vivo tumor tissue culture, results in inhibition of tumor growth and induction of apoptosis both in vivo and ex vivo, suggesting that HO-3867 is an exciting new cytotoxic agent acting through targeting STAT3; which could have a considerable role in the future treatment of ovarian cancer.
Citation Format: Uksha Saini, Shan Naidu, Adam C. ElNaggar, Hemant K. Bid, John Wallbillich, Ross Wanner, Kristin Bixel, Maria Riley, Chelsea Bolyard, Adrian A. Suarez, Balveen Kaur, Periannan Kuppusamy, John Hays, Paul Goodfellow, David E. Cohn, Karuppaiyah Selvendiran. Elevated STAT3 expression in ovarian tumor ascites regulates invasion and metastasis: a promising therapeutic target. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-036.
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Affiliation(s)
| | - Shan Naidu
- 2Louisiana State University, Baton Rouge, LA
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Dorayappan K, Wallbillich J, Saini U, Bixel K, Riley M, Zingarelli R, Wanner R, Goodfellow P, Cohn D, Karuppaiyah S. Hypoxia-facilitated exosomal release from ovarian cancer cells is regulated by STAT3 and is associated with increased metastatic tumor burden. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bixel K, Denlinger N, Marsh L, Quick A, Salani R. Primary chemoradiation for the treatment of locally advanced cervical cancer: Impact of treatment location and time on outcomes. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Alterations in the homologous repair pathway are thought to occur in 30%–50% of epithelial ovarian cancers. Cells deficient in homologous recombination rely on alternative pathways for DNA repair in order to survive, thereby providing a potential target for therapy. Olaparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, capitalizes on this concept and is the first drug in its class approved for patients with ovarian cancer. This review article will provide an overview of the BRCA genes and homologous recombination, the role of PARP in DNA repair and the biological rationale for the use of PARP inhibitors as cancer therapy, and ultimately will focus on the use of olaparib in the management of ovarian cancer.
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Affiliation(s)
- Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA
| | - John L Hays
- Department of Hematology Oncology, Ohio State University, Columbus, OH, USA
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Naidu S, Saini U, ElNaggar AC, Bid HK, Wanner R, Bixel K, Suarez AA, Bolyard C, Kaur B, Goodfellow PJ, Kuppusamy P, Cohn D, Selvendiran K. Abstract 1720: HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The lack of an efficient pre-clinical model predicting a drug's clinical response before it enters into clinical trials is a major reason behind the limited success or complete failure of most of the traditional anti-cancer compounds. In this study, we evaluate our novel, safe and selective STAT3 inhibitor HO-3867 for its anti-cancer efficacy/bio-availability using a pre-clinical relevant, orthotopic ovarian tumor model and ex-vivo human tumor tissue culture. Treatment with HO-3867 (100PPM) significantly suppressed ovarian tumor growth and metastasis when compared to the standard Cisplatin (4mg/kg). A substantial amount of HO-3867 was detected in the ovarian tumor tissues and quantified using EPR spectroscopy. Markers specific to cell proliferation (Ki-67, Cyclin D1), angiogenesis (VEGF and Kinase array) and apoptosis (caspase-3 activity) were significantly altered by treatment with HO-3867. In vivo histopathological evaluation of internal organs collected from treated tumor mice revealed no evidence of toxicity specific to HO-3867. Normal and malignant tissues were collected and TUNEL/8-OHdG staining revealed selective induction of apoptosis limited to neoplastic cells and concomitant increase in reactive oxygen species within the orthotopic tumor. Suppression of STAT3 and its downstream target proteins (cell proliferative, anti-apoptotic and angiogenic) was confirmed with proteomic array. HO-3867 treated samples had significantly reduced vessel formation (∼4 times) as compared to the untreated control as is evident by in vivo Matrigel assay. HO-3867 was also found to have cytotoxic effects in ex vivo culture of freshly collected human tumor samples, including patients with chemotherapy resistant form of the disease. Overall, these results highlight the clinical anti-cancer potential of HO-3867 using a relevant preclinical orthotopic ovarian tumor model, and provide a rationale for the inclusion of ex vivo patient tumor slice culture in oncologic drug development processes.
Citation Format: Shan Naidu, Uksha Saini, Adam C. ElNaggar, Hemant K. Bid, Ross Wanner, Kristin Bixel, Adrian A. Suarez, Chelsea Bolyard, Balveen Kaur, Paul J. Goodfellow, Periannan Kuppusamy, David Cohn, Karuppaiyah Selvendiran. HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1720. doi:10.1158/1538-7445.AM2015-1720
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Bixel K, Saini U, Fowler J, Rajendiran S, Wanner R, Hideg K, Cohn D, Karuppaiyah S. Abstract 3: Inhibition of STAT3 in ovarian clear cell carcinoma results in decreased cell proliferation and induction of apoptosis. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
UNLABELLED BACKGROUNDL: Mirror syndrome is characterized by preeclampsia-like syndrome in pregnancies complicated by fetal hydrops. We describe a case of mirror syndrome associated with angiogenic dysfunction in maternal plasma and the placenta. CASE A pregnant patient with known fetal hydrops presented at 22 weeks gestation with features of severe preeclampsia. Measurements of plasma anti- and proangiogenic factors were consistent with a profound antiangiogenic state. Immunohistochemistry of the placenta for antiangiogenic proteins showed a pattern similar to that seen in patients with severe preeclampsia. CONCLUSION Angiogenic imbalance may also be responsible for the preeclampsia-like condition seen in mirror syndrome.
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Affiliation(s)
- Kristin Bixel
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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