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Tarhini AA, Kang N, Lee SJ, Hodi FS, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Eroglu Z, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Streicher H, Sondak VK, Kirkwood JM. Immune adverse events (irAEs) with adjuvant ipilimumab in melanoma, use of immunosuppressants and association with outcome: ECOG-ACRIN E1609 study analysis. J Immunother Cancer 2021; 9:jitc-2021-002535. [PMID: 33963015 PMCID: PMC8108687 DOI: 10.1136/jitc-2021-002535] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2021] [Indexed: 01/30/2023] Open
Abstract
Background The impact of immune-related adverse events (irAEs) occurring from adjuvant use of immunotherapy and of their management on relapse-free survival (RFS) and overall survival (OS) outcomes is currently not well understood. Patients and methods E1609 enrolled 1673 patients with resected high-risk melanoma and evaluated adjuvant ipilimumab 3 mg/kg (ipi3) and 10 mg/kg (ipi10) versus interferon-α. We investigated the association of irAEs and of use of immunosuppressants with RFS and OS for patients treated with ipilimumab (n=1034). Results Occurrence of grades 1–2 irAEs was associated with RFS (5 years: 52% (95% CI 47% to 56%) vs 41% (95% CI 31% to 50%) with no AE; p=0.006) and a trend toward improved OS (5 years: 75% (95% CI 71% to 79%) compared with 67% (95% CI 56% to 75%) with no AE; p=0.064). Among specific irAEs, grades 1–2 rash was most significantly associated with RFS (p=0.002) and OS (p=0.003). In multivariate models adjusting for prognostic factors, the most significant associations were seen for grades 1–2 rash with RFS (p<0.001, HR=0.70) and OS (p=0.01, HR=0.71) and for grades 1–2 endocrine+rash with RFS (p<0.001, HR=0.66) and OS (p=0.008, HR=0.7). Overall, grades 1–2 irAEs had the best prognosis in terms of RFS and OS and those with grades 3–4 had less RFS benefits and no OS advantage over no irAE. Patients experiencing grades 3–4 irAE had significantly higher exposure to corticosteroids and immunosuppressants than those with grades 1–2 (92% vs 60%; p<0.001), but no significant associations were found between corticosteroid and immunosuppressant use and RFS or OS. In investigating the impact of non-corticosteroid immunosuppressants, although there were trends toward better RFS and OS favoring cases who were not exposed, no significant associations were found. Conclusions Rash and endocrine irAEs were independent prognostic factors of RFS and OS in patients treated with adjuvant ipilimumab. Patients experiencing lower grade irAEs derived the most benefit, but we found no significant evidence supporting a negative impact of high dose corticosteroids and immunosuppressants more commonly used to manage grades 3–4 irAEs.
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Affiliation(s)
- Ahmad A Tarhini
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
| | - Ni Kang
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra J Lee
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - F Stephen Hodi
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gary I Cohen
- Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Omid Hamid
- The Angeles Clinic & Research Institute, A Cedars Sinai Affiliate, Los Angeles, California, USA
| | - Laura F Hutchins
- Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Harriet M Kluger
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Zeynep Eroglu
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
| | - Henry B Koon
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - David R Minor
- Sutter-California Pacific Medical Center, San Francisco, California, USA
| | - Carrie B Lee
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lawrence E Flaherty
- Wayne State University and Karmanos Cancer Institute, Detroit, Michigan, USA
| | | | | | - Vernon K Sondak
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
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Tarhini AA, Lee SJ, Hodi FS, Rao UNM, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Eroglu Z, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Streicher H, Sondak VK, Kirkwood JM. Phase III Study of Adjuvant Ipilimumab (3 or 10 mg/kg) Versus High-Dose Interferon Alfa-2b for Resected High-Risk Melanoma: North American Intergroup E1609. J Clin Oncol 2020; 38:567-575. [PMID: 31880964 PMCID: PMC7030886 DOI: 10.1200/jco.19.01381] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Phase III adjuvant trials have reported significant benefits in both relapse-free survival (RFS) and overall survival (OS) for high-dose interferon alfa (HDI) and ipilimumab at 10 mg/kg (ipi10). E1609 evaluated the safety and efficacy of ipilimumab at 3 mg/kg (ipi3) and ipi10 versus HDI. PATIENTS AND METHODS E1609 was a phase III trial in patients with resected cutaneous melanoma (American Joint Committee on Cancer 7th edition stage IIIB, IIIC, M1a, or M1b). It had 2 coprimary end points: OS and RFS. A 2-step hierarchic approach first evaluated ipi3 versus HDI followed by ipi10 versus HDI. RESULTS Between May 2011 and August 2014, 1,670 adult patients were centrally randomly assigned (1:1:1) to ipi3 (n = 523), HDI (n = 636), or ipi10 (n = 511). Treatment-related adverse events grade ≥ 3 occurred in 37% of patients receiving ipi3, 79% receiving HDI, and 58% receiving ipi10, with adverse events leading to treatment discontinuation in 35%, 20%, and 54%, respectively. Comparison of ipi3 versus HDI used an intent-to-treat analysis of concurrently randomly assigned patient cases (n = 1,051) and showed significant OS difference in favor of ipi3 (hazard ratio [HR], 0.78; 95.6% repeated CI, 0.61 to 0.99; P = .044; RFS: HR, 0.85; 99.4% CI, 0.66 to 1.09; P = .065). In the second step, for ipi10 versus HDI (n = 989), trends in favor of ipi10 did not achieve statistical significance. Salvage patterns after melanoma relapse showed significantly higher rates of ipilimumab and ipilimumab/anti-programmed death 1 use in the HDI arm versus ipi3 and ipi10 (P ≤ .001). CONCLUSION Adjuvant therapy with ipi3 benefits survival versus HDI; for the first time to our knowledge in melanoma adjuvant therapy, E1609 has demonstrated a significant improvement in OS against an active control regimen. The currently approved adjuvant ipilimumab dose (ipi10) was more toxic and not superior in efficacy to HDI.
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Affiliation(s)
| | - Sandra J. Lee
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Omid Hamid
- Angeles Clinic & Research Institute, Santa Monica, CA
| | | | | | | | - Zeynep Eroglu
- H. Lee Moffitt Comprehensive Cancer Center, Tampa, FL
| | | | | | | | - David R. Minor
- Sutter-California Pacific Medical Center, San Francisco, CA
| | - Carrie B. Lee
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Tarhini AA, Lee SJ, Kang N, Hodi FS, Rao UNM, Cohen GI, Flaherty LE, Petrella TM, Sondak VK, Kirkwood JM. Immune adverse events (irAEs) with adjuvant ipilimumab in melanoma, use of hormone replacement and immunosuppressants, and association with outcome: E1609 study analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.5_suppl.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
60 Background: E1609 evaluated adjuvant ipilimumab at 3 mg/kg (ipi3) and 10 mg/kg (ipi10) versus high-dose interferon-α (HDI). In-depth analysis of irAEs and the use of immunosuppressants and hormone replacement may provide important lessons for management and future research. Methods: E1609 enrolled 1670 adult pts with resected cutaneous melanoma (AJCC7 IIIB, IIIC, M1a, M1b); Table. We investigated the characteristics of irAEs, corticosteroid, immunosuppressant and hormone use on the ipi arms and association with outcome. Stratified log-rank test was used and since most irAEs were observed within 3 months of initiating ipi, a 3-month landmark adjustment analysis was conducted. Results: The rates of corticosteroid, immunosuppressant and hormone use by treatment are summarized in Table and none had a significant association with RFS or OS. Significant association between occurrence of grade 1-4 irAEs (vs. no AE) and RFS was observed [5-year RFS: 0.49, 95% CI: (0.45, 0.52) compared to 0.41, 95% CI: (0.31, 0.50); landmark p=0.010]. Occurrence of grade 1-2 irAEs appeared to have a stronger association with RFS [5-years RFS: 0.52, 95% CI: (0.47, 0.56) compared to 0.41, 95% CI: (0.31,0.50) with no AE; p=0.006] and a trend towards improved OS [5-year OS: 0.75, 95%CI:( 0.71, 0.79) compared to 0.67, 95% CI: (0.56, 0.75) with no AE; p=0.064]. Among specific irAEs, rash was most significantly associated with RFS (p = 0.004 and 0.002) and OS (p = 0.007 and 0.003) for grade 1-4 and grade 1-2, respectively, followed by endocrinopathies, and weaker associations seen with other AEs. Conclusions: Adjuvant therapy with ipi is associated with significant irAEs that appear to be related to the immune mechanism of action. Corticosteroids and immunosuppressants were not shown to negatively affect the clinical outcomes. Predictors of irAE risk and understanding the underlying mechanisms are a major gap and are currently actively being investigated. Clinical trial information: NCT01274338. [Table: see text]
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Affiliation(s)
- Ahmad A. Tarhini
- H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, FL
| | - Sandra J. Lee
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | - Ni Kang
- Dana Farber Cancer Institute–ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Teresa M. Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - John M. Kirkwood
- Melanoma Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
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Lum LG, Thakur A, Al-Kadhimi ZS, Deol A, Simon MS, Schalk D, Liu Q, Flaherty LE. Phase II clinical trial using anti-CD3 x anti-HER2 bispecific antibody armed activated T cells (HER2 BATs) for HER2-negative (0-2+) metastatic breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1080 Background: This study presents a phase II cell therapy trial in 32 women with metastatic or locally advanced HER2- breast cancer (BrCa) who received infusions of anti-CD3 x anti-HER2 bispecific antibody armed activated T cells (BATs). This phase II study (NCT 01022138) was conducted to determine if BATs infusions could improve time to progression (TTP) and overall survival (OS), as well as to confirm the toxicity profile of BATs. Methods: The phase II included 32 patients with a median of 4 lines of therapy (7 TNBC and 25 HR/PR+ HER2- patients) with an average age of 52.5 years (range 28-75 years). Twenty-one patients had ≥3 lines of prior therapy and 11 patients had 1-2 lines. Peripheral blood mononuclear cells (PBMC) were stimulated with anti-CD3 antibody and expanded in IL-2, armed with HER2Bi, and aliquoted for the clinical trial. Patients received oncologist’s choice of chemotherapy (4 cycles/4 months) followed by 3 infusions of BATs given once per week for 3 weeks and a boost given 12 weeks after the 3rd infusion. Results: Fifteen of 32 (ORR of 46.8%) who had received any cells had stable disease (SD) at 1 month after the last infusion, and 8 of 15 (25%) had SD > 4 months. For patients who completed 3 or 4 infusions (17-83 x 109 BATs), 8 of 31 patients had TTP > 4 months. One patient completed 2 infusions (17 x 109 BATs). There were no dose limiting toxicities (DLTs). Tumor markers decreased in 13 of 23 (56.5%) patients with evaluable markers. The median OS was 13.8, 16.5, and 12.4 months for all, ER/PR+, and TNBC, respectively. OS for all patients with chemosensitive (chemoS) and chemoresistant (chemoR) disease was 14.6 and 8.6 months (NS), respectively. OS for chemoS and chemoR disease in HER2- ER/PR+ patients was 16.5 and 8.6 months (NS), respectively. OS for chemoS and chemoR disease in TNBC patients was 12.4 and 22.6 months, respectively (NS). The median TTP for all, HER2- ER/PR+, and TNBC patients was 2.7, 2.9, and 1.4 months, respectively. Increases in serum IL-2 and IL-12 were associated with BATs infusions. Conclusions: Targeting HER2- tumors was safe. There were trends toward improved survival in patients who were HER2-/ER/PR+ TNBC, patients who were chemoS, was associated with increased TTP and OS in all groups, and was associated with decreased tumor markers in those who received 4 infusions. Immune studies showed evidence for induction of adaptive immunity directed at breast cancer antigens. Targeting metastatic HER2- BrCa with BATs shows promise. Clinical trial information: NCT 01022138.
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Affiliation(s)
| | | | | | - Abhinav Deol
- Blood and Marrow Transplant Program, Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Michael S. Simon
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Qin Liu
- Wistar Institute, Philadelphia, PA
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In GK, Poorman KA, Saul M, O'Day S, Farma JM, Daveluy S, Olszanski AJ, Gordon MS, Thomas JS, Eisenberg BL, Flaherty LE, Gibney GT, Atkins MB, Vanderwalde AM. Molecular profiling of melanoma brain metastases (MBM) compared to primary cutaneous melanoma (CM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9565 Background: Nearly 50% of metastatic melanoma patients develop brain metastases, warranting further investigation into the biology of this event. Methods: We analyzed 132 MBM and 745 CM submitted to Caris Life Sciences from 2015-2018, using next generation sequencing of a 44 or 592 cancer-related gene panel, tumor mutational burden (TMB), and PD-L1 expression by IHC. Genomic alterations (GA), including somatic mutations or CNA, were reported. High TMB (TMB-H) was defined as ≥17 mut/Mb. Comparison of molecular profiles, including cancer-related genes and recurrently altered pathways, between tumor sites and by genomic subgroup (BRAF, NRAS, KIT, NF1), was performed using Fisher’s exact test. Results: Among 132 MBM, 72.7% were male, with median age 62 yo (range 25-83). The most common GAs among MBM were: BRAF (52.4%), NRAS (26.6%), CDKN2A (23.3%), NF1 (18.9%), TP53 (18%), ARID2 (13.8%), SETD2 (11.9%), and PBRM1 (7.5%). Compared to CM, MBM were more often TMB-H (53.7% v 38%, p = .025), with higher PD-L1 expression, using both a ≥1% (54.4% v 35.6%, p = .002) and ≥5% cut-off (32.9% v 15.9%, p = .0006). MBM showed higher rates of GAs among: SETD2 (11.9% v 1.9%, p = .0008), BRAF (52.4% v 35.6%, p = .017), PBRM1 (7.5% v 1.6%, p = .018), KRAS (4% v 1%, p = .026), CCND1 (2.9% v 0%, p = .03), and DICER1 (4.4% v 0.6%, p = .04), compared to CM. Alterations of the MAPK (87.9% v 77.8%, p = .015) and SWI/SNF (22.1% v 11.6%, p = .036) pathway were more frequent in MBM, than CM. When analyzed by genomic subgroup, BRAF+ MBM had more GAs involving the PI3K pathway (20% v 5.1%, p = .027), compared to BRAF WT MBM. NRAS+ MBM had higher PD-L1 expression at the ≥1% cutoff (66.7% v 38.6%, p = .05), but not ≥5%, compared to NRAS WT MBM. NF1+ MBM had more GAs involving the SWI/SNF (60% v 11.6%, p = .003) pathway, as opposed to NF1 WT MBM. No significant associations were seen between KIT status, TMB, PD-L1 or other pathways among MBM. Conclusions: In this cross-sectional study, MBM demonstrated higher PD-L1 expression and were more often TMB-H, compared to CM. MBM also featured more GAs involving BRAF and the MAPK pathway. We identified two novel genes, PBRM1 and SETD2, as well as recurrent alterations of the SWI/SNF pathway, supporting future studies of chromatin remodeling pathways in MBM.
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Affiliation(s)
- Gino Kim In
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | | | | | - Michael S. Gordon
- Pinnacle Oncology Hematology, Arizona Center for Cancer Care, HonorHealth Research Institute Clinical Trials Program, Virginia G. Piper Cancer Center, Scottsdale, AZ
| | - Jacob Stephen Thomas
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | - Ari M. Vanderwalde
- Division of Hematology/Oncology, The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN
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Tarhini AA, Lee SJ, Hodi FS, Rao UNM, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Sondak VK, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Kirkwood JM. United States Intergroup E1609: A phase III randomized study of adjuvant ipilimumab (3 or 10 mg/kg) versus high-dose interferon-α2b for resected high-risk melanoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9504 Background: Phase III adjuvant trials reported significant benefits in relapse-free survival (RFS) for 6 FDA-approved regimens and overall survival (OS) for HDI and ipi10 versus observation or placebo. E1609 evaluated the relative safety and efficacy of ipi at 3 and 10 mg/kg compared to HDI, which was the adjuvant standard until recently. Methods: E1609 had 2 co-primary endpoints: OS and RFS; considered positive if either co-primary endpoint comparison was positive. Activated on 5/25/2011 and completed accrual 8/15/2014. A 2-step hierarchical approach evaluated ipi3 vs HDI followed by ipi10 vs HDI. Patients were stratified by AJCC7 stage (IIIB, IIIC, M1a, M1b). Based on protocol criteria, the primary evaluation was conducted using a data cutoff of 2/15/2019. Results: Final adult patient accrual was 1670; 523 randomized to ipi3, 636 to HDI and 511 to ipi10. Treatment related adverse events (AEs) Grade 3 or higher were experienced by 37% pts with ipi3, 79% with HDI and 58% with ipi10, and those of any grade leading to treatment discontinuation were 35% with ipi3, 20% HDI and 54% ipi10. AEs were mostly immune related and consistent with the known toxicity profiles of these agents. Gr5 AEs considered at least possibly related were 3 with ipi3, 2 with HDI and 8 with ipi10. First step comparison of OS and RFS of ipi3 vs. HDI utilized an ITT analysis of concurrently randomized cases (N = 1051) and showed significant OS difference in favor of ipi3; HR 0.78, 95.6% RCI (.61, 1.00); p = 0.044. The prespecified efficacy boundary was crossed. For RFS, HR 0.85, 99.4% CI (.66, 1.09), p = 0.065. In the 2nd step comparison of ipi10 vs. HDI (N = 989), there were trends towards improvement in OS [HR 0.88, 95.6% CI (.69, 1.12)] and RFS [HR 0.84, 99.4% CI (.65, 1.09)] in favor of ipi10 that were not statistically significant. Conclusions: Adjuvant therapy with ipi3 benefits survival of resected high-risk melanoma pts; for the first time in the history of melanoma adjuvant therapy, E1609 has demonstrated a significant improvement in the primary endpoint of OS against an active control regimen previously shown to have OS and RFS benefits, supporting early systemic adjuvant therapy for high-risk melanoma. Clinical trial information: NCT01274338.
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Affiliation(s)
| | - Sandra J. Lee
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA
| | | | | | - Harriet M. Kluger
- Yale School of Medicine and Smilow Cancer Center, Yale New Haven Hospital, New Haven, CT
| | | | | | - Donald P. Lawrence
- Massachusetts General Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | - David R. Minor
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Carrie B. Lee
- Lineberger Comprehensive Cancer Center The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Teresa M. Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - John M. Kirkwood
- Melanoma Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
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Clark JI, Singh J, Ernstoff MS, Lao CD, Flaherty LE, Logan TF, Curti B, Agarwala SS, Taback B, Cranmer L, Lutzky J, Luna TL, Aung S, Lawson DH. A multi-center phase II study of high dose interleukin-2 sequenced with vemurafenib in patients with BRAF-V600 mutation positive metastatic melanoma. J Immunother Cancer 2018; 6:76. [PMID: 30053905 PMCID: PMC6062934 DOI: 10.1186/s40425-018-0387-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Preclinical studies suggest that BRAF inhibitors enhance anti-tumor immunity and antigen presentation. Combination BRAF inhibition with immunotherapy is an appealing therapeutic approach. We sequenced vemurafenib with HD IL-2 in patients with BRAF-mutated metastatic melanoma to improve long term outcomes. METHODS Eligible patients were HD IL-2 eligible with metastatic BRAF V600 mutated melanoma. Cohort 1 was treatment naïve and received vemurafenib 960 mg BID for 6 weeks before HD IL-2. Cohort 2 received vemurafenib for 7-18 weeks before enrollment. Both cohorts received HD IL-2 at 600,000 IU/kg every 8 h days 1-5 and days 15-19. The primary objective was to assess complete responses (CR) at 10 weeks ±3 (assessment 1) and 26 weeks ±3 (assessment 2) from the start of HD IL-2. RESULTS Fifty-three patients were enrolled, (cohort 1, n = 38; cohort 2, n = 15). Of these, 39 underwent assessment 1 and 15 assessment 2. The CR rate at assessment 1 was 10% (95% CI 3-24) for both cohorts combined, and 27% (95% CI 8-55) at assessment 2. Three-year survival was 30 and 27% for cohort 1 and cohort 2, respectively. No unexpected toxicities occurred. A shift in the melanoma treatment landscape during this trial adversely affected accrual, leading to early trial closure. CONCLUSIONS Vemurafenib in sequence with HD IL-2 did not change the known toxicity profile for either agent. Lower than expected response rates to vemurafenib were observed. Overall response rates and durability of responses appear similar to that observed with HD IL-2 alone. TRIAL REGISTRATION NCTN, NCT01683188. Registered 11 September 2012, http://www.clinicaltrials.gov/NCT01683188.
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Affiliation(s)
- Joseph I Clark
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA.
| | | | | | | | | | | | - Brendan Curti
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR, USA
| | | | - Bret Taback
- Columbia University/Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Lee Cranmer
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Jose Lutzky
- Mt. Sinai Comprehensive Cancer Center, Miami Beach, FL, USA
| | | | - Sandra Aung
- Prometheus Laboratories Inc, San Diego, CA, USA.,Nektar Inc, San Diego, CA, USA
| | - David H Lawson
- Emory Winship Cancer Institute at Emory University, Atlanta, GA, USA
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Samlowski WE, Moon J, Witter M, Atkins MB, Kirkwood JM, Othus M, Ribas A, Sondak VK, Flaherty LE. High frequency of brain metastases after adjuvant therapy for high-risk melanoma. Cancer Med 2017; 6:2576-2585. [PMID: 28994212 PMCID: PMC5673911 DOI: 10.1002/cam4.1223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022] Open
Abstract
The incidence of CNS progression in patients with high-risk regional melanoma (stages IIIAN2a-IIIC) is not well characterized. Data from the S0008 trial provided an opportunity to examine the role of CNS progression in treatment failure and survival. All patients were surgically staged. Following wide excision and full regional lymphadenectomy, patients were randomized to receive adjuvant biochemotherapy (BCT) or high-dose interferon alfa-2B (HDI). CNS progression was retrospectively identified from data forms. Survival was measured from date of CNS progression. A total of 402 eligible patients were included in the analysis (BCT: 199, HDI: 203). Median follow-up (if alive) was over 7 years (range: 1 month to 11 years). The site of initial progression was identifiable in 80% of relapsing patients. CNS progression was a component of systemic melanoma relapse in 59/402 patients (15% overall). In 34/402 patients (9%) CNS progression represented the initial site of treatment failure. CNS progression was a component of initial progression in 27% of all patients whose melanoma relapsed (59/221). The risk of CNS progression was highest within 3 years of randomization. The difference in CNS progression rates between treatment arms was not significant (BCT = 25, HDI = 34, P = 0.24). Lymph node macrometastases strongly associated with CNS progression (P = 0.001), while ulceration and head and neck primaries were not significant predictors. This retrospective analysis of the S0008 trial identified a high brain metastasis rate (15%) in regionally advanced melanoma patients. Further studies are needed to establish whether screening plus earlier treatment would improve survival following CNS progression.
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Affiliation(s)
- Wolfram E Samlowski
- Comprehensive Cancer Centers of Nevada/Southern Nevada CCOP, Las Vegas, Nevada
| | - James Moon
- SWOG Statistical Center, Seattle, Washington
| | - Merle Witter
- Comprehensive Cancer Centers of Nevada/Southern Nevada CCOP, Las Vegas, Nevada
| | | | - John M Kirkwood
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan Othus
- SWOG Statistical Center, Seattle, Washington
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Tarhini AA, Lee SJ, Hodi FS, Rao UNM, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Sondak VK, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Kirkwood JM. A phase III randomized study of adjuvant ipilimumab (3 or 10 mg/kg) versus high-dose interferon alfa-2b for resected high-risk melanoma (U.S. Intergroup E1609): Preliminary safety and efficacy of the ipilimumab arms. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9500] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9500 Background: In the U.S., 3 regimens have regulatory approval as adjuvant therapy for high-risk melanoma, including high-dose interferon-alfa (HDI) and ipilimumab 10 mg/kg (ipi10). Ipilimumab 3 mg/kg (ipi3) has regulatory approval for metastatic inoperable melanoma. The toxicity of ipi is dose- dependent, and following the recent approval of adjuvant ipi10, it has become urgent to evaluate the relative safety and efficacy of adjuvant ipi at the 2 dose levels that have been tested in E1609. Methods: E1609 randomized patients (pts) with resected high-risk melanoma (stratified by stages IIIB, IIIC, M1a, M1b) to ipi10 or ipi3 versus HDI. Co-primary endpoints were RFS and OS. The current analysis investigates the relative safety and preliminary, non-comparative RFS of the ipi arms as of 3/2/17. Results: E1609 was activated on 5/25/11 and completed adult pt accrual on 8/15/14. Accrual to ipi10 was suspended due to toxicity between 9/23-11/16/2013. Final adult pt accrual was 1670 including 511 ipi10, 636 HDI and 523 ipi3 pts. Treatment related adverse events (AEs) were reported among 503 ipi10 and 516 ipi3 pts. Worst degree (Gr 3+) AEs were experienced by 57% ipi10 and 36.4% ipi3 pts and were mostly immune related (Table 1). AEs led to discontinuation of treatment in 271 (53.8 %) of 503 ipi10 and in 180 (35.2 %) of 512 ipi3 pts during the initial 4 dose induction phase. Gr5 AEs considered at least possibly related were 8 with ipi10 and 2 with ipi3. At a median follow-up of 3.1 years, an unplanned RFS analysis of ipi3 and ipi10 on concurrently randomized pts showed no difference between the 2 arms. Three-year RFS rate was 54% (95% CI: 49, 60) with ipi10 and 56% (50, 61) with ipi3. Conclusions: Adjuvant therapy of pts with high-risk melanoma is associated with significantly more toxicity at ipi10 compared to ipi3. An unplanned RFS analysis of concurrently randomized pts on the 2 ipi arms showed no difference in RFS. Clinical trial information: NCT01274338. [Table: see text]
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Affiliation(s)
| | - Sandra J. Lee
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA
| | | | | | | | | | - Henry B. Koon
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Donald P. Lawrence
- Massachusetts General Hospital and Dana-Farber Cancer Institute, Boston, MA
| | | | - David R. Minor
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Carrie B. Lee
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Teresa M. Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - John M. Kirkwood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn K, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew DL, Gralow J, Hortobagyi GN. SWOG S0221 updated: Randomized comparison of chemotherapy schedules in breast cancer adjuvant therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
521 Background: S0221 investigated weekly vs q 2 week dosing of doxorubicin/cyclophosphamide (AC) and paclitaxel (P) in patients (pts) with high risk early breast cancer as previously reported (JCO 33:58-64, 2015). After enrollment of 2716 pts randomization to the two AC arms was stopped for futility and an additional 578 pts received 4 cycles of q 2 week AC and were randomized to P weekly (Pw) or P q 2 weeks (P2). We report updated results of the original trial design and the first report of the 578 pts treated with AC x 4 and Pw x 12 or P2 x 6. Methods: Between December 2003 and November 2010, 2716 pts were randomized in a 2x2 factorial design to 1) 15 weeks of weekly AC (A 24 mg/m2/week and C 60 mg/m2/day po) vs 6 cycles of q 2 week AC (A 60 mg/m2 and C 600 mg/m2) and 2) Pw (paclitaxel 80 mg/m2/week x 12) vs P2 (paclitaxel 175 mg/m2 q 2 weeks x 6), with growth factor support as previously described. After study amendment 578 patients received 4 cycles of q 2 week AC followed by Pw or P2. Updated survival was assessed using log-rank tests and Cox regression models. Results: At a median follow-up of 8.5 years, among the pts treated in the original protocol, there were no significant differences among the four treatments for DFS (p=0.21) or OS (p=0.08). The triple-negative subset had worse DFS (P<0.001) than the HER2-positive or ER/PR+/HER2- subsets, with 5 year DFS of 75% vs 83% and 84%, respectively. While we previously found in the triple negative subset that the arm using q 2 weeks for both AC and paclitaxel was marginally superior, the differences among the arms are no longer significant for DFS (p=0.12) or OS (p=0.11). Among the 578 pts assigned ACx4 and randomized to Pw v P2 there were no overall differences in DFS (p=0.70) or OS (p=0.63) after 4.4 years median follow-up. Conclusions: There were no significant differences in DFS or OS between any of the schedules with extended follow-up in the original cohort and no difference in outcome by paclitaxel schedule for the 578 additional patients in the revised protocol. Either paclitaxel schedule may be recommended, with selection based on toxicity, cost, or patient preference rather than efficacy. Support: NCI grants CA32102, CA38926, CA21115, CA21076, CA77597, CA25224, CA77202, CCSRI15469, and Amgen, Inc. Clinical trial information: NCT00070564.
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Affiliation(s)
| | | | | | - Timothy J. Hobday
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | | | - Kathy S. Albain
- Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Helen K. Chew
- University of California Davis Medical Center, Sacramento, CA
| | | | | | | | | | | | | | - Danika L Lew
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
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11
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Jeyakumar G, Bumma N, Kim S, Landry C, Weise A, Flaherty LE, Heath EI, Silski C, Zechar E, Vaishampayan UN. Neutrophil lymphocyte ratio (NLR) as a predictor of outcomes with immune checkpoint inhibitor (ICI) therapy in genitourinary cancer and melanoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
37 Background: Immunotherapy, such as PD-1 and PD L1, has been recently approved in melanoma and genitourinary cancers (GU) such as renal cell carcinoma and urothelial carcinoma. There is an unmet need to determine factors predictive of response, to guide therapeutic selection in these cancers. We evaluated NLR (ratio of absolute values of neutrophils to lymphocytes) as predictors of response, progression free survival (PFS) and overall survival (OS) in patients treated with PD1 or PD L1 inhibitors. We extrapolated from renal cell data with NLR and used a value of 4 as cutoff. Other known prognostic clinical factors assessed were age, race, and smoking status. Methods: Regulatory approval was obtained. A retrospective chart review of melanoma and genitourinary cancer patients at Karmanos Cancer Institute, treated with ICI was conducted. Data were collected on demographics, smoking status, pretherapy NLR, and post 4 doses of ICI. Association with clinical outcomes (response rate, PFS and OS) was conducted by univariable and multivariable analyses. A log-rank test was used to compare PFS and OS. Results: 143 pts, (59 GU and 84 Melanoma) were evaluated with median age of 61yrs (range, 24-87). 11 pts (19%) and 5 (6%) were African American (AA) in GU and melanoma respectively. 61 pts (43%) were smokers in total. Pretherapy NLR<4 and ≥4 was seen in 97(68%) and 46 (32%) pts. The table summarizes the results of the analysis. Conclusions: Pretherapy NLR ≥4 was a statistically significant predictor of shorter PFS and OS with ICI therapy in GU and melanoma cancers. NLR is an easily applicable predictive factor, however validation of this observation is required in a larger sample size. [Table: see text]
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Affiliation(s)
| | - Naresh Bumma
- Barbara Ann Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, MI
| | - SeongHo Kim
- Barbara Ann Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, MI
| | - Craig Landry
- Barbara Ann Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, MI
| | - Amy Weise
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Elisabeth I. Heath
- Barbara Ann Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, MI
| | - Cynthia Silski
- Barbara Ann Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, MI
| | - Erich Zechar
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
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12
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Agarwala SS, Lee SJ, Yip W, Rao UN, Tarhini AA, Cohen GI, Reintgen DS, Evans TL, Brell JM, Albertini MR, Atkins MB, Dakhil SR, Conry RM, Sosman JA, Flaherty LE, Sondak VK, Carson WE, Smylie MG, Pappo AS, Kefford RF, Kirkwood JM. Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E1697). J Clin Oncol 2017; 35:885-892. [PMID: 28135150 DOI: 10.1200/jco.2016.70.2951] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To test the efficacy of 4 weeks of intravenous (IV) induction with high-dose interferon (IFN) as part of the Eastern Cooperative Oncology Group regimen compared with observation (OBS) in patients with surgically resected intermediate-risk melanoma. Patients and Methods In this intergroup international trial, eligible patients had surgically resected cutaneous melanoma in the following categories: (1) T2bN0, (2) T3a-bN0, (3) T4a-bN0, and (4) T1-4N1a-2a (microscopic). Patients were randomly assigned to receive IFN α-2b at 20 MU/m2/d IV for 5 days (Monday to Friday) every week for 4 weeks (IFN) or OBS. Stratification factors were pathologic lymph node status, lymph node staging procedure, Breslow depth, ulceration of the primary lesion, and disease stage. The primary end point was relapse-free survival. Secondary end points included overall survival, toxicity, and quality of life. Results A total of 1,150 patients were randomly assigned. At a median follow-up of 7 years, the 5-year relapse-free survival rate was 0.70 (95% CI, 0.66 to 0.74) for OBS and 0.70, (95% CI, 0.66 to 0.74) for IFN ( P = .964). The 5-year overall survival rate was 0.83 (95% CI, 0.79 to 0.86) for OBS and 0.83 (95% CI, 0.80 to 0.86) for IFN ( P = .558). Treatment-related grade 3 and higher toxicity was 4.6% versus 57.9% for OBS and IFN, respectively ( P < .001). Quality of life was worse for the treated group. Conclusion Four weeks of IV induction as part of the Eastern Cooperative Oncology Group high-dose IFN regimen is not better than OBS alone for patients with intermediate-risk melanoma as defined in this trial.
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Affiliation(s)
- Sanjiv S Agarwala
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Sandra J Lee
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Waiki Yip
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Uma N Rao
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Ahmad A Tarhini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Gary I Cohen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Douglas S Reintgen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Terry L Evans
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Joanna M Brell
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Mark R Albertini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael B Atkins
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Shaker R Dakhil
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Robert M Conry
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Jeffrey A Sosman
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Lawrence E Flaherty
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Vernon K Sondak
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - William E Carson
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael G Smylie
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Alberto S Pappo
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Richard F Kefford
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - John M Kirkwood
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
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13
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Christiansen SA, Feldman R, Atkins MB, El-Deiry WS, Vanderwalde AM, Pishvaian MJ, Hwang JJ, Flaherty LE, Denlinger CS, Reddy SK, Marshall J, Salem ME. Comparative molecular analyses of BRAF-V600E mutant tumors: Colorectal cancers (CRC) vs. melanomas. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Jimmy J. Hwang
- Department of Medicine and Oncology and Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | | | | | - John Marshall
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Mohamed E. Salem
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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14
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Patel SP, Milton D, Milhem MM, Flaherty LE, Hallmeyer S, Feun LG, Hauke RJ, Cranmer LD, Daniels GA, Doolittle GC, Taback B, Morse M, Lutzky J, Sharfman WH. Sequential administration of high-dose interleukin-2 and ipilimumab in patients with metastatic melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Denai Milton
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mohammed M. Milhem
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | | | | | | | | | | | | | | | - Bret Taback
- Columbia University Medical Center, New York, NY
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15
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Clark J, Ernstoff MS, Milhem MM, Lao CD, Lawson DH, Flaherty LE, Luna TL, Aung S. A multi-center phase II study of high dose IL-2 (HD IL-2) sequenced with vemurafenib in patients with BRAF-V600E mutation positive advanced melanoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Marc S. Ernstoff
- Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH
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Abstract
High-dose interferon is the current standard of care for the adjuvant treatment of high-risk cutaneous melanoma. Despite numerous clinical trials using interferon in a variety of doses and schedules, none have demonstrated a meaningful clinical improvement relative to standard high-dose interferon. Recently however, a phase III trial using biochemotherapy demonstrated a superior relapse-free survival benefit over standard interferon. In addition, several agents approved for use in metastatic melanoma are being investigated in the adjuvant setting.
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Affiliation(s)
- Amy M Weise
- Karmanos Cancer Institute, 4100 John R. Rd., Detroit, MI, USA,
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17
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn KJ, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew DL, Gralow JR, Hortobagyi GN. SWOG S0221: a phase III trial comparing chemotherapy schedules in high-risk early-stage breast cancer. J Clin Oncol 2014; 33:58-64. [PMID: 25422488 DOI: 10.1200/jco.2014.56.3296] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the optimal dose and schedule of anthracycline and taxane administration as adjuvant therapy for early-stage breast cancer. PATIENTS AND METHODS A 2 × 2 factorial design was used to test two hypotheses: (1) that a novel continuous schedule of doxorubicin-cyclophosphamide was superior to six cycles of doxorubicin-cyclophosphamide once every 2 weeks and (2) that paclitaxel once per week was superior to six cycles of paclitaxel once every 2 weeks in patients with node-positive or high-risk node-negative early-stage breast cancer. With 3,250 patients, a disease-free survival (DFS) hazard ratio of 0.82 for each randomization could be detected with 90% power with two-sided α = .05. Overall survival (OS) was a secondary outcome. RESULTS Interim analyses crossed the futility boundaries for demonstrating superiority of both once-per-week regimens and once-every-2-weeks regimens. After a median follow-up of 6 years, a significant interaction developed between the two randomization factors (DFS P = .024; OS P = .010) in the 2,716 patients randomly assigned in the original design, which precluded interpretation of the two factors separately. Comparing all four arms showed a significant difference in OS (P = .040) but not in DFS (P = .11), with all treatments given once every 2 weeks associated with the highest OS. This difference in OS seemed confined to patients with hormone receptor-negative/human epidermal growth factor receptor 2 (HER2) -negative tumors (P = .067), with no differences seen with hormone receptor-positive/HER2-negative (P = .90) or HER2-positive tumors (P = .40). CONCLUSION Patients achieved a similar DFS with any of these regimens. Subset analysis suggests the hypothesis that once-every-2-weeks dosing may be best for patients with hormone receptor-negative/HER2-negative tumors.
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Affiliation(s)
- George T Budd
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ.
| | - William E Barlow
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Halle C F Moore
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Timothy J Hobday
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - James A Stewart
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Claudine Isaacs
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Muhammad Salim
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Jonathan K Cho
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Kristine J Rinn
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Kathy S Albain
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Helen K Chew
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gary V Burton
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Timothy D Moore
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gordan Srkalovic
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Bradley A McGregor
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Lawrence E Flaherty
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Robert B Livingston
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Danika L Lew
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Julie R Gralow
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
| | - Gabriel N Hortobagyi
- George T. Budd, Halle C. F. Moore, Cleveland Clinic, Cleveland; Timothy D. Moore, Mid Ohio Oncology Hematology, Columbus, OH; William E. Barlow, Danika L. Lew, SWOG Statistical Center; Kristine J. Rinn, Swedish Cancer Institute; Julie R Gralow, Seattle Cancer Care Alliance, Seattle, WA; Timothy J. Hobday Mayo Clinic, Rochester, MN; James A. Stewart, Baystate Medical Center, Springfield, MA; Claudine Isaacs, Georgetown University, Washington, DC; Muhammad Salim, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Jonathan K. Cho, University of Hawaii MBCCOP, Honolulu, HI; Kathy S. Albain, Loyola University Chicago, Stritch School of Medicine; Chicago, IL; Helen K. Chew, University of California-Davis, Sacramento, CA; Gary V. Burton, Louisiana State University Health Sciences Center, Shreveport, LA; Gordan Srkalovic, Sparrow Regional Cancer Center, Lansing; Lawrence E. Flaherty, Karmanos Cancer Institute/Wayne State University, Detroit, MI; Bradley A. McGregor, Willford Hall Medical Center, Lackland Air Force Base; Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Robert B. Livingston, Arizona Cancer Center, Tucson, AZ
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Flaherty LE, Othus M, Atkins MB, Tuthill RJ, Thompson JA, Vetto JT, Haluska FG, Pappo AS, Sosman JA, Redman BG, Moon J, Ribas A, Kirkwood JM, Sondak VK. Southwest Oncology Group S0008: a phase III trial of high-dose interferon Alfa-2b versus cisplatin, vinblastine, and dacarbazine, plus interleukin-2 and interferon in patients with high-risk melanoma--an intergroup study of cancer and leukemia Group B, Children's Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. J Clin Oncol 2014; 32:3771-8. [PMID: 25332243 DOI: 10.1200/jco.2013.53.1590] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-dose interferon (IFN) for 1 year (HDI) is the US Food and Drug Administration-approved adjuvant therapy for patients with high-risk melanoma. Efforts to modify IFN dose and schedule have not improved efficacy. We sought to determine whether a shorter course of biochemotherapy would be more effective. PATIENTS AND METHODS S0008 (S0008: Chemotherapy Plus Biological Therapy in Treating Patients With Melanoma) was an Intergroup phase III trial that enrolled high-risk patients (stage IIIA-N2a through IIIC-N3), randomly assigning them to receive either HDI or biochemotherapy consisting of dacarbazine, cisplatin, vinblastine, interleukin-2, IFN alfa-2b (IFN-α-2b) and granulocyte colony-stimulating factor given every 21 days for three cycles. Coprimary end points were relapse-free survival (RFS) and overall survival (OS). RESULTS In all, 432 patients were enrolled. Grade 3 and 4 adverse events occurred in 57% and 7% of HDI patients and 36% and 40% of biochemotherapy patients, respectively. At a median follow-up of 7.2 years, biochemotherapy improved RFS (hazard ratio [HR], 0.75; 95% CI, 0.58 to 0.97; P = .015), with a median RFS of 4.0 years (95% CI, 1.9 years to not reached [NR]) versus 1.9 years for HDI (95% CI, 1.2 to 2.8 years) and a 5-year RFS of 48% versus 39%. Median OS was not different (HR, 0.98; 95% CI, 0.74 to 1.31; P = .55), with a median OS of 9.9 years (95% CI, 4.62 years to NR) for biochemotherapy versus 6.7 years (95% CI, 4.5 years to NR) for HDI and a 5-year OS of 56% for both arms. CONCLUSION Biochemotherapy is a shorter, alternative adjuvant treatment for patients with high-risk melanoma that provides statistically significant improvement in RFS but no difference in OS and more toxicity compared with HDI.
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Affiliation(s)
- Lawrence E Flaherty
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL.
| | - Megan Othus
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michael B Atkins
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ralph J Tuthill
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John A Thompson
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John T Vetto
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Frank G Haluska
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Alberto S Pappo
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jeffrey A Sosman
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Bruce G Redman
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - James Moon
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Antoni Ribas
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John M Kirkwood
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Vernon K Sondak
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
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Lee SM, Moon J, Redman BG, Chidiac T, Flaherty LE, Zha Y, Othus M, Ribas A, Sondak VK, Gajewski TF, Margolin KA. Phase 2 study of RO4929097, a gamma-secretase inhibitor, in metastatic melanoma: SWOG 0933. Cancer 2014; 121:432-440. [PMID: 25250858 DOI: 10.1002/cncr.29055] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [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: 05/15/2014] [Revised: 07/12/2014] [Accepted: 07/15/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Aberrant Notch activation confers a proliferative advantage to many human tumors, including melanoma. This phase 2 trial assessed the antitumor activity of RO4929097, a gamma-secretase inhibitor of Notch signaling, with respect to the progression-free and overall survival of patients with advanced melanoma. METHODS Chemotherapy-naive patients with metastatic melanoma of cutaneous or unknown origin were treated orally with RO4929097 at a dose of 20 mg daily 3 consecutive days per week. A 2-step accrual design was used with an interim analysis of the first 32 patients and with continuation of enrollment if 4 or more of the 32 patients responded. RESULTS Thirty-six patients from 23 institutions were enrolled; 32 patients were evaluable. RO4929097 was well tolerated, and most toxicities were grade 1 or 2. The most common toxicities were nausea (53%), fatigue (41%), and anemia (22%). There was 1 confirmed partial response lasting 7 months, and there were 8 patients with stable disease lasting at least through week 12, with 1 of these continuing for 31 months. The 6-month progression-free survival rate was 9% (95% confidence interval [CI], 2%-22%), and the 1-year overall survival rate was 50% (95% CI, 32%-66%). Peripheral blood T-cell assays showed no significant inhibition of the production of interleukin-2, a surrogate pharmacodynamic marker of Notch inhibition, and this suggested that the drug levels were insufficient to achieve Notch target inhibition. CONCLUSIONS RO4929097 showed minimal clinical activity against metastatic melanoma in this phase 2 trial, possibly because of inadequate exposure to therapeutic drug levels. Although Notch inhibition remains a compelling target in melanoma, the results do not support further investigation of RO4929097 with this dose and schedule.
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Affiliation(s)
- Sylvia M Lee
- Seattle Cancer Care Alliance/University of Washington, Seattle, WA
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- Seattle Cancer Care Alliance/University of Washington, Seattle, WA
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Carson WE, Unger JM, Sosman JA, Flaherty LE, Tuthill RJ, Porter MJ, Thompson JA, Kempf RA, Othus M, Ribas A, Sondak VK. Adjuvant vaccine immunotherapy of resected, clinically node-negative melanoma: long-term outcome and impact of HLA class I antigen expression on overall survival. Cancer Immunol Res 2014; 2:981-7. [PMID: 24994597 DOI: 10.1158/2326-6066.cir-14-0052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Associations between HLA class I antigen expression and the efficacy of a melanoma vaccine (Melacine; Corixa Corp.) were initially described in stage IV melanoma. Similar associations were observed in S9035, a phase III adjuvant trial evaluating Melacine for 2 years compared with observation in patients with stage II melanoma. This report provides long-term results. The effects of treatment on relapse-free survival (RFS) and overall survival (OS) were evaluated, and prespecified analyses investigated associations between treatment and HLA expression. Multivariable analyses were adjusted for tumor thickness, ulceration and site, method of nodal staging, and sex. P = 0.01 was considered statistically significant in subset analyses to account for multiple comparisons. For the entire study population of 689 patients, there were no significant differences in RFS or OS by treatment arm. HLA serotyping was performed on 553 (80%) patients (vaccine, 294; observation, 259). Among the subpopulation with HLA-A2 and/or HLA-Cw3 serotype, vaccine arm patients (n = 178) had marginally improved RFS (adjusted P = 0.02) and significantly improved OS compared with observation arm patients (n = 145), with 10-year OS of 75% and 63%, respectively [hazard ratio (HR), 0.62; 99% confidence interval (CI), 0.37-1.02; P = 0.01]. There was no impact of HLA-A2 and/or HLA-Cw3 expression on observation arm patients. An analysis of mature data from S9035 indicates a significant OS benefit from adjuvant vaccine therapy for patients with HLA-A2- and/or HLA-Cw3-expressing melanoma. The possibility of interactions between HLA type and outcome should be considered in future immunotherapy trials. Further investigations of melanoma-associated antigens present in Melacine and presented by HLA-A2 and HLA-Cw3 may be warranted.
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Affiliation(s)
- William E Carson
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio.
| | | | | | | | | | - Mark J Porter
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | | | - Raymond A Kempf
- Los Angeles County Department of Health Services, University of Southern California, Los Angeles, California
| | - Megan Othus
- SWOG Statistical Center, Seattle, Washington
| | - Antoni Ribas
- University of California Los Angeles, Los Angeles, California
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21
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Albain KS, Rinn K, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew D, Gralow J, Hortobagyi GN. Outcome of male patients and black patients enrolled in S0221, an intergroup chemotherapy study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Gary Von Burton
- Louisiana State University Health Sciences Center/Feist Weiller cancer center, Shreveport, LA
| | | | | | | | | | | | - Danika Lew
- Southwest Oncology Group Statistical Center, Seattle, WA
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22
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Jagtap DB, Thakur A, Deol A, Al-Kadhimi Z, Simon MS, Flaherty LE, Shields AF, Schalk D, Paul E, Kondadasula V, Liu Q, Lum LG. Phase II trial evaluating HER2 targeted activated T cells in advanced HER2 low expressing breast cancer patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Archana Thakur
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | | | | | - Dana Schalk
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | - Qin Liu
- Wistar Institute, Philadelphia, PA
| | - Lawrence G. Lum
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
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23
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn K, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew D, Gralow J, Hortobagyi GN. S0221: Comparison of two schedules of paclitaxel as adjuvant therapy for breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.cra1008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA1008 Background: S0221 is a SWOG-coordinated phase III adjuvant chemotherapy intergroup trial in node-positive and high-risk node-negative operable breast cancer which hypothesized that 1) the weekly AC+G regimen is superior to ddAC x 6 and 2) 12 weeks of weekly paclitaxel (wP) is superior to q 2 week paclitaxel x 6 (ddP). Methods: Between December 2003 and November 2010, 2,716 patients were randomized in a 2 x 2 factorial design to 1) AC+G vs ddAC and 2) P 80 mg/m2/week x 12 vs P 175 mg/m2 q 2 weeks x 6. If there was no significant interaction between the factors, the trial was powered to find a disease-free survival hazard ratio (HR) ≤ 0.82 for weekly vs q 2 week for each factor. At the first interim analysis, the AC randomization was halted for futility, and S0221 was closed to accrual 10 November 2010. S0221 reopened 15 December 2010, after which time all patients received 4 cycles of ddAC and randomization to P weekly x 12 and ddP x 6 continued. Accrual halted at a total of 3,294 in January 2012. Results: By September 7, 2012, 487 events and 340 deaths had occurred, prompting the third planned interim analysis. The Data Safety and Monitoring Committee recommended reporting the results since the futility boundary was crossed. A Cox model adjusting for the AC arms had a HR = 1.08 (95% CI 0.90-1.28; p=0.42), with the 99.5% CI excluding the original alternative hypothesis that the HR=0.82. There was no significant interaction of the two factors. Estimated 5-year progression-free survivals were 82% for weekly P and 81% for ddP. Toxicity data were available for 1,385 patients treated with ddP and 1,367 treated with weekly P. Grade 5 toxicity occurred in 4 patients on ddP and 2 on weekly P. Percent grade 3-4 toxicity per arm are shown in the Table. Conclusions: Either ddPx6 or weekly P x 12 are acceptable schedules of P administration. The differences in leukopenia likely reflect ascertainment bias against weekly P. If this is accepted, weekly P x 12 produces less overall toxicity than 6 cycles of ddP. Support: NCI grants CA32102, CA38926, CA21115, CA21076, CA77597, CA25224, CA77202, CCSRI15469, and Amgen, Inc. Clinical trial information: NCT00070564. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Helen K. Chew
- University of California, Davis Cancer Center, Sacramento, CA
| | | | | | | | | | | | | | - Danika Lew
- Southwest Oncology Group Statistical Center, Seattle, WA
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24
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Hodi FS, Amin A, Saenger YM, Pennock GK, Guthrie TH, Salama AK, Flaherty LE, Koon HB, Lawson DH, Shaheen MF, Balogh A, Konto C, O'Day S. CA184-240: A single-arm, open-label phase II study of vemurafenib followed by ipilimumab in patients with BRAF V600-mutated advanced melanoma (AM). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps9103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9103 Background: Ipilimumab (Ipi), a fully human monoclonal antibody that binds to cytotoxic T-lymphocyte antigen-4 expressed on T cells, and vemurafenib (Vem), a small molecule inhibitor of BRAF V600-mutated kinase, are both approved treatments for AM. Ipi has shown improved overall survival (OS) in two randomized phase III trials of patients with previously treated (3 mg/kg monotherapy) and previously untreated (10 mg/kg plus dacarbazine) AM. Vem has shown improved OS in a randomized phase III trial of patients that harbor the BRAF V600E mutation. The most common drug-related adverse events (AEs) with Ipi monotherapy were immune-related GI tract and skin toxicities, which were generally manageable using treatment guidelines. The most common AEs with Vem were arthralgia, rash, and fatigue. Vem can induce rapid and substantial responses, and resistance mechanisms are a focus of current investigation. This study will evaluate the safety of Vem lead-in followed by Ipi (prior to resistance) in patients with BRAF V600-mutated AM. Methods: An estimated 45 patients will be enrolled. Eligible patients include those ≥18 years old with previously untreated AM, a BRAF V600 mutation, and an ECOG PS of 0 or 1. Major exclusion criteria are primary ocular melanoma, active brain metastases, and autoimmune disease. Patients will initially receive Vem for 6 weeks (960 mg twice daily). After a washout period of 3-10 days (per protocol), patients will be initiated on Ipi at 10 mg/kg (every 3 wk for 4 doses, then once every 12 wk beginning at week 24, until disease progression or unacceptable toxicity). Vem will be restarted at the time of disease progression on Ipi (no minimum time to restart) or unacceptable toxicity on Ipi (restart minimum of 1 mo after the last dose of Ipi). Vem will be restarted at the last dose level tolerated at the end of the lead-in phase. Patients will be followed every 12 weeks for toxicity and/or disease progression, and subsequently will be followed every 12 weeks for survival. The objectives of this study are to estimate the incidence of grade 3-4 drug-related AEs. Exploratory objectives include the evaluation of efficacy (OS). Clinical trial information: NCT01673854.
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Affiliation(s)
| | - Asim Amin
- Levine Cancer Institute, Charlotte, NC
| | | | | | | | | | | | | | | | | | | | | | - Steven O'Day
- The Beverly Hills Cancer Center, Beverly Hills, CA
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25
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Budd GT, Barlow WE, Moore HCF, Hobday TJ, Stewart JA, Isaacs C, Salim M, Cho JK, Rinn K, Albain KS, Chew HK, Burton GV, Moore TD, Srkalovic G, McGregor BA, Flaherty LE, Livingston RB, Lew D, Gralow J, Hortobagyi GN. S0221: Comparison of two schedules of paclitaxel as adjuvant therapy for breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.cra1008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA1008 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Monday, June, 3, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Helen K. Chew
- University of California, Davis Cancer Center, Sacramento, CA
| | | | | | | | | | | | | | - Danika Lew
- Southwest Oncology Group Statistical Center, Seattle, WA
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26
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Margolin KA, Moon J, Redman BG, Chidiac T, Othus M, Ribas A, Flaherty LE, Sondak VK, Gajewski T. Phase II trial of RO4929097 Notch gamma-secretase inhibitor in metastatic melanoma: SWOG S0933. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8525 Background: The Notch pathway regulates expression of genes for cell cycle, tissue-specific differentiation, and vasculogenesis. Notch target genes affect melanomagenesis, and Notch levels can influence stemlike versus differentiated tumor cells. Gamma-secretase, which activates intracellular Notch, can be inhibited to kill melanoma cells. We designed this trial to test RO4929097 in pts with melanoma and its effects on T lymphocytes and tumor gene expression. Methods: To assess 6-month progression-free survival (PFS) and 1-year overall survival (OS) in advanced, untreated melanoma patients (pts), a 2-stage accrual design was used. Correlative studies: markers of Notch pathway activation in archived or fresh tumor and T cell functional assays pre-treatment (Rx) and at week 3. Rx dose was 20 mg orally on 3 consecutive days, weekly. Results: 33 pts were Rx’d in stage 1 (median age 61 [range 32-85]; 70% male; 42% elevated LDH; 30% unknown primary; 24% bone mets; 36% liver; 55% lung; 55% lymph node, skin or soft tissue). The clinical outcomes did not meet criteria for stage 2 accrual. One pt had a confirmed PR of 7 months’ (mo) duration. The median PFS was 1.4 mo, [95% confidence interval, c.i. 1.3-2.7], the 6-mo PFS was 11% [95% c.i 3%-33%], and the 1-year OS was 45% [95% c.i. 23%-90%]. Treatment was well-tolerated with no grade (gr) 4-5 tox. The most common gr 2 drug tox were fatigue and nausea in 4 patients (12%) each, and only 4 of 7 gr 3 tox were considered drug-related (1 increased ALT, 1 QTc prolongation, 1 bradycardia, 1 lymphopenia). Pre- and week 3 on-Rx peripheral T cell samples assayed for IL-2 (23 pts) and IFN-γ (22 pts) secretion to Staphylococcal enterotoxin A showed no significant change, in contrast to in vitro gamma-secretase inhibitors which blocked T cell activation. Pre- and on-Rx tumor biopsies in one pt showed no decrease in the Notch target Hey1. Conclusions: RO4929097 at this dose and schedule has limited activity in molecularly-unselected pts with melanoma. Lack of effect on T cell function and tumor Hey1 expression suggests that sustained target inhibition might not have been achieved. Supported in part by PHS Cooperative Agreements, NCI, DHHS CA32102 and CA38926. ClinicalTrials.gov identifier: NCT01120275.
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Affiliation(s)
| | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | - Antoni Ribas
- University of California, Los Angeles, Los Angeles, CA
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27
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Lao CD, Moon J, Fruehauf JP, Flaherty LE, Bury MJ, Ribas A, Sondak VK. SWOG S0826: A phase II trial of SCH 727965 (NSC 747135) in patients with stage IV melanoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
8521 Background: Cyclin-dependent kinases (cdks) function to regulate cell cycle control and agents that can target cdks in malignant progression remain viable therapeutic strategies. Selective inhibition of cdk2, in particular, may be of therapeutic value in a subset of patients with melanoma. Methods: 60 patients with metastatic melanoma of cutaneous or mucosal origin were planned to be recruited to a multicenter, single-arm phase II trial of the cdk inhibitor, SCH 727965 (NSC747135). Patients were potentially eligible if they had 0-1 previous treatments, PS of 0-1, and adequate organ function. Ocular melanoma patients and patients with a history of brain metastases were excluded. SCH 727965 50 mg IV every 3 weeks was given until progression with disease assessment occurring every 2 cycles. Co-primary endpoints were 1-year overall survival (OS) and 6-month progression free survival (PFS). Results: 72 patients were enrolled from July 1, 2009 to November 1, 2010 at 24 institutions. 68% of patients had M1c disease and 43% had LDH elevation. 19% had prior therapy for metastatic disease. 28 patients (39%) experienced Grade 4 adverse events, including 20 cases of neutropenia, one case each of cardiac ischemia/infarction, cardiac troponin I elevation, dehydration, abdominal pain, leukopenia, muscle weakness, headache, syncope, and anterior ischemic optic neuropathy. 65 patients are currently evaluable for response. The response rate was 0/65 (95% C.I. (0-6%)). Stable disease was observed in 22%. The estimated median PFS was 1.5 months (95% CI: 1.4 – 1.5); 6-month PFS was 11% (5-20%). Median OS was 8 months (95% CI: 5-11 months); 1-year OS was 36% (95% CI: 24-48%). The null hypothesis of 1-year overall survival=25% was rejected (p=0.04) but 6-month PFS=11% was not (p=0.8). Data Analysis will be updated when missing data are received. Correlative studies of Rb phosphorylation and cyclin expression will be pursued. Conclusions: SCH 727965 appears to be reasonably well tolerated although grade 4 events were relatively common, particularly near the time of infusion. There were no responses but few patients had prolonged disease stabilization that may have resulted in improvement in the 1-year OS rate.
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Affiliation(s)
| | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | - Martin J. Bury
- Cancer & Hematology Centers of Western Michigan, Grand Rapids, MI
| | - Antoni Ribas
- Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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28
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Schuchter LM, Flaherty LE, Hamid O, Linette GP, Hallmeyer S, Gonzalez R, Cowey CL, Pavlick AC, Kudrik FJ, Lawson DH, Margolin KA, Ribas A, McDermott DF, Khatcheressian JL, Flaherty KT, Day BM, Linke RG, Hainsworth JD. A single-arm, open-label, U.S. expanded access study of vemurafenib in patients with metastatic melanoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8567 Background: Vemurafenib (vem) has been FDA approved for the treatment of unresectable or metastatic BRAFV600E mutated melanoma since August 2011 based on results of a randomized phase III study (treatment-naive) and a single arm phase II study (previously treated). We report results of an expanded access study that allowed appropriate patients (pts) to receive vem until the drug was approved. Methods: Eligible pts had metastatic melanoma with a BRAFV600E mutation as detected by the cobas 4800 BRAFV600 Mutation Test. Enrolled pts received oral vem 960 mg b.i.d. Adverse events (AEs) were evaluated for vem-related toxicities; tumor responses were assessed using RECIST 1.1. Results: 29 US sites screened 745 pts and enrolled 374 from December 2010 until October 2011. The following results are based on a median follow up time and treatment duration of 2 months. At baseline, mean age of pts was 54 y with 22% of pts ≥65 y; 75% had stage M1c disease; 29% had received radiotherapy for brain metastases. 19% of pts were ECOG PS 2 or 3; 71% of pts had prior systemic therapy for metastatic melanoma (21% 1 regimen; 50% ≥2 regimens). 50 pts had prior adjuvant treatment. At data cut-off, 243 pts had sufficient follow-up time for tumor assessment. In this group, the unconfirmed overall response rate was 52% (95% CI, 46 to 59). The median time to response was 1.8 months. Based on 240 pts with available ECOG PS status at time of analysis, response rate was 53% for pts with ECOG PS 0 or 1 (n=209), and 45% for pts with ECOG PS 2 or 3 (n=31). 370 pts were evaluable for safety analysis. The most common vem-related AEs were rash (36%), arthralgia (33%) and fatigue (21%) with the majority (~90%) of grade 1 or 2. 25 vem-related serious AEs were reported in 5.4% of pts with a slightly higher rate of pts with ECOG PS 2 or 3 (8.7%) compared to ECOG PS 0 or 1 (4.7%). 18% of pts missed at least one dose and 11% of pts required dose reduction of at least one level due to AEs. Conclusions: This expanded access study, with its limited follow-up time, confirms the established rapid and high tumor response rate with vem. No new safety signals were detected. Compared to the overall population, pts with an ECOG PS 2 or 3 demonstrated a similar benefit.
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Affiliation(s)
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Santa Monica, CA
| | | | | | | | | | | | | | | | | | - Antoni Ribas
- University of California, Los Angeles, Los Angeles, CA
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29
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Samlowski WE, Moon J, Witter M, Atkins MB, Kirkwood JM, Othus M, Ribas A, Sondak VK, Flaherty LE. CNS metastases as a site of progression on SWOG intergroup study S0008: A phase III trial of high-dose interferon alpha-2b versus cisplatin, vinblastine, DTIC plus IL-2 (BCT) versus high-dose interferon (HDI) in patients with high-risk melanoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8527 Background: Central nervous system (CNS) metastases (mets) are common in stage IV melanoma patients (pts). However, the incidence of CNS mets in pts with high-risk regional melanoma (HRM; stages IIIA-N2a thru IIIC N3) is not well described. A recent large prospective S0008 trial provided an opportunity to evaluate the contribution of CNS mets to treatment failure and survival. Methods: All pts had HRM treated with wide excision and full regional lymphadenectomy. Pts were then randomized to receive treatment with either BCT or HDI. All eligible pts were included in the analysis. Relapse/progression in the CNS (PCNS) was retrospectively identified only if clearly documented in case report forms. The cumulative incidence of PCNS in the presence of the competing hazard of death was estimated and potential risk factors were explored using the methods of Fine and Gray. Survival from PCNS was measured from date of PCNS to date of death. Results: 402 patients were evaluated (BCT: 200, HDI: 202), with median follow (if alive) of 6 years. The site of progression was identified in 162 (78 %) of 208 pts relapsing on study. Clearly documented PCNS occurred in 53/402 pts (13%). PCNS as a component of initial relapse/progression occurred in 34 patients (8%) and an additional 19 patients (5%) had delayed PCNS following initial systemic relapse. Most PCNS (85%) occurred within 3 years of initial surgery. Differences between arms were not significant (22 on BCT, and 31 on HDI)(p=0.21). Lymph node macromets demonstrated a strong correlation with development of PCNS (p=0.01). Neither primary tumor ulceration nor head and neck primary site were significant risk factors. Survival from diagnosis of brain mets was short (median 6 mo BCS, 5 mo HDI, p=0.93). Conclusions: Although the S0008 trial was not specifically designed to evaluate PCNS, a retrospective analysis identified a high CNS failure rate (at least 13%) in HRM pts, including 8% as the initial site of relapse. Further studies are needed to evaluate if screening for CNS mets in high-risk pts is useful and whether early treatment improves survival.
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Affiliation(s)
| | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | - Merle Witter
- Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | | | | | | | - Antoni Ribas
- University of California, Los Angeles, Los Angeles, CA
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30
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Flaherty LE, Moon J, Atkins MB, Tuthill R, Thompson JA, Vetto JT, Haluska FG, Pappo AS, Sosman JA, Redman BG, Ribas A, Kirkwood JM, Sondak VK. Phase III trial of high-dose interferon alpha-2b versus cisplatin, vinblastine, DTIC plus IL-2 and interferon in patients with high-risk melanoma (SWOG S0008): An intergroup study of CALGB, COG, ECOG, and SWOG. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8504 Background: High-dose interferon for one year (HDI) is the FDA approved adjuvant therapy for patients (pts) with high-risk melanoma (HRM). Efforts to modify IFN dose or schedule have not improved efficacy. A meta-analysis demonstrated that biochemotherapy (BCT) produced superior response rates compared with chemotherapy in pts with stage IV melanoma (Wheatley et al J Clin Oncol 25:5426, 2007). We sought to determine whether a short course of BCT would be more effective than HDI as adjuvant treatment in pts with HRM. Methods: S-0008 (an Intergroup Phase III trial) enrolled pts who were high risk (Stage III A-N2a thru Stage III C N3) and randomized them to receive either HDI or BCT consisting of dacarbazine 800 mg/m2 day 1, cisplatin 20 mg/m2/ days 1-4, vinblastine 1.2 mg/m2 days 1-4, IL-2 9 MIU/m2/day continuous IV days 1-4, IFN 5 MU/m2/day sc days 1-4, 8,10,12, and G-CSF 5 ug/kg/day sc days 7-16. BCT cycles were given every 21 days x 3 cycles (9 weeks total). Pts were stratified for number of involved nodes (1-3 v ≥4), micro v macro metastasis, and ulceration of the primary. Co-primary endpoints were relapse free survival (RFS) and overall survival (OS) using a one-sided log rank test at p= 0.05. Results: 432 pts were enrolled between 8/2000 and 11/2007: 30 were ineligible or withdrew consent. Grade 3 and 4 adverse events occurred in 57% and 7% respectively of HDI pts and 36% and 40% of BCT pts. At a median f/up of 6 yrs, BCT improved RFS (p = 0.02, HR 0.77 [90% CI: 0.62 – 0.96]) with median RFS for BCT of 4.0 yrs (90% CI:1.9 – 5.9) v 1.9 yrs (90% CI: 1.4 – 2.5) and 5 yr RFS of 47% v 39%. Median OS was not different between the two arms (p = 0.49 HR 1.0 [90% CI: 0.78 – 1.27]) with median OS not yet reached for BCT v 8.4 yrs (90% CI: 4.5 – 9.3) for HDI and 5 yr survival 56% for both arms. Conclusions: In HRM pts, BCT provides a statistically significant improvement in RFS compared to HDI, but no discernable difference in OS and more grade IV toxicity. BCT represents a shorter, alternative treatment for pts with HRM, and a potential control arm and basis for future combinations in the adjuvant setting.
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Affiliation(s)
| | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | | | | | | | | | | | - Antoni Ribas
- University of California, Los Angeles, Los Angeles, CA
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31
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Margolin KA, Moon J, Flaherty LE, Lao CD, Akerley WL, Othus M, Sosman JA, Kirkwood JM, Sondak VK. Randomized phase II trial of sorafenib with temsirolimus or tipifarnib in untreated metastatic melanoma (S0438). Clin Cancer Res 2012; 18:1129-37. [PMID: 22228638 DOI: 10.1158/1078-0432.ccr-11-2488] [Citation(s) in RCA: 65] [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: 12/22/2022]
Abstract
PURPOSE Signaling pathway stimulation by activating mutations of oncogenes occurs in most melanomas and can provide excellent targets for therapy, but the short-term therapeutic success is limited by intrinsic and acquired resistance. The mitogen-activated protein kinase and phosphoinositide 3-kinase/AKT/mTOR pathways are activated in most cutaneous melanomas. The purpose of this trial was to prospectively evaluate 2 molecularly targeted drug combinations in patients with untreated metastatic melanoma. EXPERIMENTAL DESIGN This randomized phase II study enrolled patients between May 2008 and November 2009 with nonocular melanoma, no prior systemic chemotherapy, and no history of brain metastasis. Arm A received oral sorafenib 200 mg twice daily plus i.v. temsirolimus 25 mg weekly; and arm B received oral sorafenib 400 mg every morning, 200 mg every night daily plus oral tipifarnib 100 mg twice daily, 3 weeks of every 4. The primary objectives were to evaluate progression-free survival (PFS), objective response rate, and toxicity for the 2 regimens. RESULTS On arm A (63 evaluable patients), the median PFS was 2.1 months and median overall survival (OS) was 7 months. Three patients achieved partial response (PR). Thirty-nine evaluable patients were accrued to arm B, which closed after first-stage accrual; the median PFS was 1.8 months and OS was 7 months, with 1 patient achieving PR. CONCLUSIONS The combinations of molecularly targeted agents tested did not show sufficient activity to justify further use. Newer agents and improved patient selection by characterization of the molecular targets in individual tumors show great promise and should be incorporated into future studies, along with appropriate laboratory correlates.
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Affiliation(s)
- Kim A Margolin
- University of Washington, SWOG Statistical Center, Seattle, WA98109., USA.
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Livingston RB, Barlow WE, Kash JJ, Albain KS, Gralow JR, Lew DL, Flaherty LE, Royce ME, Hortobagyi GN. SWOG S0215: a phase II study of docetaxel and vinorelbine plus filgrastim with weekly trastuzumab for HER2-positive, stage IV breast cancer. Breast Cancer Res Treat 2011; 130:123-31. [PMID: 21826527 PMCID: PMC3513946 DOI: 10.1007/s10549-011-1698-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 02/06/2023]
Abstract
SWOG trial S0102 showed significant activity of the combination of docetaxel and vinorelbine in HER2-negative metastatic breast cancer (MBC). For HER2-positive patients, additional benefit may occur with the addition of trastuzumab due to its synergy with docetaxel and vinorelbine. Patients with HER2-positive MBC, but without prior chemotherapy for MBC or adjuvant taxane, were eligible. Docetaxel (60 mg/m²) was given intravenously on Day 1, vinorelbine (27.5 mg/m²) intravenously on Days 8 and 15, and filgrastim (5 µg/kg) on Days 2-21 of a 21-day cycle. In addition, patients received weekly infusions of trastuzumab (2 mg/kg) after an initial bolus of 4 mg/kg. The primary outcome was 1 year overall survival (OS), with secondary outcomes of progression-free survival (PFS), response rate, and toxicity. Due to slow accrual (February 2003-December 2006), enrollment was stopped after 76 of 90 planned patients. There have been 32 deaths and 51 progressions among the 74 eligible patients who received treatment. The estimated 1 year OS was 93% (95% CI 84-97%) with a median of 48 months. One-year PFS was 70% (95% CI 58-79%) with a median of 20 months. Response rate for measurable disease was 84%. No deaths were attributed to treatment. Grade 4 toxicities were reported for 19% with neutropenia the most common (15%). The most common grade 3 toxicities (33%) were leucopenia (14%) and fatigue (10%). The combination of trastuzumab, docetaxel, and vinorelbine is effective as first-line chemotherapy in HER2-positive MBC with minimal toxicity. One-year survival estimates are among the highest reported in this population.
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Affiliation(s)
- Robert B Livingston
- Arizona Cancer Center, Hematology/Oncology Section, Tucson, AZ, 85724-5024, USA.
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Sosman JA, Moon J, Tuthill RJ, Warneke JA, Vetto JT, Redman BG, Liu PY, Unger JM, Flaherty LE, Sondak VK. A phase 2 trial of complete resection for stage IV melanoma: results of Southwest Oncology Group Clinical Trial S9430. Cancer 2011; 117:4740-06. [PMID: 21455999 DOI: 10.1002/cncr.26111] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND On the basis of retrospective experience at individual centers, it appears that patients with stage IV melanoma who undergo complete resection have a favorable outcome compared with patients with disseminated stage IV disease. The Southwest Oncology Group (SWOG) performed a prospective trial in patients with metastatic melanoma who were enrolled before complete resection of their metastatic disease and provided prospective outcomes in the cooperative group setting. METHODS Based on their physical examination and radiologic imaging studies, patients with a stage IV melanoma judged amenable to complete resection underwent surgery within 28 days of enrollment. All eligible patients were followed with scans (computed tomography or positron emission tomography) every 6 months until relapse and death. RESULTS Seventy-seven patients were enrolled from 18 different centers. Of those, 5 patients were ineligible; 2 had stage III disease alone; and 3 had no melanoma in their surgical specimen. In addition, 8 eligible patients had incompletely resected tumor. Therefore, the primary analysis included 64 completely resected patients. Twenty patients (31%) had visceral disease. With a median follow-up of 5 years, the median relapse-free survival was 5 months (95% CI, 3-7 months) whereas median overall survival was 21 months (95% CI, 16-34 months). Overall survivals at 3 and 4 years were 36% and 31%, respectively. CONCLUSIONS In a prospective multicenter setting, appropriately selected patients with stage IV melanoma achieved prolonged overall survival after complete surgical resection. Although median relapse-free survival was only 5 months, patients could still frequently undergo subsequent surgery for isolated recurrences. This patient population is appropriate for aggressive surgical therapy and for trials evaluating adjuvant therapy.
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Affiliation(s)
- Jeffrey A Sosman
- Vanderbilt University School of Medicine, Department of Medicine, Nashville, Tennessee, USA.
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Clark JI, Moon J, Hutchins LF, Sosman JA, Kast WM, Da Silva DM, Liu PY, Thompson JA, Flaherty LE, Sondak VK. Phase 2 trial of combination thalidomide plus temozolomide in patients with metastatic malignant melanoma: Southwest Oncology Group S0508. Cancer 2010; 116:424-31. [PMID: 19918923 PMCID: PMC2811758 DOI: 10.1002/cncr.24739] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In limited institution phase 2 studies, thalidomide and temozolomide has yielded response rates (RRs) up to 32% for advanced melanoma, leading to the use of this combination as "standard" by some. We conducted a multicenter phase 2 trial to better define the clinical efficacy of thalidomide and temozolomide and the immune modulatory effects of thalidomide, when combined with temozolomide, in patients with metastatic melanoma. METHODS Patients must have had stage IV cutaneous melanoma, no active brain metastases, Zubrod PS 0-1, up to 1 prior systemic therapy excluding thalidomide, temozolomide, or dacarbazine, adequate organ function, and given informed consent. The primary endpoint was 6-month progression-free survival (PFS). Secondary endpoints included overall survival (OS), RR, toxicities, and assessment of relationships between biomarkers and clinical outcomes. Patients received thalidomide (200 mg/d escalated to 400 mg/d for patients <70, or 100 mg/d escalated to 250 mg/d for patients > or =70) plus temozolomide (75 mg/m(2)/d x 6 weeks, and then 2 weeks rest). RESULTS Sixty-four patients were enrolled; 2 refused treatment. The 6-month PFS was 15% (95% confidence interval [CI], 6%-23%), the 1-year OS was 35% (95% CI, 24%-47%), and the RR was 13% (95% CI, 5%-25%), all partial. One treatment-related death occurred from myocardial infarction; 3 other grade 4 events occurred, including pulmonary embolism, neutropenia, and central nervous system (CNS) ischemia. There was no significant correlation between biomarkers and PFS or OS. CONCLUSIONS This combination of thalidomide and temozolomide does not appear to have a clinical benefit that exceeds dacarbazine alone. We would not recommend it further for phase 3 trials or for standard community use.
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Affiliation(s)
- Joseph I Clark
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Division of Hematology/Oncology, 2160 South First Avenue, Maywood, IL 60153, USA.
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Atkins MB, Hsu J, Lee S, Cohen GI, Flaherty LE, Sosman JA, Sondak VK, Kirkwood JM. Phase III trial comparing concurrent biochemotherapy with cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon alfa-2b with cisplatin, vinblastine, and dacarbazine alone in patients with metastatic malignant melanoma (E3695): a trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 2008; 26:5748-54. [PMID: 19001327 DOI: 10.1200/jco.2008.17.5448] [Citation(s) in RCA: 250] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Phase II trials with biochemotherapy (BCT) have shown encouraging response rates in metastatic melanoma, and meta-analyses and one phase III trial have suggested a survival benefit. In an effort to determine the relative efficacy of BCT compared with chemotherapy alone, a phase III trial was performed within the United States Intergroup. PATIENTS AND METHODS Patients were randomly assigned to receive cisplatin, vinblastine, and dacarbazine (CVD) either alone or concurrent with interleukin-2 and interferon alfa-2b (BCT). Treatment cycles were repeated at 21-day intervals for a maximum of four cycles. Tumor response was assessed after cycles 2 and 4, then every 3 months. RESULTS Four hundred fifteen patients were enrolled, and 395 patients (CVD, n = 195; BCT, n = 200) were deemed eligible and assessable. The two study arms were well balanced for stratification factors and other prognostic factors. Response rate was 19.5% for BCT and 13.8% for CVD (P = .140). Median progression-free survival was significantly longer for BCT than for CVD (4.8 v 2.9 months; P = .015), although this did not translate into an advantage in either median overall survival (9.0 v 8.7 months) or the percentage of patients alive at 1 year (41% v 36.9%). More patients experienced grade 3 or worse toxic events with BCT than CVD (95% v 73%; P = .001). CONCLUSION Although BCT produced slightly higher response rates and longer median progression-free survival than CVD alone, this was not associated with either improved overall survival or durable responses. Considering the extra toxicity and complexity, this concurrent BCT regimen cannot be recommended for patients with metastatic melanoma.
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Affiliation(s)
- Michael B Atkins
- Beth Israel Deaconess Medical Center; Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Affiliation(s)
- Vernon K Sondak
- H Lee Moffitt Cancer Center and University of South Florida College of Medicine, Tampa, FL 33612, USA.
| | - Lawrence E Flaherty
- Karmanos Cancer Institute and Wayne State University School of Medicine, MI, Detroit, USA
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Hutchins LF, Moon J, Clark JI, Thompson JA, Lange MK, Flaherty LE, Sondak VK. Evaluation of interferon alpha-2B and thalidomide in patients with disseminated malignant melanoma, phase 2, SWOG 0026. Cancer 2008; 110:2269-75. [PMID: 17932881 DOI: 10.1002/cncr.23035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Southwest Oncology Group protocol 0026 evaluated interferon alpha-2b plus thalidomide in patients with disseminated melanoma. Endpoints were 6-month progression-free survival rate, response rate, and toxicity. METHODS Twenty-six patients with Stage IV melanoma, measurable or nonmeasurable disease, performance status of 0-2, and adequate renal and hepatic functions were registered. One prior systemic therapy for Stage IV disease was required. Interferon was administered subcutaneously (1 million U) twice daily; thalidomide was orally administered (200-400 mg) each evening in a dose-escalating manner. Response evaluations using Response Evaluation Criteria in Solid Tumors were performed every 8 weeks. RESULTS After 2 sudden deaths and 1 grade 4 treatment-related pulmonary embolism, this study was temporarily closed. One patient with deep-vein thrombosis and 2 with grade 3 cardiac arrhythmias were reported. The relationship of these events to the treatment was worrisome but not definitive. Grade 3 treatment-related adverse events occurred in 14 of 26 patients. Because of concern for patient safety the study was permanently closed. No treatment responses were seen in the 22 evaluable patients. Estimated 6-month progression-free survival rate was 15% (95% confidence interval [CI], 2%-29%), estimated 6-month overall survival was 58% (95% CI, 39%-77%), and estimated response probability was 0 of 22 (95% CI, 0%-15%). CONCLUSIONS This regimen demonstrated a lack of response and was associated with multiple severe toxicities. Further investigation of interferon alpha-2b and thalidomide in this dose and schedule is not warranted.
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Affiliation(s)
- Laura F Hutchins
- Division of Hematology/Oncology, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Vaishampayan UN, Heilbrun LK, Marsack C, Smith DW, Flaherty LE. Phase II trial of pegylated interferon and thalidomide in malignant metastatic melanoma. Anticancer Drugs 2007; 18:1221-6. [PMID: 17893524 DOI: 10.1097/cad.0b013e3282eea391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pegylated interferon and thalidomide demonstrate immunomodulatory and antiangiogenic activity, and efficacy in melanoma. The combination was evaluated in a phase II trial. Eligibility included biopsy-confirmed malignant melanoma with metastases and progression, maximum of two earlier systemic therapies, performance status of 0-2, and adequate hepatic, bone marrow and renal function. Pegylated interferon was administered at a dose of 0.5 microg/kg subcutaneously weekly and thalidomide 200 mg orally daily. Toxicity was evaluated every 2 weeks and response every 8 weeks. Eighteen patients were enrolled in this trial. Median age was 55.5 years (range: 29-80 years). Seventeen patients had visceral metastases and one had lymph node-only metastases. Two patients had brain metastases. Nine patients had received earlier adjuvant therapy and 16 patients had received earlier therapy for metastatic disease. Performance status was 0, 1 and 2 in 11, six and one patients, respectively. Severe (grade 4) toxicities observed were anemia in two patients and thrombocytopenia in one patient. No treatment-related deaths occurred. Dose escalation of thalidomide to 300 mg daily was feasible in four patients. One therapy-related hospitalization for nausea and dehydration occurred. No objective responses were noted; three patients demonstrated disease stabilization. The regimen of pegylated interferon and thalidomide was well tolerated. The combination, however, failed to demonstrate clinical efficacy in pretreated metastatic malignant melanoma.
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Affiliation(s)
- Ulka N Vaishampayan
- Division of Oncology, Department of Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
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Vaishampayan UN, Heilbrun LK, Shields AF, Lawhorn-Crews J, Baranowski K, Smith D, Flaherty LE. Phase II trial of interferon and thalidomide in metastatic renal cell carcinoma. Invest New Drugs 2006; 25:69-75. [PMID: 16937078 DOI: 10.1007/s10637-006-9005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 07/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the toxicity and efficacy of interferon and thalidomide combination in a phase II clinical trial. PATIENTS AND METHODS Eligibility included metastatic renal cancer with a maximum of two prior regimens, performance status of 0-2 and adequate renal, hepatic and bone marrow function. RESULTS Twenty patients were enrolled on this phase II trial. Median age was 60.5 years (Range: 39-75 years). 17 patients had visceral metastases (lung/liver/both) and 3 patients had lymph node only metastases. A total of 26 cycles of 4 weeks each were administered; median of 1 cycle and range from 0-9 cycles. The therapy was poorly tolerated with grade 3 adverse events noted in 12 (60%) of the 20 patients. No objective responses were noted. Of the 14 response evaluable patients, one had an unconfirmed response (38% decrease in size) and one had prolonged disease stabilization for 10 months. The median time to progression was 1.0 month and median survival was 2.8 months. Pre and post therapy PET scans were performed nine weeks apart on one patient. The mean standardized uptake values (SUV) declined from 1.45 (SUV min-max 0.89-1.76) to 1.12 (SUV min-max 0.55-1.47), denoting anti vascular effect. The patient did not have an objective response but had a disease stabilization sustained for 10 months. CONCLUSION The combination of interferon and thalidomide has minimal efficacy and considerable toxicity which makes this combination unworthy of future investigation in metastatic renal cancer.
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Affiliation(s)
- Ulka N Vaishampayan
- Division of Oncology, Department of Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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Muss HB, Von Roenn J, Damon LE, Deangelis LM, Flaherty LE, Harari PM, Kelly K, Kosty MP, Loscalzo MJ, Mennel R, Mitchell BS, Mortimer JE, Muggia F, Perez EA, Pisters PWT, Saltz L, Schapira L, Sparano J. ACCO: ASCO Core Curriculum Outline. J Clin Oncol 2005; 23:2049-77. [PMID: 15728218 DOI: 10.1200/jco.2005.99.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hyman B Muss
- Education, Science and Career Development, American Society of Clinical Oncology, 1900 Duke Street, Suite 200, Alexandria, VA 22314, USA
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McDermott DF, Regan MM, Clark JI, Flaherty LE, Weiss GR, Logan TF, Kirkwood JM, Gordon MS, Sosman JA, Ernstoff MS, Tretter CPG, Urba WJ, Smith JW, Margolin KA, Mier JW, Gollob JA, Dutcher JP, Atkins MB. Randomized Phase III Trial of High-Dose Interleukin-2 Versus Subcutaneous Interleukin-2 and Interferon in Patients With Metastatic Renal Cell Carcinoma. J Clin Oncol 2005; 23:133-41. [PMID: 15625368 DOI: 10.1200/jco.2005.03.206] [Citation(s) in RCA: 540] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Cytokine Working Group conducted a randomized phase III trial to determine the value of outpatient interleukin-2 (IL-2) and interferon alfa-2b (IFN) relative to high-dose (HD) IL-2 in patients with metastatic renal cell carcinoma. Patients and Methods Patients were stratified for bone and liver metastases, primary tumor in place, and Eastern Cooperative Oncology Group performance status 0 or 1 and then randomly assigned to receive either IL-2 (5 MIU/m2 subcutaneously every 8 hours for three doses on day 1, then daily 5 days/wk for 4 weeks) and IFN (5 MIU/m2 subcutaneously three times per week for 4 weeks) every 6 weeks or HD IL-2 (600,000 U/kg/dose intravenously every 8 hours on days 1 through 5 and 15 to 19 [maximum 28 doses]) every 12 weeks. Results One hundred ninety-two patients were enrolled between April 1997 and July 2000. Toxicities were as anticipated for these regimens. The response rate was 23.2% (22 of 95 patients) for HD IL-2 versus 9.9% (nine of 91 patients) for IL-2/IFN (P = .018). Ten patients receiving HD IL-2 were progression-free at 3 years versus three patients receiving IL-2 and IFN (P = .082). The median response durations were 24 and 15 months (P = .18), and median survivals were 17.5 and 13 months (P = .24). For patients with bone or liver metastases (P = .001) or a primary tumor in place (P = .040), survival was superior with HD IL-2. Conclusion This randomized phase III trial provides additional evidence that HD IL-2 should remain the preferred therapy for selected patients with metastatic renal cell carcinoma.
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Affiliation(s)
- David F McDermott
- Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, E/KS-153, Boston, MA 02215, USA.
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Abstract
Despite the evaluation of many different chemotherapy and immunotherapy drugs, the median survival in metastatic melanoma remains in the range of 6 to 9 months. Combination chemotherapy or combination immunotherapy has not produced a significant advantage over single-agent therapy but is associated with greater toxicity. Based on the potential for additive or synergistic activity with the combination of chemotherapy and biotherapy, many investigators have evaluated biochemotherapy in patients with advanced melanoma. Aggregate results suggest that biochemotherapy is tolerable and produces a response rate in the range of 50% with a complete response rate of 10%. Although these phase II results appear superior to previous results with chemotherapy or immunotherapy alone, the true benefits of biochemotherapy can only be determined with the results of randomized phase III trials; therefore, biochemotherapy should be considered an as yet experimental therapy. Many other issues regarding biochemotherapy, such as sequence, outpatient administration, and use in the adjuvant setting, for stage III melanoma are being actively evaluated.
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Affiliation(s)
- Lawrence E Flaherty
- Department of Internal Medicine, Division of Hematology and Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Tuthill RJ, Unger JM, Liu PY, Flaherty LE, Sondak VK. Risk assessment in localized primary cutaneous melanoma: a Southwest Oncology Group study evaluating nine factors and a test of the Clark logistic regression prediction model. Am J Clin Pathol 2002; 118:504-11. [PMID: 12375635 DOI: 10.1309/wbf7-n8kh-71kt-rvq9] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We studied 9 clinical and pathologic factors in 259 patients using Cox model regression analysis to determine which factors have independent predictive value. Median follow-up time in all patients still alive was 12.3 years (range, 1.7 to 16.7 years). Tumor-infiltrating lymphocytes (P = .005), primary site (P = .006), and thickness (P = .02) had independent predictive value. Ulceration (P = .06) and age (P = .07) had marginal value. We used 6 of those factors to test the Clark logistic regression prediction model, which accurately predicted 8-year survival in 121 (72.9%) of 166 patients and accurately predicted melanoma-specific mortality in 32 (43%) of 74 patients. The combined or overall accuracy of the Clark model was only 64%.
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Affiliation(s)
- Ralph J Tuthill
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA
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Sosman JA, Unger JM, Liu PY, Flaherty LE, Park MS, Kempf RA, Thompson JA, Terasaki PI, Sondak VK. Adjuvant immunotherapy of resected, intermediate-thickness, node-negative melanoma with an allogeneic tumor vaccine: impact of HLA class I antigen expression on outcome. J Clin Oncol 2002; 20:2067-75. [PMID: 11956267 DOI: 10.1200/jco.2002.08.072] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE An association between expression of > or = two of five HLA class I antigens (HLA-A2, HLA-A28, HLA-B44, HLA-B45, and HLA-C3; collectively called M5) and response to an allogeneic melanoma vaccine (Melacine; Corixa Corporation, Seattle, WA) has been described in stage IV melanoma. This study investigated whether class I antigen expression impacted relapse-free survival (RFS) after adjuvant therapy with this vaccine. PATIENTS AND METHODS We performed class I (HLA-A, HLA-B, and HLA-C) serotyping on patients enrolled onto Southwest Oncology Group Trial 9035, a randomized, observation-controlled, phase III trial of adjuvant Melacine. All patients had clinically node-negative cutaneous melanoma (1.5 to 4.0 mm). Interactions between treatment and class I antigen expression were tested. Analyses involved all serotyped patients and were adjusted for tumor thickness, method of nodal staging, sex, ulceration, and primary tumor site. RESULTS HLA typing was performed on 553 (80%) of the 689 enrolled patients (294 vaccinated and 259 observed). Expression of > or = two M5 antigens was associated with a superior vaccine treatment effect. Among patients who matched > or = two of the M5, the 97 vaccine-treated patients had improved RFS compared with the 78 observation patients (5-year relapse-free survival, 83% v 59%; P =.0002). The major components of this effect were contributed by HLA-A2 and HLA-C3. Among those who were HLA-A2-positive and/or HLA-C3-positive, the 5-year RFS for vaccinated patients was 77%, compared with 64% for observation (P =.004). There was no impact of HLA-A2 and/or HLA-C3 expression among observation patients. CONCLUSION This prospective analysis indicates a highly significant benefit of adjuvant therapy with Melacine among patients expressing > or = two of the M5 class I antigens, validating a prior observation in stage IV disease. HLA-A2 and HLA-C3 contributed most to this effect. Processed melanoma peptides found in Melacine may be presented by HLA-A2 and HLA-C3 and play a role in preventing relapse in vaccinated patients.
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Rao UNM, Ibrahim J, Flaherty LE, Richards J, Kirkwood JM. Implications of microscopic satellites of the primary and extracapsular lymph node spread in patients with high-risk melanoma: pathologic corollary of Eastern Cooperative Oncology Group Trial E1690. J Clin Oncol 2002; 20:2053-7. [PMID: 11956265 DOI: 10.1200/jco.2002.08.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To correlate the presence of extracapsular spread (ECS) of regional nodal metastases, and micrometastasis near the primary tumor, with disease outcome in the intergroup study E1690 in relation to the impact of recombinant interferon-alfa (rIFN alpha)-2b. PATIENTS AND METHODS E1690 included 642 patients with American Joint Committee on Cancer stage IIB or III cutaneous melanoma. Patients were randomized into high- and low-dose rIFN alpha-2b treatment arms and an observation arm. Pathologic slides were reviewed for selected parameters from at least half of the subjects in all three arms. Evaluation of the primary tumor included notations regarding ulceration, mitotic activity, thickness, microscopic satellites (MS), and nodal ECS on a standardized pathology form. These data were collated in relation to relapse-free survival (RFS) and overall survival (OS) at 50 months' follow-up and studied using Cox regression analysis. RESULTS Ulceration, mitotic activity, thickness, and size of tumor-bearing lymph nodes did not show a statistically significant correlation with either OS or RFS across all treatment arms. The presence of MS was correlated with RFS (P =.0008) and OS (P =.05). ECS correlated with RFS (hazard ratio = 1.44, P =.032) but not OS (P =.11). CONCLUSION The presence of MS (in 6% [18 of 308 patients]) had a significant adverse impact on both RFS (P =.0008) and OS (P =.053). Ulceration, mitotic activity, thickness, and number of positive lymph nodes had no significant effect on OS in this subset study (univariate or multivariate Cox analysis). The presence of ECS in lymph nodes had a significant adverse effect on RFS (P =.032) but not on OS.
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Affiliation(s)
- U N M Rao
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, PA 15213-2582, USA.
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Sondak VK, Liu PY, Tuthill RJ, Kempf RA, Unger JM, Sosman JA, Thompson JA, Weiss GR, Redman BG, Jakowatz JG, Noyes RD, Flaherty LE. Adjuvant immunotherapy of resected, intermediate-thickness, node-negative melanoma with an allogeneic tumor vaccine: overall results of a randomized trial of the Southwest Oncology Group. J Clin Oncol 2002; 20:2058-66. [PMID: 11956266 DOI: 10.1200/jco.2002.08.071] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with clinically negative nodes constitute over 85% of new melanoma cases. There is no adjuvant therapy for intermediate-thickness, node-negative melanoma patients. PATIENTS AND METHODS The Southwest Oncology Group conducted a randomized phase III trial of an allogeneic melanoma vaccine for 2 years versus observation in patients with intermediate-thickness (1.5 to 4.0 mm or Clark's level IV if thickness unknown), clinically or pathologically node-negative melanoma (T3N0M0). RESULTS Six hundred eighty-nine patients were accrued over 4.5 years; 89 patients (13%) were ineligible. Surgical node staging was performed in 24%, the remainder were clinical N0. Thirteen eligible patients refused assigned treatment: seven on the observation arm and six on the vaccine arm. Most vaccine patients experienced mild to moderate local toxicity, but 26 (9%) experienced grade 3 toxicity. After a median follow-up of 5.6 years, there were 107 events (tumor recurrences or deaths) among the 300 eligible patients randomized to vaccine compared with 114 among the 300 eligible patients randomized to observation (hazard ratio, 0.92; Cox-adjusted P(2) = 0.51). There was no difference in vaccine efficacy among patients with tumors < or = 3 mm or > 3 mm. CONCLUSION This represents one of the largest randomized, controlled trials of adjuvant vaccine therapy in human cancer reported to date. Compliance with randomization was excellent, with only 2% refusing assigned therapy. There is no evidence of improved disease-free survival among patients randomized to receive vaccine, although the power to detect a small but clinically significant difference was low. Future investigations of adjuvant vaccine approaches for patients with intermediate-thickness melanoma should involve larger numbers of patients and ideally should include sentinel node biopsy staging.
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Affiliation(s)
- Vernon K Sondak
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
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Whitehead RP, Unger JM, Flaherty LE, Eckardt JR, Taylor SA, Didolkar MS, Samlowski W, Sondak VK. Phase II trial of CI-980 in patients with disseminated malignant melanoma and no prior chemotherapy. A Southwest Oncology Group study. Invest New Drugs 2002; 19:239-43. [PMID: 11561681 DOI: 10.1023/a:1010624702340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Malignant melanoma is increasing in frequency at a rapid rate in the United States. Metastatic disease is chemoresistant with DTIC considered the most active single agent. CI-980 is a synthetic mitotic inhibitor that blocks the assembly of tubulin and microtubules. It has shown cytotoxic activity against a broad spectrum of murine and human tumor cell tines. CI-980 can cross the blood brain barrier, is effective when given orally or parenterally, and is active against multidrug resistant cell lines overexpressing P-glycoprotein. In this trial, patients with disseminated melanoma with measurable disease, SWOG performance status of 0-1, no prior chemotherapy or immunotherapy for metastatic disease, and adequate hepatic and renal function, were enrolled. Treatment with CI-980 was given by 72 h continuous i.v. infusion at a dose of 4.5 mg/m2/day, days 1-3 every 21 days. Twenty-four patients were registered on this study with no patients ineligible. They ranged in age from 33-78 with performance status of 0 in 15 patients and 1 in 9 patients. Nineteen patients had visceral disease with 12 having liver involvement. There were no confirmed responses. The overall response rate was 0% (95% CI 0%-14%). The median overall survival is eleven months (95% CI 4-14 months). The most common toxicities were hematologic and consisted of leukopenia/granulocytopenia and anemia, with nausea/vomiting and malaise/fatigue/weakness also frequent. CI-980 administered at this dose and schedule has insufficient activity in the treatment of disseminated malignant melanoma to warrant further investigation.
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Affiliation(s)
- R P Whitehead
- University of Texas Medical Branch at Galveston, USA
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Whitehead RP, Unger JM, Flaherty LE, Kraut EH, Mills GM, Klein CE, Chapman RA, Doolittle GC, Hammond N, Sondak VK. A phase II trial of pyrazine diazohydroxide in patients with disseminated malignant melanoma and no prior chemotherapy--Southwest Oncology Group study. Invest New Drugs 2002; 20:105-11. [PMID: 12003185 DOI: 10.1023/a:1014484821460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Malignant melanoma is rapidly increasing in the United States. Metastatic disease responds poorly to currently available chemotherapy. Pyrazine diazohydroxide (PZDH) is a new agent inhibiting DNA synthesis that is active in mouse tumor models and human xenografts and lacks cross resistance with multiple standard agents. In this phase II trial, patients with no prior chemotherapy or immunotherapy for metastatic disease and performance status (SWOG) of 0-1, were treated with pyrazine diazohydroxide at a dose of 100 mg/m2/day by i.v. bolus injection over 5-15 minutes for 5 consecutive days every 6 weeks. There were 23 eligible patients entered on this trial with 74% having PS of 0 and 91% having visceral metastases. There were no confirmed anti-tumor responses. The overall response rate is 0% (95% CI 0%-15%). Median overall survival is six months (95% CI 5-8 months). The most common toxicities were hematologic and consisted of lymphopenia, thrombocytopenia, anemia, and leukopenia. Fatigue. and nausea and vomiting were the next most common toxicities. Pyrazine diazohydroxide by this dose and schedule has insufficient activity in the treatment of disseminated malignant melanoma to warrant further investigation.
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Flaherty LE, Atkins M, Sosman J, Weiss G, Clark JI, Margolin K, Dutcher J, Gordon MS, Lotze M, Mier J, Sorokin P, Fisher RI, Appel C, Du W. Outpatient biochemotherapy with interleukin-2 and interferon alfa-2b in patients with metastatic malignant melanoma: results of two phase II cytokine working group trials. J Clin Oncol 2001; 19:3194-202. [PMID: 11432886 DOI: 10.1200/jco.2001.19.13.3194] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Cytokine Working Group performed a randomized phase II trial of two outpatient biochemotherapy regimens to identify an outpatient regimen with high antitumor activity and less toxicity than inpatient regimens which might be compared with chemotherapy or inpatient biochemotherapy regimens in future phase III trials. PATIENTS AND METHODS Eighty-one patients with metastatic malignant melanoma received dacarbazine 250 mg/m(2)/d intravenously (IV) and cisplatin 25 mg/m(2)/d IV on days 1, 2, and 3, plus interferon (IFN) alfa-2b 5 mU/m(2) subcutaneously (SC) on days 6, 8, 10, 13, and 15, given every 28 days. Interleukin-2 (IL-2) was given daily on days 6 to 10 and 13 to 15. In group 1, IV IL-2 was given at 18.0 MU/m(2), and in group 2, SC IL-2 was given at 5.0 mU/m(2). RESULTS In group 1 (IV IL-2), there were five complete responses (CRs) and 11 partial responses (PRs) among 44 patients (objective response rate [ORR], 36%; 95% confidence interval [CI], 22% to 51%). In group 2 (SC IL-2), there was one CR and five PRs among the 36 patients (ORR, 17%; 95% CI, 4% to 29%). The median survival was 10.7 months in group 1 and 7.3 months in group 2. Eleven patients in group 1 and four patients in group 2 remain alive as of the last follow-up. Toxicities in both groups were similar. No patient required hospitalization for neutropenic fever. CONCLUSION Biochemotherapy has activity in these outpatient regimens with acceptable toxicity. The antitumor activity observed with the IV IL-2 regimen seems similar to that of inpatient biochemotherapy regimens. If inpatient biochemotherapy regimens develop an established role in the management of melanoma, future phase III trial comparisons with this outpatient IV IL-2 regimen would be appropriate.
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Affiliation(s)
- L E Flaherty
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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Abstract
BACKGROUND Some studies have suggested that women with metastatic malignant melanoma have a better survival rate than men. However, little is known about the effect of gender on survival in combination with other clinical variables and treatment variables. Thus, an analysis of 813 eligible patients from 15 consecutive Southwest Oncology Group (SWOG) Phase II or III trials evaluating chemotherapy or chemoimmunotherapy for metastatic melanoma was performed. METHODS A multivariate Cox regression model was used. RESULTS Poor performance status (P < 0.001), more organ sites with metastases (OSM) (P < 0.001), liver involvement (P < 0.001), and nonliver visceral involvement (P = 0.01) were highly significant predictors of worse survival, whereas the disease free interval (P = 0.08) had borderline significance. After adjustment for all factors, there was no difference in overall survival between men and women (P = 0.19). Women had a longer disease free interval (P = 0.003) and fewer OSM (P = 0.004) at study registration than men. CONCLUSIONS The current study found that performance status, OSM, and type of visceral involvement were independent predictors of survival in patients with metastic malignant melanoma and should be used as stratification factors in future Phase III trials. However, the current study also found that gender did not appear to be a significant independent predictor of survival for this stage of disease. A longer disease free interval from initial diagnosis and fewer OSMs may partly explain the improved outcome reported for women in selected trials. The study concluded that further investigation of the biologic differences at early stage diagnosis should be undertaken to determine whether women truly have a different pace of disease progression and a different metastatic pattern.
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Affiliation(s)
- J M Unger
- Southwest Oncology Group Statistical Center, Seattle, Washington , USA
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