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Justice JM, Slutsky AS, Stanford N, Isennock C, Siddiqui S, Zamir H, Walker JR, Brady MF. Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient. Respir Care 2024:respcare.11588. [PMID: 38688544 DOI: 10.4187/respcare.11588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. METHODS This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). RESULTS A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). CONCLUSIONS Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.
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Affiliation(s)
- Joshua M Justice
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; and Department of Emergency Medicine, TriStar Centennial Medical Center, Nashville, Tennessee.
| | - Arthur S Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Stanford
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher Isennock
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | - J Richard Walker
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mark F Brady
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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2
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Ni S, Hawkins B, Brady MF. A Novel Approach to the Treatment of a Stingray Injury to the Abdomen. R I Med J (2013) 2023; 106:9-10. [PMID: 37643332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Samantha Ni
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Brian Hawkins
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Mark F Brady
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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3
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Castaneda-Guarderas A, Brady MF, Bruccoleri R. Dermal Toxicity from a Paraquat-Poisoned Patient's Urine. R I Med J (2013) 2023; 106:40-41. [PMID: 37195161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Ana Castaneda-Guarderas
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Mark F Brady
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Rebecca Bruccoleri
- Tennessee Poison Center and Vanderbilt School of Medicine, Nashville, TN
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4
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Brady MF, Kumar P, Currier C, Ruha AM. Treatment of Scorpion Envenomations in the Middle East: Understanding the Stinging Controversy. Wilderness Environ Med 2023:S1080-6032(23)00002-9. [PMID: 36872164 DOI: 10.1016/j.wem.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Mark F Brady
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
| | - Prasanna Kumar
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
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5
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Copeland LJ, Brady MF, Burger RA, Rodgers WH, Huang HQ, Cella D, O'Malley DM, Street DG, Tewari KS, Bender DP, Morris RT, Lowery WJ, Miller DS, Dewdney SB, Spirtos NM, Lele SB, Guntupalli S, Ueland FR, Glaser GE, Mannel RS, DiSaia PJ. Phase III Randomized Trial of Maintenance Taxanes Versus Surveillance in Women With Advanced Ovarian/Tubal/Peritoneal Cancer: A Gynecologic Oncology Group 0212:NRG Oncology Study. J Clin Oncol 2022; 40:4119-4128. [PMID: 35759733 PMCID: PMC9746779 DOI: 10.1200/jco.22.00146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare taxane maintenance chemotherapy, paclitaxel (P) and paclitaxel poliglumex (PP), with surveillance (S) in women with ovarian, peritoneal, or fallopian tube (O/PC/FT) cancer who attained clinical complete response after first-line platinum-taxane therapy. METHODS Women diagnosed with O/PC/FT cancer who attained clinical complete response after first-line platinum-taxane-based chemotherapy were randomly allocated 1:1:1 to S or maintenance, P 135 mg/m2 once every 28 days for 12 cycles, or PP at the same dose and schedule. Overall survival (OS) was the primary efficacy end point. RESULTS Between March 2005 and January 2014, 1,157 individuals were enrolled. Grade 2 or worse GI adverse events were more frequent among those treated with taxane (PP: 20%, P: 27% v S: 11%). Grade 2 or worse neurologic adverse events occurred more often with taxane treatment (PP: 46%, P: 36% v S: 14%). At the fourth scheduled interim analysis, both taxane regimens passed the OS futility boundary and the Data Monitoring Committee approved an early release of results. With a median follow-up of 8.1 years, 653 deaths were reported; none were attributed to the study treatment. Median survival durations were 58.3, 56.8, and 60.0 months for S, P, and PP, respectively. Relative to S, the hazard of death for P was 1.091 (95% CI, 0.911 to 1.31; P = .343) and for PP, it was 1.033 (95% CI, 0.862 to 1.24; P = .725). The median times to first progression or death (PFS) were 13.4, 18.9, and 16.3 months for S, P, and PP, respectively. Hazard ratio = 0.801; 95% CI, 0.684 to 0.938; P = .006 for P and hazard ratio = 0.854; 95% CI, 0.729 to 1.00; P = .055 for PP. CONCLUSION Maintenance therapy with P and PP did not improve OS among patients with newly diagnosed O/tubal/peritoneal cancer, but may modestly increase PFS. GI and neurologic toxicities were more frequent in the taxane treatment arms.
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Affiliation(s)
| | - Mark F. Brady
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, Buffalo, NY
| | | | | | - Helen Q. Huang
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, Buffalo, NY
| | | | | | | | | | | | | | - William J. Lowery
- Murtha Cancer Center, Walter Reed National Military Medical Center, Chicago, IL
| | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
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6
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Ni SA, Carpenter RS, Walker JR, Holley J, Brady MF. Emergency Medical Services Responder Manual Ventilation Performance. PREHOSP EMERG CARE 2022; 27:496-500. [PMID: 35442149 DOI: 10.1080/10903127.2022.2066234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: Manual ventilation is a basic skill that every emergency medical services (EMS) responder is expected to perform proficiently. Improper manual ventilation may result in significant morbidity; however, there is no feedback mechanism or method of control for the volume, pressure, or frequency during manual ventilation. In this study, we aimed to quantify the volume and peak pressures of manually delivered breaths using a simulated lung.Methods: One hundred ninety-nine volunteer EMS responders from the EMS World Expo 2019 and EMS Today 2020 participated in this study. Each volunteer manually ventilated a simulated lung using a bag-valve-mask (BVM) for 18 breaths. Descriptive statistics were computed for peak pressures (Ppeak) and tidal volumes (VT)), and a multivariable linear regression was conducted to determine whether there was an independent correlation between Ppeak or VT and seven different variables.Results: Both Ppeak and VT delivered by EMS responders had a high level of variability; 82.9% of clinicians delivered at least one breath exceeding the recommended safety thresholds; and 98.0% delivered at least one breath that was inadequate or excessive. Our results showed no likely clinical significant role of sex, hand size, frequency of use, or years of experience in determining Ppeak and VT. Tidal volumes were significantly higher in males (p < 0.001), those using two-hand manual ventilation (p < 0.001), shorter hand length (p = 0.013), higher confidence (p < 0.001), and more years of experience (p < 0.001). Peak pressures were significantly higher in those using two-hand manual ventilation (p < 0.001), wider hand width (p = 0.004), higher confidence (p < 0.001), less frequent use of the BVM per month (p < 0.001), more experience (p < 0.001).Conclusions: Our study demonstrated large variability of VT and Ppeak within and, to a lesser degree, between clinicians. Of the seven variables that might have affected tidal volume or peak pressures, only the use of two hands versus one hand had a potentially clinically significant effect. Our study identifies a clear need for BVM improvement to ensure every practitioner can deliver breaths at appropriate volumes and safe pressures.
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Affiliation(s)
- Samantha A Ni
- University of Tennessee Health Science Center, Department of Emergency Medicine, Memphis, TN
| | - Randy S Carpenter
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - J Richard Walker
- University of Tennessee Health Science Center, UTHSC Department of Emergency Medicine, Memphis, TN
| | - Joe Holley
- University of Tennessee Health Science Center, UTHSC Department of Emergency Medicine, Memphis, TN
| | - Mark F Brady
- University of Tennessee Health Science Center, UTHSC Department of Emergency Medicine, Memphis, TN
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7
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Liu JF, Brady MF, Matulonis UA, Miller A, Kohn EC, Swisher EM, Cella D, Tew WP, Cloven NG, Muller CY, Bender DP, Moore RG, Michelin DP, Waggoner SE, Geller MA, Fujiwara K, D'Andre SD, Carney M, Alvarez Secord A, Moxley KM, Bookman MA. Olaparib With or Without Cediranib Versus Platinum-Based Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer (NRG-GY004): A Randomized, Open-Label, Phase III Trial. J Clin Oncol 2022; 40:2138-2147. [PMID: 35290101 DOI: 10.1200/jco.21.02011] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Platinum-based chemotherapy is the standard of care for platinum-sensitive ovarian cancer, but complications from repeated platinum therapy occur. We assessed the activity of two all-oral nonplatinum alternatives, olaparib or olaparib/cediranib, versus platinum-based chemotherapy. PATIENTS AND METHODS NRG-GY004 is an open-label, randomized, phase III trial conducted in the United States and Canada. Eligible patients had high-grade serous or endometrioid platinum-sensitive ovarian cancer. Patients were randomly assigned 1:1:1 to platinum-based chemotherapy, olaparib, or olaparib/cediranib. The primary end point was progression-free survival (PFS) in the intention-to-treat population. Secondary end points included activity within germline BRCA-mutated or wild-type subgroups and patient-reported outcomes (PROs). RESULTS Between February 04, 2016, and November 13, 2017, 565 eligible patients were randomly assigned. Median PFS was 10.3 (95% CI, 8.7 to 11.2), 8.2 (95% CI, 6.6 to 8.7), and 10.4 (95% CI, 8.5 to 12.5) months with chemotherapy, olaparib, and olaparib/cediranib, respectively. Olaparib/cediranib did not improve PFS versus chemotherapy (hazard ratio [HR] 0.86; 95% CI, 0.66 to 1.10; P = .077). In women with germline BRCA mutation, the PFS HR versus chemotherapy was 0.55 (95% CI, 0.32 to 0.94) for olaparib/cediranib and 0.63 (95% CI, 0.37 to 1.07) for olaparib. In women without a germline BRCA mutation, the PFS HR versus chemotherapy was 0.97 (95% CI, 0.73 to 1.30) for olaparib/cediranib and 1.41 (95% CI, 1.07 to 1.86) for olaparib. Hematologic adverse events occurred more commonly with chemotherapy; however, nonhematologic adverse events were higher with olaparib/cediranib. In 489 patients evaluable for PROs, patients receiving olaparib/cediranib scored on average 1.1 points worse on the NFOSI-DRS-P subscale (97.5% CI, -2.0 to -0.2, P = .0063) versus chemotherapy; no difference between olaparib and chemotherapy was observed. CONCLUSION Combination olaparib/cediranib did not improve PFS compared with chemotherapy and resulted in reduced PROs. Notably, in patients with a germline BRCA mutation, both olaparib and olaparib/cediranib had significant clinical activity.
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Affiliation(s)
- Joyce F Liu
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA
| | - Mark F Brady
- NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ursula A Matulonis
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA
| | - Austin Miller
- NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elise C Kohn
- Gynecologic Cancer Therapeutics, National Cancer Institute, Rockville, MD
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Health System, Chicago, IL
| | - William P Tew
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - David P Bender
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Richard G Moore
- Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - David P Michelin
- Gynecologic Oncology, Cancer Research Consortium of West Michigan, Munson Medical Center, Traverse City, MI
| | | | - Melissa A Geller
- Ob/Gyn & Women's Health, University of Minnesota, Minneapolis, MN
| | - Keiichi Fujiwara
- Gynecologic Oncology, Saitama Medical University International Medical Center; Hidaka-Shi, Japan
| | - Stacy D D'Andre
- Executive Chair, Sutter Cancer Research Consortium, Sutter Health Research Enterprise, Sacramento, CA
| | - Michael Carney
- Kapialoni Medical Center for Women & Children, University of Hawaii, Honolulu, HI
| | | | - Katherine M Moxley
- Stephenson Cancer Center Gynecologic Cancers Clinic, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michael A Bookman
- Director, Gynecologic Oncology Therapeutics, Kaiser Permanente Northern California, San Francisco, CA
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8
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duPont NC, Enserro D, Brady MF, Moxley K, Walker JL, Cosgrove C, Bixel K, Tewari KS, Thaker P, Wahner Hendrickson AE, Rubin S, Fujiwara K, Casey AC, Soper J, Burger RA, Monk BJ. Prognostic significance of ethnicity and age in advanced stage epithelial ovarian cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2022; 164:398-405. [PMID: 34857397 PMCID: PMC9400113 DOI: 10.1016/j.ygyno.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Age and ethnicity are among several factors that influence overall survival (OS) in ovarian cancer. The study objective was to determine whether ethnicity and age were of prognostic significance in women enrolled in a clinical trial evaluating the addition of bevacizumab to front-line therapy. METHODS Women with advanced stage ovarian, primary peritoneal, or fallopian tube cancer were enrolled in a phase III clinical trial. All women had surgical staging and received adjuvant chemotherapy with one of three regimens. Cox proportional hazards models were used to evaluate the relationship between OS with age and race/ethnicity among the study participants. RESULTS One-thousand-eight-hundred-seventy-three women were enrolled in the study. There were 280 minority women and 328 women over the age of 70. Women age 70 and older had a 34% increase risk for death when compared to women under 60 (HR = 1.34; 95% CI 1.16-1.54). Non-Hispanic Black women had a 54% decreased risk of death with the addition of maintenance bevacizumab (HR = 0.46, 95% CI:0.26-0.83). Women of Asian descent had more hematologic grade 3 or greater adverse events and a 27% decrease risk of death when compared to non-Hispanic Whites (HR = 0.73; 95% CI: 0.59-0.90). CONCLUSIONS Non-Hispanic Black women showed a decreased risk of death with the addition of bevacizumab and patients of Asian ancestry had a lower death rate than all other minority groups, but despite these clinically meaningful improvements there was no statistically significant difference in OS among the groups.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Black or African American/statistics & numerical data
- Age Factors
- Aged
- Aged, 80 and over
- Angiogenesis Inhibitors/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian/statistics & numerical data
- Bevacizumab/therapeutic use
- Carboplatin/administration & dosage
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/pathology
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/pathology
- Chemotherapy, Adjuvant/methods
- Ethnicity/statistics & numerical data
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/pathology
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Middle Aged
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/pathology
- Prognosis
- Proportional Hazards Models
- Survival Rate
- White People/statistics & numerical data
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Affiliation(s)
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Mark F Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Katherine Moxley
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | - Joan L Walker
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | | | | | | | | | | | - Stephen Rubin
- Abramson Cancer Center at University of Pennsylvania, Philadelphia, PA 19111, USA.
| | - Keiichi Fujiwara
- Saitama Medical University/International Medical Center, Saitama, JP 350-1298, Japan.
| | | | - John Soper
- University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Robert A Burger
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), Phoenix, AZ, USA.
| | - Bradley J Monk
- University of Arizona College of Medicine, Phoenix Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ, USA.
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9
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Buechel ME, Enserro D, Burger RA, Brady MF, Wade K, Secord AA, Nixon AB, Mirniaharikandehei S, Liu H, Zheng B, O'Malley DM, Gray H, Tewari KS, Mannel RS, Birrer MJ, Moore KN. Correlation of imaging and plasma based biomarkers to predict response to bevacizumab in epithelial ovarian cancer (EOC). Gynecol Oncol 2021; 161:382-388. [PMID: 33712274 DOI: 10.1016/j.ygyno.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Increasing measures of adiposity have been correlated with poor oncologic outcomes and a lack of response to anti-angiogenic therapies. Limited data exists on the impact of subcutaneous fat density (SFD) and visceral fat density (VFD) on oncologic outcomes. This ancillary analysis of GOG-218, evaluates whether imaging markers of adiposity were predictive biomarkers for bevacizumab (bev) use in epithelial ovarian cancer (EOC). PATIENTS AND METHODS There were 1249 patients (67%) from GOG-218 with imaging measurements. SFD and VFD were calculated utilizing Hounsfield units (HU). Proportional hazards models were used to assess the association between SFD and VFD with overall survival (OS). RESULTS Increased SFD and VFD showed an increased HR for death (HR per 1-SD increase 1.12, 95% CI:1.05-1.19 p = 0.0009 and 1.13, 95% CI: 1.05-1.20 p = 0.0006 respectively). In the predictive analysis for response to bev, high VFD showed an increased hazard for death in the placebo group (HR per 1-SD increase 1.22, 95% CI: 1.09-1.37; p = 0.025). However, in the bev group there was no effect seen (HR per 1-SD increase: 1.01, 95% CI: 0.90-1.14) Median OS was 45 vs 47 months in the VFD low groups and 36 vs 42 months in the VFD high groups on placebo versus bev, respectively. CONCLUSION High VFD and SFD have a negative prognostic impact on patients with EOC. High VFD appears to be a predictive marker of bev response and patients with high VFD may be more likely to benefit from initial treatment with bev.
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Affiliation(s)
- Megan E Buechel
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
| | - Danielle Enserro
- NRG Oncology SDMC, CTD Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Robert A Burger
- University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Mark F Brady
- NRG Oncology SDMC, CTD Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Katrina Wade
- Oschner Medical Center, New Orleans, LA, United States of America.
| | - Angeles Alvarez Secord
- Duke University, Division of Gynecologic Oncology, Durham, NC, United States of America.
| | - Andrew B Nixon
- Duke University, Division of Medical Oncology, Durham, NC, United States of America.
| | | | - Hong Liu
- University of Oklahoma, Department of Electrical and Computer Engineering, Norman, OK, United States of America.
| | - Bin Zheng
- University of Oklahoma, Department of Electrical and Computer Engineering, Norman, OK, United States of America.
| | - David M O'Malley
- James Cancer Center at the Ohio State University, Columbus, OH, United States of America.
| | - Heidi Gray
- University of Washington, Seattle, WA, United States of America.
| | | | - Robert S Mannel
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
| | - Michael J Birrer
- University of Alabama, Birmingham, AL, United States of America.
| | - Kathleen N Moore
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
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10
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Stader D, Wald H, Rossi MacKay D, Mannerings A, Valuck R, Kuljis D, Brady MF. Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain. J Am Coll Emerg Physicians Open 2020; 1:1493-1499. [PMID: 33392555 PMCID: PMC7771803 DOI: 10.1002/emp2.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine whether instituting an alternative to opioids (ALTO) protocol significantly reduced opioid use in emergency departments (EDs). The secondary objective was to determine whether patient-reported pain and satisfaction were affected. METHODS Electronic health records for 10 EDs in Colorado were retrospectively examined for the 6 months before the intervention and for the same 6 months the following year after the intervention, which consisted of systemic and educational initiatives in line with the Colorado American College of Emergency Physicians 2017 Opioid Prescribing and Treatment Guidelines. RESULTS Of the total preintervention and postintervention unique patient visits, 47.2% received 1 of the drugs of interest, an opioid or ALTO, while in the ED. In aggregate, the EDs decreased opioid usage, measured in morphine equivalent units per 1000 ED visits, by 37.4% (95% confidence interval, 33.6%-76.2%; P < 0.0001) after the intervention. Statistically significant decreases were seen in every type of opioid. Statistically significant increases in ALTO usage were also noted across all study hospitals. There were no significant changes observed in Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores before and after the intervention in the hospitals with Hospital Consumer Assessment of Healthcare Providers and Systems data (preintervention mean, 3.74; postintervention mean, 3.74; P = 0.637), and there was a small but statistically significant improvement in pain scores (preintervention mean, 3.62; postintervention mean, 3.66; P = 0.002). In a subgroup analysis of patients presenting with chief complaints of long bone fractures and malignant neoplasms, there were no significant reductions in opioid use. CONCLUSIONS This study demonstrated the feasibility and effectiveness of implementing ALTO protocols to reduce opioid use in the ED setting without an overall reduction in patient perception of pain or satisfaction with care.
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Affiliation(s)
- Donald Stader
- Department of Emergency MedicineSwedish Medical CenterDenverColoradoUSA
| | - Heidi Wald
- Sisters of Charity of Leavenworth HealthBroomfieldColoradoUSA
| | | | | | - Robert Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of ColoradoAuroraColoradoUSA
| | | | - Mark F. Brady
- Department of Emergency MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
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11
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Arnold CG, Walker JR, Metter EJ, Young S, Brady MF. Pulse oximeter plethysmograph waveform and automated oscillometric sphygmomanometer for ankle-brachial index measurement. Am J Emerg Med 2020; 40:162-165. [PMID: 33143956 DOI: 10.1016/j.ajem.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES There are limited non-invasive methods to assess lower extremity arterial injuries in the emergency department (ED) and pre-hospital setting. The ankle-brachial index (ABI) requires careful auscultation by Doppler, an approach made difficult in noisy environments. We sought to determine the agreement of the ABI measured using the pulse oximeter plethysmograph waveform (Pleth) with auscultation by Doppler in a controlled setting. A secondary outcome sought to examine the agreement of ABI by automated oscillometric sphygmomanometer (AOS) with Doppler. METHODS We measured blood pressure in the right upper and lower extremities of healthy volunteers using: (1) Doppler and manual sphygmomanometer; (2) Pleth and manual sphygmomanometer; and (3) AOS. The Bland-Altman approach to assessing agreement between methods was used comparing mean differences between ABI pairs to their means for Doppler versus Pleth and Doppler versus AOS. The intraclass correlation coefficient (ICC) from mixed effects models examined intra- and inter-rater reliability. RESULTS Among 100 participants with normal ABI the mean ABI (95%CI) were Doppler 1.11 (0.90-1.33), Pleth 1.10 (0.91-1.30), and AOS 1.10 (0.90-1.30). The ABI difference (95% CI for limits of agreement) were 0.01 (-0.20,0.18) for Doppler-Pleth and 0.02 (-0.26, 0.22) for Doppler-AOS. The ICC for the Doppler-Pleth comparison (ICC = 0.56, 95% CI 0.47-0.63) was greater than for the Doppler-AOS (ICC = 0.32, 95% CI 0.19-0.43). CONCLUSIONS The ABI measured using the Pleth has a high level of agreement with measurement by Doppler. The AOS and Doppler have good agreement with greater measurement variability. Pleth and AOS may be reasonable alternatives to Doppler for ABI.
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Affiliation(s)
- Cosby G Arnold
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA.
| | - J Richard Walker
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shane Young
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mark F Brady
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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12
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Justice JM, Holley JE, Brady MF, Walker JR. Association of race and socioeconomic status with the rate of bystander-initiated CPR in Memphis. J Am Coll Emerg Physicians Open 2020; 1:440-444. [PMID: 33000068 PMCID: PMC7493508 DOI: 10.1002/emp2.12095] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
STUDY OBJECTIVE This study evaluated the association of race and socioeconomic status with the rate of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest in Memphis, TN and compared it to 25 years prior. METHODS This was a retrospective cross-sectional study of out-of-hospital cardiac arrest events in the Memphis area from 2012-2018. The primary outcome of interest was the provision of bystander CPR. Socioeconomic status was estimated using the Economic Hardship Index model. A generalized linear mixed model analysis was conducted. RESULTS The overall rate of bystander CPR was 33.6%. White patients were more likely to receive bystander CPR compared to black patients (44.0% vs 29.8%, adjusted odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.40-2.05). Patients in areas of increased economic hardship were less likely to receive bystander CPR (OR = 0.713, 95% CI = 0.569-0.894). Overall bystander CPR rate increased by 18.7% over the past 25 years. CONCLUSION Despite significant increases in bystander CPR compared to 25 years ago, black individuals are still less likely to receive bystander CPR than white individuals in Memphis. Both race and socioeconomic status were independent predictors of the rate of bystander CPR. By using neighborhood demographics and the Economic Hardship Index, communities with low overall bystander CPR rates, such as Memphis, can focus limited resources on areas of greatest need and potential effectiveness.
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Affiliation(s)
- Joshua M Justice
- Department of Emergency Medicine University of Tennessee Health Science Center Memphis Tennessee USA
| | - Joseph E Holley
- Department of Emergency Medicine University of Tennessee Health Science Center Memphis Tennessee USA
| | - Mark F Brady
- Department of Emergency Medicine University of Tennessee Health Science Center Memphis Tennessee USA
| | - James R Walker
- Department of Emergency Medicine University of Tennessee Health Science Center Memphis Tennessee USA
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13
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Liu JF, Brady MF, Matulonis UA, Miller A, Kohn EC, Swisher EM, Tew WP, Cloven NG, Muller C, Bender D, Moore RG, Michelin DP, Waggoner SE, Geller MA, Fujiwara K, D'Andre SD, Carney M, Secord AA, Moxley KM, Bookman MA. A phase III study comparing single-agent olaparib or the combination of cediranib and olaparib to standard platinum-based chemotherapy in recurrent platinum-sensitive ovarian cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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
6003 Background: Combination cediranib (C) and olaparib (O) improved progression-free survival (PFS) in patients (pts) with relapsed platinum (plat)-sensitive high-grade ovarian cancer (ovca) compared to O alone in a Phase 2 trial (NCT01116648). We conducted this randomized, open-label Phase 3 trial (NCT02446600) to assess whether combination C+O, or O alone, was superior to standard of care (SOC) plat-based therapy in relapsed plat-sensitive ovca. Methods: Eligible pts had recurrent plat-sensitive [ > 6-month plat-free interval (PFI)] high-grade serous or endometrioid, or BRCA-related, ovca. One prior non-plat therapy and unlimited prior plat-therapies were allowed; prior anti-angiogenics in the recurrent setting or prior PARP inhibitor were exclusions. Pts were randomized 1:1:1 to SOC (carboplatin/paclitaxel; carboplatin/gemcitabine; or carboplatin/liposomal doxorubicin), O (300mg twice daily), or C+O (C 30mg daily + O 200mg twice daily). Randomization was stratified by g BRCA status, PFI (6-12 vs > 12 months), and prior anti-angiogenic therapy. Target sample size was 549 pts; primary analysis occurred 2 years after the last pt enrolled. The primary endpoint was PFS. Type 1 error = 0.025 was controlled by a gatekeeping hierarchy that assessed C+O vs SOC, then O alone vs SOC, and finally C+O vs O. All maintenance therapy was prohibited. Results: Between 4FEB2016 and 13NOV2017, 565 pts enrolled (187 SOC, 189 O, 189 C+O), and 528 pts initiated treatment (166 SOC, 183 O, 179 C+O). 23.7% of patients had g BRCAmut. Median follow-up was 29.1 months. 53 pts on SOC initiated non-protocol therapy (predominantly PARP inhibitor maintenance) before disease progression. The hazard ratio (HR) for PFS was 0.856 (95% CI 0.66-1.11, p = 0.08, 1-tail) between C+O and SOC and 1.20 (95% CI 0.93-1.54) between O and SOC, with median PFS of 10.3, 8.2, and 10.4 months for SOC, O, and C+O, respectively. Response rates were 71.3% (SOC), 52.4% (O), and 69.4% (C+O). In gBRCA pts, HR for PFS was 0.55 (95% CI 0.73-1.30) for C+O vs SOC, and 0.63 (95% CI 0.37-1.07) for O vs SOC. In non-g BRCA pts, HR for these comparisons was 0.97 (95% CI 0.73-1.30) and 1.41 (1.07-1.86). No OS differences between arms were observed at 44% events. Pts receiving C+O (vs SOC) had more frequent Grade 3 or higher gastrointestinal (30.1% vs 8.4%), hypertension (31.7% vs 1.8%), and fatigue events (17.5% vs 1.8%). Conclusion: C+O demonstrated similar activity to SOC in relapsed plat-sensitive ovca but did not meet the primary endpoint of improved PFS. Clinical trial information: NCT02446600.
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Affiliation(s)
| | | | | | - Austin Miller
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | - Steven E. Waggoner
- Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH
| | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
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14
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Aghajanian C, Bookman MA, Fleming GF, Brady MF, Swisher EM, Steffensen KD, Friedlander M, Okamoto A, Moore KN, Sullivan DM, Fallstrom M, Dinh M, Ratajczak C, Coleman RL. PFS by blinded independent central review (BICR) in the VELIA trial of veliparib (V) plus carboplatin/paclitaxel (CP) and as monotherapy in newly diagnosed patients (pts) with high-grade serous ovarian cancer (HGSC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6077] [Citation(s) in RCA: 2] [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
6077 Background: The phase III VELIA trial (NCT02470585) demonstrated statistically significant improvement in PFS per investigator (INV) for V added to CP and continued as maintenance (CPV-V) vs. CP alone in pts with newly diagnosed HGSC in the BRCA mutated ( BRCAm), homologous recombination deficient (HRD), and whole populations. Here we present pre-specified analyses of PFS per BICR. Methods: Pts with Stage III-IV HGSC received V or Placebo (PL) with CP (6 cycles) and as maintenance (30 additional cycles). Primary analysis of PFS by INV compared CPV-V to CP alone in the BRCAm, HRD, and whole populations. Exploratory analyses of PFS in BRCA wildtype (wt) and non-HRD HGSC were performed. Radiologic tumor assessments were also prospectively submitted to an independent central reviewer for blinded assessment per RECIST v 1.1. PFS per BICR and rates of concordance between INV and BICR for determination of disease progression were analyzed. Safety data from the primary analysis were previously reported. Results: 1140 total pts were enrolled (CPV-V 382; CP 375). In the whole population, 26% of HGSCs were BRCAm and 55% were HRD. Concordance rates between INV and BICR were 68-85% by arm for each population. Analyses of PFS per BICR and per INV were consistent (Table). PFS was prolonged in the CPV-V vs. CP arm in all primary and exploratory populations assessed. Conclusions: Analyses of PFS per BICR supported the primary analysis of PFS per INV in the BRCAm, HRD, and whole populations, as well as exploratory BRCAwt and non-HRD populations. Median PFS per BICR was longer compared to PFS per INV assessments in all populations and in both arms. These findings support the reliability of PFS by INV in ovarian cancer trials. Alternate strategies like audits may be appropriate to support PFS by INV with less time and expense than full BICR. Clinical trial information: NCT02470585. [Table: see text]
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Affiliation(s)
| | | | | | - Mark F. Brady
- NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | - Michael Friedlander
- Prince of Wales Clinical School University of New South Wales, and Prince of Wales Hospital, Sydney, Australia
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Kathleen N. Moore
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Coleman RL, Fleming GF, Brady MF, Swisher EM, Steffensen KD, Friedlander M, Okamoto A, Moore KN, Efrat Ben-Baruch N, Werner TL, Cloven NG, Oaknin A, DiSilvestro PA, Morgan MA, Nam JH, Leath CA, Nicum S, Hagemann AR, Littell RD, Cella D, Baron-Hay S, Garcia-Donas J, Mizuno M, Bell-McGuinn K, Sullivan DM, Bach BA, Bhattacharya S, Ratajczak CK, Ansell PJ, Dinh MH, Aghajanian C, Bookman MA. Veliparib with First-Line Chemotherapy and as Maintenance Therapy in Ovarian Cancer. N Engl J Med 2019; 381:2403-2415. [PMID: 31562800 PMCID: PMC6941439 DOI: 10.1056/nejmoa1909707] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data are limited regarding the use of poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitors, such as veliparib, in combination with chemotherapy followed by maintenance as initial treatment in patients with high-grade serous ovarian carcinoma. METHODS In an international, phase 3, placebo-controlled trial, we assessed the efficacy of veliparib added to first-line induction chemotherapy with carboplatin and paclitaxel and continued as maintenance monotherapy in patients with previously untreated stage III or IV high-grade serous ovarian carcinoma. Patients were randomly assigned in a 1:1:1 ratio to receive chemotherapy plus placebo followed by placebo maintenance (control), chemotherapy plus veliparib followed by placebo maintenance (veliparib combination only), or chemotherapy plus veliparib followed by veliparib maintenance (veliparib throughout). Cytoreductive surgery could be performed before initiation or after 3 cycles of trial treatment. Combination chemotherapy was 6 cycles, and maintenance therapy was 30 additional cycles. The primary end point was investigator-assessed progression-free survival in the veliparib-throughout group as compared with the control group, analyzed sequentially in the BRCA-mutation cohort, the cohort with homologous-recombination deficiency (HRD) (which included the BRCA-mutation cohort), and the intention-to-treat population. RESULTS A total of 1140 patients underwent randomization. In the BRCA-mutation cohort, the median progression-free survival was 34.7 months in the veliparib-throughout group and 22.0 months in the control group (hazard ratio for progression or death, 0.44; 95% confidence interval [CI], 0.28 to 0.68; P<0.001); in the HRD cohort, it was 31.9 months and 20.5 months, respectively (hazard ratio, 0.57; 95 CI, 0.43 to 0.76; P<0.001); and in the intention-to-treat population, it was 23.5 months and 17.3 months (hazard ratio, 0.68; 95% CI, 0.56 to 0.83; P<0.001). Veliparib led to a higher incidence of anemia and thrombocytopenia when combined with chemotherapy as well as of nausea and fatigue overall. CONCLUSIONS Across all trial populations, a regimen of carboplatin, paclitaxel, and veliparib induction therapy followed by veliparib maintenance therapy led to significantly longer progression-free survival than carboplatin plus paclitaxel induction therapy alone. The independent value of adding veliparib during induction therapy without veliparib maintenance was less clear. (Funded by AbbVie; VELIA/GOG-3005 ClinicalTrials.gov number, NCT02470585.).
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Affiliation(s)
- Robert L Coleman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Gini F Fleming
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mark F Brady
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Elizabeth M Swisher
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Karina D Steffensen
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Michael Friedlander
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Aikou Okamoto
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Kathleen N Moore
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Noa Efrat Ben-Baruch
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Theresa L Werner
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Noelle G Cloven
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Ana Oaknin
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Paul A DiSilvestro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mark A Morgan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Joo-Hyun Nam
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Charles A Leath
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Shibani Nicum
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Andrea R Hagemann
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Ramey D Littell
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - David Cella
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Sally Baron-Hay
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Jesus Garcia-Donas
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mika Mizuno
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Katherine Bell-McGuinn
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Danielle M Sullivan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Bruce A Bach
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Sudipta Bhattacharya
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Christine K Ratajczak
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Peter J Ansell
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Minh H Dinh
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Carol Aghajanian
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Michael A Bookman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
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Coleman RL, Spirtos NM, Enserro D, Herzog TJ, Sabbatini P, Armstrong DK, Kim JW, Park SY, Kim BG, Nam JH, Fujiwara K, Walker JL, Casey AC, Alvarez Secord A, Rubin S, Chan JK, DiSilvestro P, Davidson SA, Cohn DE, Tewari KS, Basen-Engquist K, Huang HQ, Brady MF, Mannel RS. Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer. N Engl J Med 2019; 381:1929-1939. [PMID: 31722153 PMCID: PMC6941470 DOI: 10.1056/nejmoa1902626] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation. METHODS We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival. RESULTS A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery. CONCLUSIONS In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone. (Funded by the National Cancer Institute and others; GOG-0213 ClinicalTrials.gov number, NCT00565851.).
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Affiliation(s)
- Robert L Coleman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Nick M Spirtos
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Danielle Enserro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Thomas J Herzog
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Paul Sabbatini
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Deborah K Armstrong
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Jae-Weon Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Sang-Yoon Park
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Byoung-Gie Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Joo-Hyun Nam
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Keiichi Fujiwara
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Joan L Walker
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Ann C Casey
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Angeles Alvarez Secord
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Steve Rubin
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - John K Chan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Paul DiSilvestro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Susan A Davidson
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - David E Cohn
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Krishnansu S Tewari
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Karen Basen-Engquist
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Helen Q Huang
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Mark F Brady
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Robert S Mannel
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
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Wade KNS, Brady MF, Thai T, Wang Y, Zheng B, Salani R, Tewari KS, Gray HJ, Bakkum-Gamez JN, Burger RA, Moore KN, Bookman MA. Measurements of adiposity as prognostic biomarkers for survival with anti-angiogenic treatment in epithelial ovarian cancer: An NRG Oncology/Gynecologic Oncology Group ancillary data analysis of GOG 218. Gynecol Oncol 2019; 155:69-74. [PMID: 31409486 PMCID: PMC7048388 DOI: 10.1016/j.ygyno.2019.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/21/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adiposity has been hypothesized to interfere with the activity of bevacizumab (BEV), an anti-angiogenic agent. Measurements of adiposity, BMI, surface fat area (SFA), and visceral fat area (VFA) were investigated as prognostic of oncologic outcomes among patients treated with chemotherapy, with or without BEV, on GOG 218, a prospective phase III trial. METHOD Pretreatment computed tomography (CT) for 1538 GOG 218 participants were analyzed. Proportional hazards models assessed association between adiposity and overall survival (OS) adjusted for other prognostic factors. The predictive value of adiposity as a function of BEV treatment was assessed in 1019 patients randomized to either chemotherapy (CT) + placebo (P) → P or CT + BEV → BEV. RESULTS After adjusting for prognostic factors, SFA was not associated with the overall hazard of death (p = 0.981). There was a non-significant 0.1% (p = 0.062) increase in hazard of death associated with a unit increase in VFA. When comparing the treatment HRs for patients who did and did not receive BEV, there was no association with SFA (p = 0.890) or VFA (p = 0.106). A non-significant 0.8% increase in the hazard of death with unit increase in BMI (p = 0.086) was observed. BMI values were not predictive of a longer survival for patients with BEV vs placebo (p = 0.606). CONCLUSION Measures of adiposity strongly correlated to one another but were not predictive of efficacy for BEV. VFA is a weak prognostic factor.
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Affiliation(s)
| | - M F Brady
- NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, University of Buffalo, Buffalo, NY, USA.
| | - T Thai
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Y Wang
- The University of Oklahoma, Norman, OK, USA.
| | - B Zheng
- The University of Oklahoma, Norman, OK, USA.
| | - R Salani
- The Ohio State University, James Cancer Hospital, Columbus, OH, USA.
| | - K S Tewari
- UC Irvine Medical Center, Orange, CA, USA.
| | - H J Gray
- University of Washington Medical Center, Seattle, WA, USA.
| | | | - R A Burger
- University of Pennsylvania, Philadelphia, PA, USA.
| | - K N Moore
- The University of Oklahoma, Oklahoma City, OK, USA.
| | - M A Bookman
- US Oncology Research and Arizona Oncology, Tucson, AZ, USA.
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Tewari KS, Burger RA, Enserro D, Norquist BM, Swisher EM, Brady MF, Bookman MA, Fleming GF, Huang H, Homesley HD, Fowler JM, Greer BE, Boente M, Liang SX, Ye C, Bais C, Randall LM, Chan JK, Ferriss JS, Coleman RL, Aghajanian C, Herzog TJ, DiSaia PJ, Copeland LJ, Mannel RS, Birrer MJ, Monk BJ. Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer. J Clin Oncol 2019; 37:2317-2328. [PMID: 31216226 DOI: 10.1200/jco.19.01009] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We report the final, protocol-specified analysis of overall survival (OS) in GOG-0218, a phase III, randomized trial of bevacizumab in women with newly diagnosed ovarian, fallopian tube, or primary peritoneal carcinoma. METHODS A total of 1,873 women with incompletely resected stage III to IV disease were randomly assigned 1:1:1 to six 21-day cycles of intravenous carboplatin (area under the concentration v time curve 6) and paclitaxel (175 mg/m2) versus chemotherapy plus concurrent bevacizumab (15 mg/kg, cycles 2 to 6) versus chemotherapy plus concurrent and maintenance bevacizumab (cycles 2 to 22). Inclusion criteria included a Gynecologic Oncology Group performance status of 0 to 2 and no history of clinically significant vascular events or evidence of intestinal obstruction. OS was analyzed in the intention-to-treat population. A total of 1,195 serum and/or tumor specimens were sequenced for BRCA1/2 and damaging mutations in homologous recombination repair (HRR) genes. Intratumoral microvessel density was studied using CD31 immunohistochemistry. RESULTS Median follow-up was 102.9 months. Relative to control (n = 625), for patients receiving bevacizumab-concurrent (n = 625), the hazard ratio (HR) of death was 1.06 (95% CI, 0.94 to 1.20); for bevacizumab-concurrent plus maintenance (n = 623), the HR was 0.96 (95% CI, 0.85 to 1.09). Disease-specific survival was not improved in any arm. No survival advantage was observed after censoring patients who received bevacizumab at crossover or as second line. Median OS for stage IV bevacizumab-concurrent plus maintenance was 42.8 v 32.6 months for stage IV control (HR, 0.75; 95% CI, 0.59 to 0.95). Relative to wild type, the HR for death for BRCA1/2 mutated carcinomas was 0.62 (95% CI, 0.52 to 0.73), and for non-BRCA1/2 HRR, the HR was 0.65 (95% CI, 0.51 to 0.85). BRCA1/2, HRR, and CD31 were not predictive of bevacizumab activity. CONCLUSION No survival differences were observed for patients who received bevacizumab compared with chemotherapy alone. Testing for BRCA1/2 mutations and homologous recombination deficiency is essential.
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Affiliation(s)
| | - Robert A Burger
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - John K Chan
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - J Stuart Ferriss
- Dell Seton Medical Center at The University of Texas, Austin, TX
| | | | | | | | - Philip J DiSaia
- University of California, Irvine, Medical Center, Orange, CA
| | | | - Robert S Mannel
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Bradley J Monk
- University of Arizona and Creighton University, Phoenix, AZ
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Walker JL, Brady MF, Wenzel L, Fleming GF, Huang HQ, DiSilvestro PA, Fujiwara K, Alberts DS, Zheng W, Tewari KS, Cohn DE, Powell MA, Van Le L, Davidson SA, Gray HJ, Rose PG, Aghajanian C, Myers T, Alvarez Secord A, Rubin SC, Mannel RS. Randomized Trial of Intravenous Versus Intraperitoneal Chemotherapy Plus Bevacizumab in Advanced Ovarian Carcinoma: An NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2019; 37:1380-1390. [PMID: 31002578 PMCID: PMC6544459 DOI: 10.1200/jco.18.01568] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [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: 02/04/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the impact of two different intraperitoneal (IP) chemotherapy regimens on progression-free survival (PFS) among women with newly diagnosed advanced ovarian carcinoma. METHODS Eligible patients were randomly assigned to six cycles of IV paclitaxel 80 mg/m2 once per week with intravenous (IV) carboplatin area under the curve 6 (IV carboplatin) versus IV paclitaxel 80 mg/m2 once per week with IP carboplatin area under the curve 6 (IP carboplatin) versus once every 3 weeks IV paclitaxel 135 mg/m2 over 3 hours day 1, IP cisplatin 75 mg/m2 day 2, and IP paclitaxel 60 mg/m2 day 8 (IP cisplatin). All participants received bevacizumab 15 mg/kg IV every 3 weeks in cycles 2 to 22. RESULTS A total of 1,560 participants were enrolled and had 84.8 months of follow-up. The median PFS duration was 24.9 months in the IV carboplatin arm, 27.4 months in the IP carboplatin arm, and 26.2 months in the IP cisplatin arm. For the subgroup of 1,380 patients with stage II/III and residual disease of 1 cm or less, median PFS was 26.9 (IV-carboplatin), 28.7 (IP-carboplatin), and 27.8 months (IP cisplatin), respectively. Median PFS for patients with stage II/III and no residual disease was 35.9, 38.8, and 35.5 months, respectively. Median overall survival for all enrolled was 75.5, 78.9, and 72.9 months, respectively, and median overall survival for stage II/III with no gross residual disease was 98.8 months, 104.8 months, and not reached. Mean patient-reported Functional Assessment of Cancer Therapy neurotoxicity scores (Gynecologic Oncology Group) were similar for all arms, but the mean Trial Outcome Index of the Functional Assessment of Cancer Therapy-Ovary scores during chemotherapy were statistically worse in the IP cisplatin arm. CONCLUSION Compared with the IV carboplatin reference arm, the duration of PFS was not significantly increased with either IP regimen when combined with bevacizumab and was better tolerated than IP cisplatin.
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Affiliation(s)
- Joan L. Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Lari Wenzel
- University of California, Irvine, Medical Center, Orange, CA
| | | | | | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka-Shi, Japan
| | | | | | | | | | | | - Linda Van Le
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Heidi J. Gray
- University of Washington School of Medicine, Seattle, WA
| | | | | | | | | | | | - Robert S. Mannel
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Bagnoli M, Shi TY, Gourley C, Speiser P, Reuss A, Nijman HW, Creutzberg CL, Scholl S, Negrouk A, Brady MF, Hasegawa K, Oda K, McNeish IA, Kohn EC, Oza AM, MacKay H, Millan D, Bennett K, Scott C, Mezzanzanica D. Gynecological Cancers Translational, Research Implementation, and Harmonization: Gynecologic Cancer InterGroup Consensus and Still Open Questions. Cells 2019; 8:E200. [PMID: 30813545 PMCID: PMC6468728 DOI: 10.3390/cells8030200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
In the era of personalized medicine, the introduction of translational studies in clinical trials has substantially increased their costs, but provides the possibility of improving the productivity of trials with a better selection of recruited patients. With the overall goal of creating a roadmap to improve translational design for future gynecological cancer trials and of defining translational goals, a main discussion was held during a brainstorming day of the Gynecologic Cancer InterGroup (GCIG) Translational Research Committee and overall conclusions are here reported. A particular emphasis was dedicated to the new frontier of the immunoprofiling of gynecological cancers. The discussion pointed out that to maximize patients' benefit, translational studies should be integral to clinical trial design with standardization and optimization of procedures including a harmonization program of Standard Operating Procedures. Pathology-reviewed sample collection should be mandatory and ensured by dedicated funding. Biomarker validation and development should be made public and transparent to ensure rapid progresses with positive outcomes for patients. Guidelines/templates for patients' informed consent are needed. Importantly for the public, recognized goals are to increase the involvement of advocates and to improve the reporting of translational data in a forum accessible to patients.
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Affiliation(s)
- Marina Bagnoli
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
| | - Ting Yan Shi
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, MRC IGMM, Edinburgh EH4 2XU, UK.
| | - Paul Speiser
- Department of Gynaecologic Oncology, Medical University Vienna, General Hospital Vienna, 1090 Wien, Austria.
| | - Alexander Reuss
- Coordinating Center for Clinical Trials, at the Philipps-University of Marburg, 35043 Marburg, Germany.
| | - Hans W Nijman
- Department of Obstetrics & Gynecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Suzy Scholl
- Department of Drug Development and Innovation, Institut Curie, 75005 Paris, France.
| | - Anastassia Negrouk
- European Organisation for Research and Treatment of Cancer (EORTC), 1200 Brussels, Belgium.
| | - Mark F Brady
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama 1397-1, Japan.
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan.
| | - Iain A McNeish
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
| | - Elise C Kohn
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD 20852, USA.
| | - Amit M Oza
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada.
| | - Helen MacKay
- Division of Medical Oncology, University of Toronto/Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada.
| | - David Millan
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TR, UK.
| | - Katherine Bennett
- Gynecologic Cancer InterGroup, Operations, Kingston, ON K7K-7A6, Canada.
| | - Clare Scott
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia.
| | - Delia Mezzanzanica
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
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Buechel M, Enserro D, Burger RA, Brady MF, Wade K, Secord AA, Nixon AB, Mirniaharikandehei S, Liu H, Zheng B, Gray H, Tewari KS, O'Malley DM, Mannel RS, Moore KN, Birrer MJ. Correlation of imaging and plasma-based biomarkers to predict response to bevacizumab in epithelial ovarian cancer (EOC): A GOG 218 ancillary data analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Megan Buechel
- University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | - Hong Liu
- University of Oklahom, Norman, OK
| | | | | | | | | | | | | | - Michael J. Birrer
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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22
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Coleman RL, Enserro D, Spirtos N, Herzog TJ, Sabbatini P, Armstrong DK, Kim B, Fujiwara K, Walker JL, Flynn PJ, Secord AA, Cohn DE, Brady MF, Mannel RS. A phase III randomized controlled trial of secondary surgical cytoreduction (SSC) followed by platinum-based combination chemotherapy (PBC), with or without bevacizumab (B) in platinum-sensitive, recurrent ovarian cancer (PSOC): A NRG Oncology/Gynecologic Oncology Group (GOG) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5501] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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)
| | | | | | - Thomas J. Herzog
- University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Paul Sabbatini
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Byoung Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Patrick J. Flynn
- NSABP/NRG Oncology, and Metro-Minnesota Community Oncology Research Consotrium (MMCORC), Minneapolis, MN
| | | | | | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
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23
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Burger RA, Enserro D, Tewari KS, Brady MF, Bookman MA, Fleming GF, Huang HQ, Homesley HD, Fowler J, Boente M, Randall LM, Chan JK, Ferris JS, DiSaia PJ, Copeland LJ, Mannel RS, Birrer MJ, Monk BJ. Final overall survival (OS) analysis of an international randomized trial evaluating bevacizumab (BEV) in the primary treatment of advanced ovarian cancer: A NRG oncology/Gynecologic Oncology Group (GOG) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5517] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | - Michael J. Birrer
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Bradley J. Monk
- University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ
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24
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Norquist BM, Brady MF, Harrell MI, Walsh T, Lee MK, Gulsuner S, Bernards SS, Casadei S, Burger RA, Tewari KS, Backes F, Mannel RS, Glaser G, Bailey C, Rubin S, Soper J, Lankes HA, Ramirez NC, King MC, Birrer MJ, Swisher EM. Mutations in Homologous Recombination Genes and Outcomes in Ovarian Carcinoma Patients in GOG 218: An NRG Oncology/Gynecologic Oncology Group Study. Clin Cancer Res 2017; 24:777-783. [PMID: 29191972 DOI: 10.1158/1078-0432.ccr-17-1327] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/26/2017] [Accepted: 11/21/2017] [Indexed: 12/30/2022]
Abstract
Purpose: We hypothesized that mutations in homologous recombination repair (HRR) genes beyond BRCA1 and BRCA2 improve outcomes for ovarian carcinoma patients treated with platinum therapy and would impact the relative benefit of adding prolonged bevacizumab.Experimental Design: We sequenced DNA from blood and/or neoplasm from 1,195 women enrolled in GOG-0218, a randomized phase III trial in advanced ovarian carcinoma of bevacizumab added to carboplatin and paclitaxel. Defects in HRR were defined as damaging mutations in 16 genes. Proportional hazards models were used to estimate relative hazards for progression-free survival (PFS) and overall survival (OS).Results: Of 1,195 women with ovarian carcinoma, HRR mutations were identified in 307 (25.7%). Adjusted hazards for progression and death compared with those without mutations were lower for women with non-BRCA HRR mutations [HR = 0.73; 95% confidence interval (CI), 0.57-0.94; P = 0.01 for PFS; HR = 0.67; 95% CI, 0.50-0.90; P = 0.007 for OS] and BRCA1 mutations (HR = 0.80; 95% CI, 0.66-0.97; P = 0.02 for PFS; HR = 0.74; 95% CI, 0.59-0.94; P = 0.01 for OS) and were lowest for BRCA2 mutations (HR = 0.52; 95% CI, 0.40-0.67; P < 0.0001 for PFS; HR = 0.36; 95% CI, 0.25-0.53; P < 0.0001 for OS). A test of interaction showed no difference in the effect of bevacizumab on PFS between cases with and without mutations.Conclusions: HRR mutations, including non-BRCA genes, significantly prolong PFS and OS in ovarian carcinoma and should be stratified for in clinical trials. The benefit of adding bevacizumab was not significantly modified by mutation status. Clin Cancer Res; 24(4); 777-83. ©2017 AACR.
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Affiliation(s)
- Barbara M Norquist
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington.
| | - Mark F Brady
- The NRG Oncology Statistical and Data Center, Roswell Park Cancer Center Institute, Buffalo, New York
| | - Maria I Harrell
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington
| | - Tom Walsh
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Ming K Lee
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Suleyman Gulsuner
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Sarah S Bernards
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington
| | - Silvia Casadei
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California at Irvine, Orange, California
| | - Floor Backes
- Division of Gynecologic Oncology, The Ohio State University Medical Center, Columbus, Ohio
| | - Robert S Mannel
- Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Gretchen Glaser
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cheryl Bailey
- Division of Gynecologic Oncology, Minnesota Oncology, Minneapolis, Minnesota
| | - Stephen Rubin
- Division of Gynecologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John Soper
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Heather A Lankes
- Department of Pathology and Laboratory Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nilsa C Ramirez
- Department of Pathology and Laboratory Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mary Claire King
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Michael J Birrer
- Division of Hematology/Oncology, University of Alabama, Birmingham, Alabama
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington.,Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
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25
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Bais C, Mueller B, Brady MF, Mannel RS, Burger RA, Wei W, Marien KM, Kockx MM, Husain A, Birrer MJ. Tumor Microvessel Density as a Potential Predictive Marker for Bevacizumab Benefit: GOG-0218 Biomarker Analyses. J Natl Cancer Inst 2017; 109:3845957. [PMID: 29059426 DOI: 10.1093/jnci/djx066] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/15/2017] [Indexed: 12/30/2022] Open
Abstract
Background Combining bevacizumab with frontline chemotherapy statistically significantly improved progression-free survival (PFS) but not overall survival (OS) in the phase III GOG-0218 trial. Evaluation of candidate biomarkers was an exploratory objective. Methods Patients with stage III (incompletely resected) or IV ovarian cancer were randomly assigned to receive six chemotherapy cycles with placebo or bevacizumab followed by single-agent placebo or bevacizumab. Five candidate tumor biomarkers were assessed by immunohistochemistry. The biomarker-evaluable population was categorized into high or low biomarker-expressing subgroups using median and quartile cutoffs. Associations between biomarker expression and efficacy were analyzed. All statistical tests were two-sided. Results The biomarker-evaluable population (n = 980) comprising 78.5% of the intent-to-treat population had representative baseline characteristics and efficacy outcomes. Neither prognostic nor predictive associations were seen for vascular endothelial growth factor (VEGF) receptor-2, neuropilin-1, or MET. Higher microvessel density (MVD; measured by CD31) showed predictive value for PFS (hazard ratio [HR] for bevacizumab vs placebo = 0.40, 95% confidence interval [CI] = 0.29 to 0.54, vs 0.80, 95% CI = 0.59 to 1.07, for high vs low MVD, respectively, P interaction = .003) and OS (HR = 0.67, 95% CI = 0.51 to 0.88, vs 1.10, 95% CI = 0.84 to 1.44, P interaction = .02). Tumor VEGF-A was not predictive for PFS but showed potential predictive value for OS using a third-quartile cutoff for high VEGF-A expression. Conclusions These retrospective tumor biomarker analyses suggest a positive association between density of vascular endothelial cells (the predominant cell type expressing VEGF receptors) and tumor VEGF-A levels and magnitude of bevacizumab effect in ovarian cancer. The potential predictive value of MVD (CD31) and tumor VEGF-A is consistent with a mechanism of action driven by VEGF-A signaling blockade.
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Affiliation(s)
- Carlos Bais
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Barbara Mueller
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark F Brady
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert S Mannel
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert A Burger
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Wei Wei
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Koen M Marien
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark M Kockx
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Amreen Husain
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Michael J Birrer
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
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26
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Bais C, Mueller B, Brady MF, Mannel RS, Burger RA, Wei W, Marien KM, Kockx MM, Husain A, Birrer MJ. Tumor Microvessel Density as a Potential Predictive Marker for Bevacizumab Benefit: GOG-0218 Biomarker Analyses. J Natl Cancer Inst 2017. [PMID: 29059426 DOI: 10.1093/jnci/djx066] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Combining bevacizumab with frontline chemotherapy statistically significantly improved progression-free survival (PFS) but not overall survival (OS) in the phase III GOG-0218 trial. Evaluation of candidate biomarkers was an exploratory objective. Methods Patients with stage III (incompletely resected) or IV ovarian cancer were randomly assigned to receive six chemotherapy cycles with placebo or bevacizumab followed by single-agent placebo or bevacizumab. Five candidate tumor biomarkers were assessed by immunohistochemistry. The biomarker-evaluable population was categorized into high or low biomarker-expressing subgroups using median and quartile cutoffs. Associations between biomarker expression and efficacy were analyzed. All statistical tests were two-sided. Results The biomarker-evaluable population (n = 980) comprising 78.5% of the intent-to-treat population had representative baseline characteristics and efficacy outcomes. Neither prognostic nor predictive associations were seen for vascular endothelial growth factor (VEGF) receptor-2, neuropilin-1, or MET. Higher microvessel density (MVD; measured by CD31) showed predictive value for PFS (hazard ratio [HR] for bevacizumab vs placebo = 0.40, 95% confidence interval [CI] = 0.29 to 0.54, vs 0.80, 95% CI = 0.59 to 1.07, for high vs low MVD, respectively, P interaction = .003) and OS (HR = 0.67, 95% CI = 0.51 to 0.88, vs 1.10, 95% CI = 0.84 to 1.44, P interaction = .02). Tumor VEGF-A was not predictive for PFS but showed potential predictive value for OS using a third-quartile cutoff for high VEGF-A expression. Conclusions These retrospective tumor biomarker analyses suggest a positive association between density of vascular endothelial cells (the predominant cell type expressing VEGF receptors) and tumor VEGF-A levels and magnitude of bevacizumab effect in ovarian cancer. The potential predictive value of MVD (CD31) and tumor VEGF-A is consistent with a mechanism of action driven by VEGF-A signaling blockade.
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Affiliation(s)
- Carlos Bais
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Barbara Mueller
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark F Brady
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert S Mannel
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert A Burger
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Wei Wei
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Koen M Marien
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark M Kockx
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Amreen Husain
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Michael J Birrer
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
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Bais C, Mueller B, Brady MF, Mannel RS, Burger RA, Wei W, Marien KM, Kockx MM, Husain A, Birrer MJ. Tumor Microvessel Density as a Potential Predictive Marker for Bevacizumab Benefit: GOG-0218 Biomarker Analyses. J Natl Cancer Inst 2017. [PMID: 29059426 DOI: 10.1093/jnci/djx066]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Combining bevacizumab with frontline chemotherapy statistically significantly improved progression-free survival (PFS) but not overall survival (OS) in the phase III GOG-0218 trial. Evaluation of candidate biomarkers was an exploratory objective. Methods Patients with stage III (incompletely resected) or IV ovarian cancer were randomly assigned to receive six chemotherapy cycles with placebo or bevacizumab followed by single-agent placebo or bevacizumab. Five candidate tumor biomarkers were assessed by immunohistochemistry. The biomarker-evaluable population was categorized into high or low biomarker-expressing subgroups using median and quartile cutoffs. Associations between biomarker expression and efficacy were analyzed. All statistical tests were two-sided. Results The biomarker-evaluable population (n = 980) comprising 78.5% of the intent-to-treat population had representative baseline characteristics and efficacy outcomes. Neither prognostic nor predictive associations were seen for vascular endothelial growth factor (VEGF) receptor-2, neuropilin-1, or MET. Higher microvessel density (MVD; measured by CD31) showed predictive value for PFS (hazard ratio [HR] for bevacizumab vs placebo = 0.40, 95% confidence interval [CI] = 0.29 to 0.54, vs 0.80, 95% CI = 0.59 to 1.07, for high vs low MVD, respectively, P interaction = .003) and OS (HR = 0.67, 95% CI = 0.51 to 0.88, vs 1.10, 95% CI = 0.84 to 1.44, P interaction = .02). Tumor VEGF-A was not predictive for PFS but showed potential predictive value for OS using a third-quartile cutoff for high VEGF-A expression. Conclusions These retrospective tumor biomarker analyses suggest a positive association between density of vascular endothelial cells (the predominant cell type expressing VEGF receptors) and tumor VEGF-A levels and magnitude of bevacizumab effect in ovarian cancer. The potential predictive value of MVD (CD31) and tumor VEGF-A is consistent with a mechanism of action driven by VEGF-A signaling blockade.
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Affiliation(s)
- Carlos Bais
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Barbara Mueller
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark F Brady
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert S Mannel
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Robert A Burger
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Wei Wei
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Koen M Marien
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Mark M Kockx
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Amreen Husain
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Michael J Birrer
- Genentech Inc., South San Francisco, CA; F Hoffmann-La Roche Ltd, Basel, Switzerland; NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; University of Oklahoma, Oklahoma City, OK; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA; Center for Cancer Research, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; HistoGeneX NV, Antwerp, Belgium; Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium
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Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet 2017; 390:1654-1663. [PMID: 28756902 PMCID: PMC5714293 DOI: 10.1016/s0140-6736(17)31607-0] [Citation(s) in RCA: 349] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND On Aug 14, 2014, the US Food and Drug Administration approved the antiangiogenesis drug bevacizumab for women with advanced cervical cancer on the basis of improved overall survival (OS) after the second interim analysis (in 2012) of 271 deaths in the Gynecologic Oncology Group (GOG) 240 trial. In this study, we report the prespecified final analysis of the primary objectives, OS and adverse events. METHODS In this randomised, controlled, open-label, phase 3 trial, we recruited patients with metastatic, persistent, or recurrent cervical carcinoma from 81 centres in the USA, Canada, and Spain. Inclusion criteria included a GOG performance status score of 0 or 1; adequate renal, hepatic, and bone marrow function; adequately anticoagulated thromboembolism; a urine protein to creatinine ratio of less than 1; and measurable disease. Patients who had received chemotherapy for recurrence and those with non-healing wounds or active bleeding conditions were ineligible. We randomly allocated patients 1:1:1:1 (blocking used; block size of four) to intravenous chemotherapy of either cisplatin (50 mg/m2 on day 1 or 2) plus paclitaxel (135 mg/m2 or 175 mg/m2 on day 1) or topotecan (0·75 mg/m2 on days 1-3) plus paclitaxel (175 mg/m2 on day 1) with or without intravenous bevacizumab (15 mg/kg on day 1) in 21 day cycles until disease progression, unacceptable toxic effects, voluntary withdrawal by the patient, or complete response. We stratified randomisation by GOG performance status (0 vs 1), previous radiosensitising platinum-based chemotherapy, and disease status (recurrent or persistent vs metastatic). We gave treatment open label. Primary outcomes were OS (analysed in the intention-to-treat population) and adverse events (analysed in all patients who received treatment and submitted adverse event information), assessed at the second interim and final analysis by the masked Data and Safety Monitoring Board. The cutoff for final analysis was 450 patients with 346 deaths. This trial is registered with ClinicalTrials.gov, number NCT00803062. FINDINGS Between April 6, 2009, and Jan 3, 2012, we enrolled 452 patients (225 [50%] in the two chemotherapy-alone groups and 227 [50%] in the two chemotherapy plus bevacizumab groups). By March 7, 2014, 348 deaths had occurred, meeting the prespecified cutoff for final analysis. The chemotherapy plus bevacizumab groups continued to show significant improvement in OS compared with the chemotherapy-alone groups: 16·8 months in the chemotherapy plus bevacizumab groups versus 13·3 months in the chemotherapy-alone groups (hazard ratio 0·77 [95% CI 0·62-0·95]; p=0·007). Final OS among patients not receiving previous pelvic radiotherapy was 24·5 months versus 16·8 months (0·64 [0·37-1·10]; p=0·11). Postprogression OS was not significantly different between the chemotherapy plus bevacizumab groups (8·4 months) and chemotherapy-alone groups (7·1 months; 0·83 [0·66-1·05]; p=0·06). Fistula (any grade) occurred in 32 (15%) of 220 patients in the chemotherapy plus bevacizumab groups (all previously irradiated) versus three (1%) of 220 in the chemotherapy-alone groups (all previously irradiated). Grade 3 fistula developed in 13 (6%) versus one (<1%). No fistulas resulted in surgical emergencies, sepsis, or death. INTERPRETATION The benefit conferred by incorporation of bevacizumab is sustained with extended follow-up as evidenced by the overall survival curves remaining separated. After progression while receiving bevacizumab, we did not observe a negative rebound effect (ie, shorter survival after bevacizumab is stopped than after chemotherapy alone is stopped). These findings represent proof-of-concept of the efficacy and tolerability of antiangiogenesis therapy in advanced cervical cancer. FUNDING National Cancer Institute.
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Affiliation(s)
- Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
| | - Michael W Sill
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Helen Huang
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Lisa M Landrum
- Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City, OK, USA
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Thomas J Reid
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Women's Cancer Center at Kettering, Cincinnati, OH, USA
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Philip J DiSaia
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | | | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mark F Brady
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Tate Thigpen
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Steven E Waggoner
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Wui-Jin Koh
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St Joseph's Hospital, Phoenix, AZ, USA
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Coleman RL, Brady MF, Herzog TJ, Sabbatini P, Armstrong DK, Walker JL, Kim BG, Fujiwara K, Tewari KS, O'Malley DM, Davidson SA, Rubin SC, DiSilvestro P, Basen-Engquist K, Huang H, Chan JK, Spirtos NM, Ashfaq R, Mannel RS. Bevacizumab and paclitaxel-carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG Oncology/Gynecologic Oncology Group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2017; 18:779-791. [PMID: 28438473 DOI: 10.1016/s1470-2045(17)30279-6] [Citation(s) in RCA: 393] [Impact Index Per Article: 56.1] [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] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Platinum-based chemotherapy doublets are a standard of care for women with ovarian cancer recurring 6 months after completion of initial therapy. In this study, we aimed to explore the roles of secondary surgical cytoreduction and bevacizumab in this population, and report the results of the bevacizumab component here. METHODS The multicentre, open-label, randomised phase 3 GOG-0213 trial was done in 67 predominantly academic centres in the USA (65 centres), Japan (one centre), and South Korea (one centre). Eligible patients were adult women (aged ≥18 years) with recurrent measurable or evaluable epithelial ovarian, primary peritoneal, or fallopian tube cancer, and a clinical complete response to primary platinum-based chemotherapy, who had been disease-free for at least 6 months following last infused cycle of platinum. Patients were randomly assigned (1:1) to standard chemotherapy (six 3-weekly cycles of paclitaxel [175 mg/m2 of body surface area] and carboplatin [area under the curve 5]) or the same chemotherapy regimen plus bevacizumab (15 mg/kg of bodyweight) every 3 weeks and continued as maintenance every 3 weeks until disease progression or unacceptable toxicity. Individuals who participated in both the bevacizumab objective and surgical objective (which is ongoing) were randomly assigned (1:1:1:1) to receive either of these two chemotherapy regimens with or without prior secondary cytoreductive surgery. Randomisation for the bevacizumab objective was stratified by treatment-free interval and participation in the surgical objective. The primary endpoint was overall survival, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00565851. FINDINGS Between Dec 10, 2007, and Aug 26, 2011, 674 women were enrolled and randomly assigned to standard chemotherapy (n=337) or chemotherapy plus bevacizumab (n=377). Median follow-up at the end of the trial on Nov 5, 2014, was 49·6 months in each treatment group (IQR 41·5-62·2 for chemotherapy plus bevacizumab; IQR 40·8-59·3 for chemotherapy), at which point 415 patients had died (214 in the chemotherapy group and 201 in the chemotherapy plus bevacizumab group). Based on pretreatment stratification data, median overall survival in the chemotherapy plus bevacizumab group was 42·2 months (95% CI 37·7-46·2) versus 37·3 months (32·6-39·7) in the chemotherapy group (hazard ratio [HR] 0·829; 95% CI 0·683-1·005; p=0·056). We identified incorrect treatment-free interval stratification data for 45 (7%) patients (equally balanced between treatment groups); a sensitivity analysis of overall survival based on the audited treatment-free interval stratification data gave an adjusted HR of 0·823 (95% CI 0·680-0·996; p=0·0447). In the safety population (all patients who initiated treatment), 317 (96%) of 325 patients in the chemotherapy plus bevacizumab group had at least one grade 3 or worse adverse event compared with 282 (86%) of 332 in the chemotherapy group; the most frequently reported of these in the chemotherapy plus bevacizumab group compared with the chemotherapy group were hypertension (39 [12%] vs two [1%]), fatigue (27 [8%] vs eight [2%]), and proteinuria (27 [8%] vs none). Two (1%) treatment-related deaths occurred in the chemotherapy group (infection [n=1] and myelodysplastic syndrome [n=1]) compared with nine (3%) in the chemotherapy plus bevacizumab group (infection [n=1], febrile neutropenia [n=1], myelodysplastic syndrome [n=1], secondary malignancy [n=1]; deaths not classified with CTCAE terms: disease progression [n=3], sudden death [n=1], and not specified [n=1]). INTERPRETATION The addition of bevacizumab to standard chemotherapy, followed by maintenance therapy until progression, improved the median overall survival in patients with platinum-sensitive recurrent ovarian cancer. Although the intention-to-treat analysis for overall survival was not significant, our sensitivity analysis based on corrected treatment-free interval stratification indicates that this strategy might be an important addition to the therapeutic armamentarium in these patients. FUNDING National Cancer Institute and Genentech.
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Affiliation(s)
- Robert L Coleman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mark F Brady
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, University of Buffalo, Buffalo, NY, USA
| | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - Paul Sabbatini
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah K Armstrong
- Departments of Obstetrics and Gynecology and Department of Medical Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, USA
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwayn University School of Medicine, Seoul, South Korea
| | - Keiichi Fujiwara
- Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Hidaka-Shi, Japan
| | - Krishnansu S Tewari
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA
| | - David M O'Malley
- Department of Obstetrics and Gynecology, The Ohio State University, James Cancer Hospital, Columbus, OH, USA
| | - Susan A Davidson
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine and Denver Health Medical Center, Denver, CO, USA
| | - Stephen C Rubin
- Department of Obstetrics and Gynecology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paul DiSilvestro
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
| | - Karen Basen-Engquist
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Helen Huang
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, University of Buffalo, Buffalo, NY, USA
| | - John K Chan
- Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco, CA, USA
| | | | | | - Robert S Mannel
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, USA
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Norquist BM, Harrell MI, Brady MF, Walsh T, Lee MK, Gulsuner S, Bernards SS, Casadei S, Yi Q, Burger RA, Chan JK, Davidson SA, Mannel RS, DiSilvestro PA, Lankes HA, Ramirez NC, King MC, Swisher EM, Birrer MJ. Inherited Mutations in Women With Ovarian Carcinoma. JAMA Oncol 2016; 2:482-90. [PMID: 26720728 DOI: 10.1001/jamaoncol.2015.5495] [Citation(s) in RCA: 495] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Germline mutations in BRCA1 and BRCA2 are relatively common in women with ovarian, fallopian tube, and peritoneal carcinoma (OC) causing a greatly increased lifetime risk of these cancers, but the frequency and relevance of inherited mutations in other genes is less well characterized. OBJECTIVE To determine the frequency and importance of germline mutations in cancer-associated genes in OC. DESIGN, SETTING, AND PARTICIPANTS A study population of 1915 woman with OC and available germline DNA were identified from the University of Washington (UW) gynecologic tissue bank (n = 570) and from Gynecologic Oncology Group (GOG) phase III clinical trials 218 (n = 788) and 262 (n = 557). Patients were enrolled at diagnosis and were not selected for age or family history. Germline DNA was sequenced from women with OC using a targeted capture and multiplex sequencing assay. MAIN OUTCOMES AND MEASURES Mutation frequencies in OC were compared with the National Heart, Lung, and Blood Institute GO Exome Sequencing Project (ESP) and the Exome Aggregation Consortium (ExAC). Clinical characteristics and survival were assessed by mutation status. RESULTS Overall, the median (range) age at diagnosis was 60 (28-91) years in patients recruited from UW and 61 (23-87) years in patients recruited from the GOG trials. A higher number of black women were recruited from the GOG trials (4.3% vs 1.4%; P = .009); but in patients recruited from UW, there was a higher proportion of fallopian tube carcinomas (13.3% vs 5.7%; P < .001); stage I and II disease (14.6% vs 0% [GOG trials were restricted to advanced-stage cancer]); and nonserous carcinomas (29.9% vs 13.1%, P < .001). Of 1915 patients, 280 (15%) had mutations in BRCA1 (n = 182), or BRCA2 (n = 98), and 8 (0.4%) had mutations in DNA mismatch repair genes. Mutations in BRIP1 (n = 26), RAD51C (n = 11), RAD51D (n = 11), PALB2 (n = 12), and BARD1 (n = 4) were significantly more common in patients with OC than in the ESP or ExAC, present in 3.3%. Race, histologic subtype, and disease site were not predictive of mutation frequency. Patients with a BRCA2 mutation from the GOG trials had longer progression-free survival (hazard ratio [HR], 0.60; 95% CI, 0.45-0.79; P < .001) and overall survival (HR, 0.39; 95% CI, 0.25-0.60; P < .001) compared with those without mutations. CONCLUSIONS AND RELEVANCE Of 1915 patients with OC, 347 (18%) carried pathogenic germline mutations in genes associated with OC risk. PALB2 and BARD1 are suspected OC genes and together with established OC genes (BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, MSH2, MLH1, PMS2, and MSH6) bring the total number of genes suspected to cause hereditary OC to 11.
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Affiliation(s)
- Barbara M Norquist
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Maria I Harrell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Mark F Brady
- The NRG Oncology Statistical and Data Center, Roswell Park Cancer Center Institute, Buffalo, New York
| | - Tom Walsh
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Ming K Lee
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Suleyman Gulsuner
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Sarah S Bernards
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Silvia Casadei
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Qian Yi
- Department of Genome Sciences, University of Washington, Seattle
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia
| | - John K Chan
- Division of Gynecologic Oncology, Sutter Health California Pacific Medical Center, San Francisco, California
| | - Susan A Davidson
- Division of Gynecologic Oncology, University of Colorado, Denver
| | - Robert S Mannel
- Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City
| | - Paul A DiSilvestro
- Division of Gynecologic Oncology, Women and Infants Hospital, Providence, Rhode Island
| | - Heather A Lankes
- The NRG Oncology Statistical and Data Center, Roswell Park Cancer Center Institute, Buffalo, New York
| | - Nilsa C Ramirez
- Department of Pathology and Laboratory Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mary Claire King
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle3Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
| | - Michael J Birrer
- Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston
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Coleman RL, Brady MF, Herzog TJ, Armstrong DK, Sabbatini P, Walker JL, Kim B, Fujiwara K, Tewari KS, O'Malley DM. Bevacizumab after bevacizumab in platinum-sensitive recurrent ovarian cancer: A subgroup analysis of GOG0213. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5523] [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)
| | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Thomas J Herzog
- Division of Gynecologic Oncology, The University of Cincinnati Cancer Institute, Cincinnati, OH
| | | | - Paul Sabbatini
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Byoung Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
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Bookman MA, Brady MF. Reply to F.M. Muggia. J Clin Oncol 2016; 34:884. [PMID: 26834059 DOI: 10.1200/jco.2015.63.4303] [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
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Chan JK, Brady MF, Penson RT, Huang H, Birrer MJ, Walker JL, DiSilvestro PA, Rubin SC, Martin LP, Davidson SA, Huh WK, O'Malley DM, Boente MP, Michael H, Monk BJ. Weekly vs. Every-3-Week Paclitaxel and Carboplatin for Ovarian Cancer. N Engl J Med 2016; 374:738-48. [PMID: 26933849 PMCID: PMC5081077 DOI: 10.1056/nejmoa1505067] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A dose-dense weekly schedule of paclitaxel (resulting in a greater frequency of drug delivery) plus carboplatin every 3 weeks or the addition of bevacizumab to paclitaxel and carboplatin administered every 3 weeks has shown efficacy in ovarian cancer. We proposed to determine whether dose-dense weekly paclitaxel and carboplatin would prolong progression-free survival as compared with paclitaxel and carboplatin administered every 3 weeks among patients receiving and those not receiving bevacizumab. METHODS We prospectively stratified patients according to whether they elected to receive bevacizumab and then randomly assigned them to receive either paclitaxel, administered intravenously at a dose of 175 mg per square meter of body-surface area every 3 weeks, plus carboplatin (dose equivalent to an area under the curve [AUC] of 6) for six cycles or paclitaxel, administered weekly at a dose of 80 mg per square meter, plus carboplatin (AUC, 6) for six cycles. The primary end point was progression-free survival. RESULTS A total of 692 patients were enrolled, 84% of whom opted to receive bevacizumab. In the intention-to-treat analysis, weekly paclitaxel was not associated with longer progression-free survival than paclitaxel administered every 3 weeks (14.7 months and 14.0 months, respectively; hazard ratio for disease progression or death, 0.89; 95% confidence interval [CI], 0.74 to 1.06; P=0.18). Among patients who did not receive bevacizumab, weekly paclitaxel was associated with progression-free survival that was 3.9 months longer than that observed with paclitaxel administered every 3 weeks (14.2 vs. 10.3 months; hazard ratio, 0.62; 95% CI, 0.40 to 0.95; P=0.03). However, among patients who received bevacizumab, weekly paclitaxel did not significantly prolong progression-free survival, as compared with paclitaxel administered every 3 weeks (14.9 months and 14.7 months, respectively; hazard ratio, 0.99; 95% CI, 0.83 to 1.20; P=0.60). A test for interaction that assessed homogeneity of the treatment effect showed a significant difference between treatment with bevacizumab and without bevacizumab (P=0.047). Patients who received weekly paclitaxel had a higher rate of grade 3 or 4 anemia than did those who received paclitaxel every 3 weeks (36% vs. 16%), as well as a higher rate of grade 2 to 4 sensory neuropathy (26% vs. 18%); however, they had a lower rate of grade 3 or 4 neutropenia (72% vs. 83%). CONCLUSIONS Overall, weekly paclitaxel, as compared with paclitaxel administered every 3 weeks, did not prolong progression-free survival among patients with ovarian cancer. (Funded by the National Cancer Institute and Genentech; GOG-0262 ClinicalTrials.gov number, NCT01167712.).
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Affiliation(s)
- John K Chan
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Mark F Brady
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Richard T Penson
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Helen Huang
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Michael J Birrer
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Joan L Walker
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Paul A DiSilvestro
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Stephen C Rubin
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Lainie P Martin
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Susan A Davidson
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Warner K Huh
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - David M O'Malley
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Matthew P Boente
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Helen Michael
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
| | - Bradley J Monk
- From the California Pacific-Palo Alto Medical Foundation, Sutter Cancer Research Institute, San Francisco (J.K.C.); NRG Oncology-Gynecologic Oncology Group Statistics and Data Center, Roswell Park Cancer Institute, Buffalo, NY (M.F.B., H.H.); Massachusetts General Hospital, Boston (R.T.P., M.J.B.); University of Oklahoma, Oklahoma City (J.L.W.); Women and Infants Hospital, Providence, RI (P.A.D.S.); University of Pennsylvania (S.C.R.) and Fox Chase Cancer Center (L.P.M.) - both in Philadelphia; University of Colorado Cancer Center, Aurora (S.A.D.); University of Alabama at Birmingham, Birmingham (W.K.H.); James Cancer Center, Ohio State University, Columbus (D.M.O.); Minnesota Oncology/Hematology-Oncology Service, Edina (M.P.B.); Indiana University School of Medicine, Carmel (H.M.); and University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center (B.J.M.) - all in Phoenix
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Norquist BM, Brady MF, Harrell MI, Walsh TD, Lee MK, Gulsuner S, Bernards SS, Casadei S, Burger RA, Davidson SA, Mannel RS, DiSilvestro PA, Lankes HA, Ramirez NC, King MC, Birrer MJ, Swisher EM. Abstract A12: Mutations in homologous recombination genes and response to treatment in GOG 218: An NRG Oncology Study. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.ovca15-a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody with activity in ovarian cancer. GOG 218 was a phase III, randomized trial in advanced primary ovarian, fallopian tube, and peritoneal carcinoma (collectively, OC), examining the role of adding bevacizumab to a regimen of q21 day carboplatin and paclitaxel. Our objective was to examine whether mutations in homologous recombination (HR) genes affect response to treatment.
Methods: We sequenced germline (from blood) and/or somatic (from neoplastic tissue) DNA from 1195 women enrolled in GOG 218 using the targeted capture and multiplex sequencing assay BROCA-HR, focusing on 16 DNA repair genes. Defects in HR were defined as germline or somatic mutations in genes predicted to affect HR, including BRCA1, BRCA2, and others. Proportional hazards models were used to provide estimates of relative hazards for progression free survival (PFS) and overall survival (OS) adjusted for clinical characteristics.
Results: Of 1195 women with OC, germline or somatic mutations were identified in 147 (12.3%) in BRCA1, 78 (6.5%) in BRCA2, and 81 (6.8%) in other, non-BRCA HR genes. Total mutation frequency (all genes combined) in those with high-grade serous histology was 26.9% (261/971), but this was not significantly higher than the mutation frequency in endometrioid histology (10/42, 23.8%), clear cell histology (6/28, 21.4%), or unspecified carcinoma (20/90, 22.2%). Mutation frequency also did not differ by disease site. Median PFS and OS by group were as follows: BRCA1: 15.6 and 53.7 months, BRCA2: 21.6 and 75.2 months, non-BRCA HR: 16 and 56 months, and no mutation: 12.6 and 42 months. Adjusting for study treatment, stage, residual disease, and initial performance status, hazards for progression and death compared to those without mutations were significantly lower for those with mutations, specifically with BRCA1 mutations (hazard ratio (HR) 0.80, 95% CI 0.66 – 0.97, p=0.02 for PFS; HR 0.75, 95% CI 0.60 – 0.95, p=0.02 for OS), with BRCA2 mutations (HR 0.52, 95% CI 0.40 – 0.67, p<0.0001 for PFS; HR 0.37, 95% CI 0.25 – 0.53, p<0.0001 for OS), and with non-BRCA HR mutations (HR 0.73, 95% CI 0.57 – 0.94, p=0.01 for PFS; HR 0.67, 95% CI 0.50 – 0.90, p=0.007 for OS). The analysis of PFS and OS by mutation status and treatment arm is underway.
Conclusions: Women with OC with either germline or somatic mutations affecting HR have significantly longer PFS and OS than those without mutations. Disease site and histology were not predictive of mutation status. The effect of mutation status on response by treatment arm will be reported at presentation.
Citation Format: Barbara M. Norquist, Mark F. Brady, Maria I. Harrell, Tom D. Walsh, Ming K. Lee, Suleyman Gulsuner, Sarah S. Bernards, Silvia Casadei, Robert A. Burger, Susan A. Davidson, Robert S. Mannel, Paul A. DiSilvestro, Heather A. Lankes, Nilsa C. Ramirez, Mary Claire King, Michael J. Birrer, Elizabeth M. Swisher. Mutations in homologous recombination genes and response to treatment in GOG 218: An NRG Oncology Study. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr A12.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nilsa C. Ramirez
- 7The Research Institute at Nationwide Children's Hospital, Columbus, OH,
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Harrell MI, Norquist BM, Walsh T, Brady MF, Lee MK, Hershberg R, Kalli KR, Lankes H, Konnick EQ, Pritchard CC, Monk BJ, Chan JK, Burger R, Kaufmann SH, Birrer MJ, Swisher EM. Abstract B71: Old age and chemotherapy contribute to the selection of PPM1D somatic mosaic mutations in ovarian cancer. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.ovca15-b71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Somatic mosaic mutation in the PPM1D gene have been associated with risk of breast and ovarian cancer. Somatic mosaic mutations in blood cells may be associated with older age and chemotherapy exposure. We wanted to determine if somatic mosaic mutations in PPM1D and in other genes are associated with older age and repeated exposure to chemotherapy, rather than a contributor to risk of disease.
Experimental design: We used targeted capture and massively parallel genomic sequencing to sequence DNA from PBMCs from affected patients for PPM1D as well as 60 other DNA repair genes. For a number of samples with PPM1D mutations, we re-sequenced at greater depth on patients where PBMCs that were collected at diagnosis and recurrence.
Results: We identified somatic mosaic mutations in exon 6 of PPM1D in 4 out of 474 (0.8%) individuals that were newly diagnosed and had no previous chemotherapy, in 3 out of 29 (10%) individuals newly diagnosed but receiving chemotherapy and in 58 of 274 (21%) individuals with relapsed platinum resistant ovarian cancer (p<0.0001). The presence of PPM1D mutations in exon 6 was strongly associated with more advanced age (p=0.011, Wilcoxon test) and more than one chemotherapy regimen (p=0.026, Fisher's exact test). In paired blood samples from 13 patients, PPM1D mutations present at relapse were either not detected or detected at a lower percentage compared to blood obtained soon after diagnosis. Somatic mosaic mutations were also identified in TP53 in 7 of 274 (2.5%) women with relapsed platinum resistant cancer. In one of these cases, we had an earlier blood sample from diagnosis in which the mutation was not present at time near diagnosis.
Conclusion: We found that somatic mosaic PPM1D mutations in PMBCs are associated with advanced age and repeated exposure to chemotherapy. Mosaic mutations in other genes were not confirmed with the exception of TP53, for which mutations are also detectable after extensive treatment. It seems likely that mosaic PPM1D mutations in blood from cancer patients may be a result of selection by chemotherapy of age-induced somatic mutations during exposure to chemotherapy. Further studies are needed to determine the clinical significance of these mutations.
Citation Format: Maria I. Harrell, Barbara M. Norquist, Tom Walsh, Mark F. Brady, Ming K. Lee, Robert Hershberg, Kimberly R. Kalli, Heather Lankes, Eric Q. Konnick, Colin C. Pritchard, Bradley J. Monk, John K. Chan, Robert Burger, Scott H. Kaufmann, Michael J. Birrer, Elizabeth M. Swisher. Old age and chemotherapy contribute to the selection of PPM1D somatic mosaic mutations in ovarian cancer. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B71.
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Affiliation(s)
| | | | - Tom Walsh
- 1University of Washington, Seattle, WA,
| | | | | | | | | | | | | | | | | | - John K. Chan
- 6California Pacific Medical Center, Palo Alto Sutter Health, San Francisco, CA,
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Norquist BM, Harrell MI, Brady MF, Walsh T, Lee MK, Gulsuner S, Bernards SS, Casadei S, Yi Q, Burger RA, Chan JK, Davidson SA, Mannel RS, DiSilvestro PA, Lankes HA, Ramirez NC, King MC, Swisher EM, Birrer MJ. Inherited Mutations in Women With Ovarian Carcinoma. JAMA Oncol 2016. [PMID: 26720728 DOI: 10.1001/jamaoncol.2015.5495] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Germline mutations in BRCA1 and BRCA2 are relatively common in women with ovarian, fallopian tube, and peritoneal carcinoma (OC) causing a greatly increased lifetime risk of these cancers, but the frequency and relevance of inherited mutations in other genes is less well characterized. OBJECTIVE To determine the frequency and importance of germline mutations in cancer-associated genes in OC. DESIGN, SETTING, AND PARTICIPANTS A study population of 1915 woman with OC and available germline DNA were identified from the University of Washington (UW) gynecologic tissue bank (n = 570) and from Gynecologic Oncology Group (GOG) phase III clinical trials 218 (n = 788) and 262 (n = 557). Patients were enrolled at diagnosis and were not selected for age or family history. Germline DNA was sequenced from women with OC using a targeted capture and multiplex sequencing assay. MAIN OUTCOMES AND MEASURES Mutation frequencies in OC were compared with the National Heart, Lung, and Blood Institute GO Exome Sequencing Project (ESP) and the Exome Aggregation Consortium (ExAC). Clinical characteristics and survival were assessed by mutation status. RESULTS Overall, the median (range) age at diagnosis was 60 (28-91) years in patients recruited from UW and 61 (23-87) years in patients recruited from the GOG trials. A higher number of black women were recruited from the GOG trials (4.3% vs 1.4%; P = .009); but in patients recruited from UW, there was a higher proportion of fallopian tube carcinomas (13.3% vs 5.7%; P < .001); stage I and II disease (14.6% vs 0% [GOG trials were restricted to advanced-stage cancer]); and nonserous carcinomas (29.9% vs 13.1%, P < .001). Of 1915 patients, 280 (15%) had mutations in BRCA1 (n = 182), or BRCA2 (n = 98), and 8 (0.4%) had mutations in DNA mismatch repair genes. Mutations in BRIP1 (n = 26), RAD51C (n = 11), RAD51D (n = 11), PALB2 (n = 12), and BARD1 (n = 4) were significantly more common in patients with OC than in the ESP or ExAC, present in 3.3%. Race, histologic subtype, and disease site were not predictive of mutation frequency. Patients with a BRCA2 mutation from the GOG trials had longer progression-free survival (hazard ratio [HR], 0.60; 95% CI, 0.45-0.79; P < .001) and overall survival (HR, 0.39; 95% CI, 0.25-0.60; P < .001) compared with those without mutations. CONCLUSIONS AND RELEVANCE Of 1915 patients with OC, 347 (18%) carried pathogenic germline mutations in genes associated with OC risk. PALB2 and BARD1 are suspected OC genes and together with established OC genes (BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, MSH2, MLH1, PMS2, and MSH6) bring the total number of genes suspected to cause hereditary OC to 11.
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Affiliation(s)
- Barbara M Norquist
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Maria I Harrell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Mark F Brady
- The NRG Oncology Statistical and Data Center, Roswell Park Cancer Center Institute, Buffalo, New York
| | - Tom Walsh
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Ming K Lee
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Suleyman Gulsuner
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Sarah S Bernards
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Silvia Casadei
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Qian Yi
- Department of Genome Sciences, University of Washington, Seattle
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia
| | - John K Chan
- Division of Gynecologic Oncology, Sutter Health California Pacific Medical Center, San Francisco, California
| | - Susan A Davidson
- Division of Gynecologic Oncology, University of Colorado, Denver
| | - Robert S Mannel
- Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City
| | - Paul A DiSilvestro
- Division of Gynecologic Oncology, Women and Infants Hospital, Providence, Rhode Island
| | - Heather A Lankes
- The NRG Oncology Statistical and Data Center, Roswell Park Cancer Center Institute, Buffalo, New York
| | - Nilsa C Ramirez
- Department of Pathology and Laboratory Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mary Claire King
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle4Department of Genome Sciences, University of Washington, Seattle
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle3Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
| | - Michael J Birrer
- Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston
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Wei W, Brady MF, Tsang TY, Vathipadiekal V, Burger RA, Mannel RS, Hanjani P, Huh WK, Swisher EM, Rutherford TJ, Tanyi JL, Schink JC, Lele SB, DiSilvestro PA, Birrer MJ. Abstract PR05: An assessment of the prognostic and predictive associations of 13 angiogenic biomarkers in women with newly diagnosed advanced ovarian cancer treated with chemotherapy with or without bevacizumab. Mol Cancer Ther 2015. [DOI: 10.1158/1538-8514.tumang15-pr05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Targeting ovarian cancer vasculature by humanized VEGFA neutralizing antibody bevacizumab has been demonstrated effective in multiple randomized phase III clinical studies to improve standard chemotherapy in patients with primary (GOG-0218, ICON-7) and recurrent (OCEANS, AURELIA) ovarian cancer. Nevertheless, potential benefits observed in these randomized bevacizumab clinical trials are modest, which has stimulated the search for predictive molecular biomarkers which would identify those women with ovarian cancer who would likely benefit from bevacizumab treatment, while reducing toxicity and expense for those patients who are unlikely to benefit.
Methods and Results: In this study, we evaluated prognostic and predictive values of post-surgery, pre-treatment circulating levels of 13 angiogenesis biomarkers (ANG1, ANG2, Tie-2, FGF2, VEGFR1, VEGFR2, VEGFR3, ICAM1, IL8, PDGFC, E-selectin, VEGFA and VEGFC) in 922 plasma samples from GOG-0218 randomized phase III clinical trial. Prognostic and predictive associations of each biomarker with overall survival (OS) and progression-free survival (PFS) were assessed by proportional hazards models on 2.5% winsorized values while adjusting for FIGO stage, initial performance status, and study treatment. Holm-Bonferroni stepwise procedure was used to control the family-wise type I error at 5%.Increased overall risk of first progression or death (PFS) was significantly associated with higher pretreatment levels of IL8, ANG2 or lower levels of VEGFR2. IL8, ANG2 and VEGFR2 were each associated with overall survival also (p<0.0001). However, in predictive analyses, the bevacizumab treatment-related hazard ratios for PFS were not significantly associated with the plasma levels of any of the 13 angiogenesis biomarkers investigated.
Conclusions: We provide a comprehensive evaluation of the circulating levels of angiogenesis biomarkers in ovarian cancer. Angiogenesis biomarkers do not exhibit clinically appreciable predictive power for outcome after bevacizumab in ovarian cancer patients, probably due to the complex biology of ovarian cancer. ANG2, IL8 and VEGFR2 are prognostic markers for ovarian cancer and may serve as candidates for targeted therapy.
Citation Format: Wei Wei, Mark F. Brady, Tsun-Yee Tsang, Vinod Vathipadiekal, Robert A. Burger, Robert S. Mannel, Parviz Hanjani, Warner K. Huh, Elizabeth M. Swisher, Thomas J. Rutherford, Janos L. Tanyi, Julian C. Schink, Shashikant B. Lele, Paul A. DiSilvestro, Michael J. Birrer. An assessment of the prognostic and predictive associations of 13 angiogenic biomarkers in women with newly diagnosed advanced ovarian cancer treated with chemotherapy with or without bevacizumab. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Angiogenesis and Vascular Normalization: Bench to Bedside to Biomarkers; Mar 5-8, 2015; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl):Abstract nr PR05.
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Affiliation(s)
- Wei Wei
- 1Massachusetts General Hospital, Boston, MA,
| | | | | | | | | | | | | | - Warner K. Huh
- 6University of Alabama at Birmingham, Birmingham, AL,
| | - Elizabeth M. Swisher
- 7University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA,
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Birrer MJ, Choi Y, Brady MF, Mannel RS, Burger RA, WEI WEI, Husain A, Bais C. Retrospective analysis of candidate predictive tumor biomarkers (BMs) for efficacy in the GOG-0218 trial evaluating front-line carboplatin–paclitaxel (CP) ± bevacizumab (BEV) for epithelial ovarian cancer (EOC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael J. Birrer
- Massachusetts General Hospital/Dana Farber Cancer Center, Boston, MA
| | | | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - WEI WEI
- Center for Cancer Research, The Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Affiliation(s)
- Michael A. Bookman
- US Oncology Research, The Woodlands, TX, and Arizona Oncology, Tucson, AZ
| | - Mark F. Brady
- NRG Oncology Statistical and Data Center, Buffalo, NY
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Burger RA, Brady MF, Bookman MA, Monk BJ, Walker JL, Homesley HD, Fowler J, Greer BE, Boente M, Fleming GF, Lim PC, Rubin SC, Katsumata N, Liang SX. Risk factors for GI adverse events in a phase III randomized trial of bevacizumab in first-line therapy of advanced ovarian cancer: A Gynecologic Oncology Group Study. J Clin Oncol 2014; 32:1210-7. [PMID: 24637999 PMCID: PMC3986384 DOI: 10.1200/jco.2013.53.6524] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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: 12/11/2022] Open
Abstract
PURPOSE To evaluate risk factors for GI adverse events (AEs) within a phase III trial of bevacizumab in first-line ovarian cancer therapy. PATIENTS AND METHODS Women with previously untreated advanced disease after surgery were randomly allocated to six cycles of platinum-taxane chemotherapy plus placebo cycles (C)2 to C22 (R1); chemotherapy plus bevacizumab C2 to C6 plus placebo C7 to C22 (R2); or chemotherapy plus bevacizumab C2 to C22 (R3). Patients were evaluated for history or on-study development of potential risk factors for GI AEs defined as grade ≥ 2 perforation, fistula, necrosis, or hemorrhage. RESULTS Of 1,873 patients enrolled, 1,759 (94%) were evaluable, and 2.8% (50 of 1,759) experienced a GI AE: 10 of 587 (1.7%, R1), 20 of 587 (3.4%, R2), and 20 of 585 (3.4%, R3). Univariable analyses indicated that previous treatment of inflammatory bowel disease (IBD; P = .005) and small bowel resection (SBR; P = .032) or large bowel resection (LBR; P = .012) at primary surgery were significantly associated with a GI AE. The multivariable estimated relative odds of a GI AE were 13.4 (95% CI, 3.44 to 52.3; P < .001) for IBD; 2.05 (95% CI, 1.09 to 3.88; P = .026) for LBR; 1.95 (95% CI, 0.894 to 4.25; P = .093) for SBR; and 2.15 for bevacizumab exposure (aggregated 95% CI, 1.05 to 4.40; P = .036). CONCLUSION History of treatment for IBD, and bowel resection at primary surgery, increase the odds of GI AEs in patients receiving first-line platinum-taxane chemotherapy for advanced ovarian cancer. After accounting for these risk factors, concurrent bevacizumab doubles the odds of a GI AE, but is not appreciably increased by continuation beyond chemotherapy.
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Affiliation(s)
- Robert A. Burger
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Mark F. Brady
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Michael A. Bookman
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Bradley J. Monk
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Joan L. Walker
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Howard D. Homesley
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Jeffrey Fowler
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Benjamin E. Greer
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Matthew Boente
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Gini F. Fleming
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Peter C. Lim
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Stephen C. Rubin
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Noriyuki Katsumata
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
| | - Sharon X. Liang
- Robert A. Burger, Fox Chase Cancer Center, Philadelphia, PA; Mark F. Brady, GOG Statistical and Data Center, Buffalo, NY; Michael A. Bookman, Arizona Cancer Center, Tucson, AZ; Bradley J. Monk, University of California at Irvine, Orange, CA; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; Howard D. Homesley, Wake Forest University Medical Center, Winston-Salem, NC; Jeffrey Fowler, Ohio State University, Columbus, OH; Benjamin E. Greer, University of Washington Medical Center, Seattle, WA; Matthew Boente, Minnesota Oncology Hematology, Minneapolis, MN; Gini F. Fleming, University of Chicago, Chicago, IL; Peter C. Lim, Center of Hope at Renown Regional Medical Center, Reno, NV; Stephen C. Rubin, University of Pennsylvania Cancer Center, Philadelphia, PA; Noriyuki Katsumata, Saitama Medical University/International Medical Center–GOG Japan, Saitama, Japan; and Sharon X. Liang, North Shore University Hospital, Manhasset, NY
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Herzog TJ, Armstrong DK, Brady MF, Coleman RL, Einstein MH, Monk BJ, Mannel RS, Thigpen JT, Umpierre SA, Villella JA, Alvarez RD. Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper. Gynecol Oncol 2013; 132:8-17. [PMID: 24239753 DOI: 10.1016/j.ygyno.2013.11.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/04/2013] [Accepted: 11/07/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the value of multiple clinical endpoints in the unique setting of ovarian cancer. METHODS A clinical trial workgroup was established by the Society of Gynecologic Oncology to develop a consensus statement via multiple conference calls, meetings and white paper drafts. RESULTS Clinical trial endpoints have profound effects on late phase clinical trial design, result interpretation, drug development, and regulatory approval of therapeutics. Selection of the optimal clinical trial endpoint is particularly provocative in ovarian cancer where long overall survival (OS) is observed. The lack of new regulatory approvals and the lack of harmony between regulatory bodies globally for ovarian cancer therapeutics are of concern. The advantages and disadvantages of the numerous endpoints available are herein discussed within the unique context of ovarian cancer where both crossover and post-progression therapies potentially uncouple surrogacy between progression-free survival (PFS) and OS, the two most widely supported and utilized endpoints. The roles of patient reported outcomes (PRO) and health related quality of life (HRQoL) are discussed, but even these widely supported parameters are affected by the unique characteristics of ovarian cancer where a significant percentage of patients may be asymptomatic. Original data regarding the endpoint preferences of ovarian cancer advocates is presented. CONCLUSIONS Endpoint selection in ovarian cancer clinical trials should reflect the impact on disease burden and unique characteristics of the treatment cohort while reflecting true patient benefit. Both OS and PFS have led to regulatory approvals and are clinically important. OS remains the most objective and accepted endpoint because it is least vulnerable to bias; however, the feasibility of OS in ovarian cancer is compromised by the requirement for large trial size, prolonged time-line for final analysis, and potential for unintended loss of treatment effect from active post-progression therapies. A large magnitude of effect in PFS improvement should establish benefit, and further communication with regulatory authorities to clarify acceptable endpoints should be undertaken.
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Affiliation(s)
| | | | | | - Robert L Coleman
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mark H Einstein
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Bradley J Monk
- Creighton University School of Medicine, Phoenix, AZ, USA; University of Arizona Cancer Center, Phoenix, AZ, USA
| | | | - J Tate Thigpen
- University of Mississippi Medical Center, Jackson, MS, USA
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Burger RA, Brady MF, Rhee J, Sovak MA, Kong G, Nguyen HP, Bookman MA. Independent radiologic review of the Gynecologic Oncology Group Study 0218, a phase III trial of bevacizumab in the primary treatment of advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. Gynecol Oncol 2013; 131:21-6. [PMID: 23906656 DOI: 10.1016/j.ygyno.2013.07.100] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/18/2013] [Accepted: 07/21/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Gynecologic Oncology Group Study 0218 (GOG-0218), a phase III, placebo-controlled trial in newly diagnosed stage III/IV ovarian cancer (OC), demonstrated a benefit in investigator (INV)-assessed progression-free survival (PFS) with bevacizumab (BEV) administered with and following carboplatin/paclitaxel (CP) for up to 15 months vs. CP alone. To determine the reliability of Response Evaluation Criteria in Solid Tumors (RECIST) in assessing disease progression (PD) in GOG-0218, an independent review of radiologic and clinical data (IRC) was conducted. METHODS Blinded reviews followed RECIST 1.0 in accordance with the study protocol; PFS was analyzed in the intent-to-treat population. RESULTS CP+BEV→BEV achieved a significant PFS improvement in both assessments. Hazard ratios for PFS (IRC: 0.623; 95% confidence interval [CI]: 0.503-0.772; p<0.0001 vs. INV: 0.624; 95% CI: 0.520-0.749; p<0.0001) and the improvement in median PFS (IRC: 19.1 and 13.1 months vs. INV: 18.2 and 12 months) were similar between IRC and INV assessments. There was high concordance between IRC- and INV-determined PD status (77%) and date (73%). Subgroup analyses were consistent with the primary IRC findings. Early and late discontinuation discordance measures showed no evidence of INV bias. CONCLUSION IRC analysis confirmed a significant PFS improvement with CP+BEV→BEV vs. CP alone. Concordance was not influenced by extent of residual disease after cytoreductive surgery or initial stage. The IRC size, high participation rate, and strong concordance between IRC and INV assessments suggest that RECIST can be applied objectively in OC studies.
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Stehman FB, Brady MF, Thigpen JT, Rossi EC, Burger RA. Cytokine use and survival in the first-line treatment of ovarian cancer: a Gynecologic Oncology Group Study. Gynecol Oncol 2012; 127:495-501. [PMID: 23000389 DOI: 10.1016/j.ygyno.2012.09.002] [Citation(s) in RCA: 5] [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] [Received: 07/18/2012] [Revised: 08/30/2012] [Accepted: 09/01/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Granulocyte colony stimulating factor (G-CSF) and erythropoietin stimulating agents (ESA) may be used to support patients during chemotherapy. We assessed whether G-CSF or ESA were associated with progression or death in patients with ovarian cancer. METHODS Patients with ovarian cancer following surgery, were on a protocol to evaluate bevacizumab with chemotherapy. Guidelines for administering G-CSF and ESA were specified in the protocol. Overall survival (OS) was analyzed with landmark procedures and multivariate, time-dependent hazard models. RESULTS Eighteen-hundred-seventy-three women were enrolled, with no differences in clinical and pathologic variables among treatment group. Performance status, hemoglobin, and white cell counts were associated with G-CSF and/or ESA usage during treatment. Nine patients received no protocol directed therapy, leaving 1864 patients for this review. One-thousand-one-hundred-twenty-five patients received neither ESA nor G-CSF; 311 received G-CSF but no ESA; 241 received ESA but no G-CSF; and 187 received both. Median survival following a five month landmark from the start of treatment was 34 versus 38 months for those who did versus did not receive ESA (multivariate hazard ratio: 0.989; 95% confidence interval: 0.849-1.15) and 40 versus 37 months for those who did versus did not receive G-CSF (multivariate hazard ratio: 0.932; 95% confidence interval: 0.800-1.08). CONCLUSIONS Neither ESA nor G-CSF had a negative impact on survival after adjustment of prognostic factors among patients with ovarian cancer receiving chemotherapy. ESA may appear to be associated with shorter survival in univariate analyses because factors prognostic for ESA use are also prognostic for progression-free survival.
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Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, Mannel RS, Homesley HD, Fowler J, Greer BE, Boente M, Birrer MJ, Liang SX. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011; 365:2473-83. [PMID: 22204724 DOI: 10.1056/nejmoa1104390] [Citation(s) in RCA: 1641] [Impact Index Per Article: 126.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vascular endothelial growth factor is a key promoter of angiogenesis and disease progression in epithelial ovarian cancer. Bevacizumab, a humanized anti-vascular endothelial growth factor monoclonal antibody, has shown single-agent activity in women with recurrent tumors. Thus, we aimed to evaluate the addition of bevacizumab to standard front-line therapy. METHODS In our double-blind, placebo-controlled, phase 3 trial, we randomly assigned eligible patients with newly diagnosed stage III (incompletely resectable) or stage IV epithelial ovarian cancer who had undergone debulking surgery to receive one of three treatments. All three included chemotherapy consisting of intravenous paclitaxel at a dose of 175 mg per square meter of body-surface area, plus carboplatin at an area under the curve of 6, for cycles 1 through 6, plus a study treatment for cycles 2 through 22, each cycle of 3 weeks' duration. The control treatment was chemotherapy with placebo added in cycles 2 through 22; bevacizumab-initiation treatment was chemotherapy with bevacizumab (15 mg per kilogram of body weight) added in cycles 2 through 6 and placebo added in cycles 7 through 22. Bevacizumab-throughout treatment was chemotherapy with bevacizumab added in cycles 2 through 22. The primary end point was progression-free survival. RESULTS Overall, 1873 women were enrolled. The median progression-free survival was 10.3 months in the control group, 11.2 in the bevacizumab-initiation group, and 14.1 in the bevacizumab-throughout group. Relative to control treatment, the hazard ratio for progression or death was 0.908 (95% confidence interval [CI], 0.795 to 1.040; P=0.16) with bevacizumab initiation and 0.717 (95% CI, 0.625 to 0.824; P<0.001) with bevacizumab throughout. At the time of analysis, 76.3% of patients were alive, with no significant differences in overall survival among the three groups. The rate of hypertension requiring medical therapy was higher in the bevacizumab-initiation group (16.5%) and the bevacizumab-throughout group (22.9%) than in the control group (7.2%). Gastrointestinal-wall disruption requiring medical intervention occurred in 1.2%, 2.8%, and 2.6% of patients in the control group, the bevacizumab-initiation group, and the bevacizumab-throughout group, respectively. CONCLUSIONS The use of bevacizumab during and up to 10 months after carboplatin and paclitaxel chemotherapy prolongs the median progression-free survival by about 4 months in patients with advanced epithelial ovarian cancer. (Funded by the National Cancer Institute and Genentech; ClinicalTrials.gov number, NCT00262847.).
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Mannel RS, Brady MF, Kohn EC, Hanjani P, Hiura M, Lee R, Degeest K, Cohn DE, Monk BJ, Michael H. A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 2011; 122:89-94. [PMID: 21529904 DOI: 10.1016/j.ygyno.2011.03.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 03/14/2011] [Accepted: 03/17/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the recurrence-free interval (RFI) and safety profile in patients with completely resected high-risk early-stage ovarian cancer treated with intravenous (IV) carboplatin and paclitaxel with or without maintenance low-dose paclitaxel for 24 weeks. METHODS Eligibility was limited to patients with stage IA/B (grade 3 or clear cell), all IC or II epithelial ovarian cancer. All patients were to receive carboplatin AUC 6 and paclitaxel 175 mg/m² q3 weeks × 3 courses with random assignment to either observation or maintenance paclitaxel 40 mg/m²/week × 24 weeks. Recurrence required clinical or radiological evidence of new tumor. RESULTS There were 571 patients enrolled onto this study, of whom 29 were deemed ineligible due to inappropriate stage or pathology, leaving 542 patients. At least 3 cycles of treatment were administered to 524/542 (97%) of patients, and among those assigned to maintenance paclitaxel, 80% completed the regimen. The incidence of grade 2 or worse peripheral neuropathy (15.5% vs. 6%), infection/fever (19.9% vs. 8.7%), and dermatologic events (70.8% vs. 52.1%) was higher on the maintenance regimen (p<0.001). The cumulative probability of recurring within 5 years for the maintenance paclitaxel regimen is 20% vs. 23% for surveillance (hazard ratio 0.807; 95% CI: 0.565-1.15). The probability of surviving 5 years was 85.4% and 86.2%, respectively. CONCLUSION Maintenance paclitaxel at 40 mg/m²/week × 24 weeks added to standard dose AUC6 and paclitaxel 175 mg/m² × 3 doses provides no significant increase in RFI.
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Farley J, Smith LM, Darcy KM, Brady MF, Bell J, McGuire W, Birrer MJ. Nuclear P27 expression in benign, borderline (LMP) and invasive tumors of the ovary and its association with prognosis: a gynecologic oncology group study. Gynecol Oncol 2011; 121:395-401. [PMID: 21310472 DOI: 10.1016/j.ygyno.2010.11.023] [Citation(s) in RCA: 8] [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] [Received: 09/23/2010] [Revised: 11/12/2010] [Accepted: 11/15/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Nuclear p27 expression was examined in non-invasive and invasive ovarian tumors from a cross-sectional study, and clinical relevance of p27 was evaluated in the primary tumors from women participating in two randomized phase III treatment trials. METHODS An immunohistochemistry assay was used to detect p27 in formalin-fixed paraffin-embedded ovarian tumors from 3 distinct sources. RESULTS Among the initial 91 ovarian tumors tested, low p27 expression (<50% positive cells) was observed in 5.4% of non-invasive tumors versus 42.6% of invasive tumors (p<0.001). In 145 ovarian cancers with high-risk early stage disease, 16.5% exhibited low p27 expression, and categorized p27 was not associated with age, race, or performance status. Low expression of p27 was common in poorly differentiated tumors (35.7%) compared to moderately (15.0%) and well (9.5%) differentiated tumors (p=0.024) and rare in clear cell carcinomas (2.4%) compared to other histologies (p=0.014). In the 139 cancers with advanced disease, 60% displayed low p27 expression, and categorized p27 expression was not associated with age, race, performance status, tumor grade, histologic subtype, measurable disease status or survival. Exploratory analyses revealed an association of cyclin E to p27 ratio >1.0 with an increased risk of death (hazard ratio=1.53; p=0.017). CONCLUSIONS Low p27 expression could be associated with malignant transformation of the ovarian epithelium and FIGO stage. A cyclin E to p27 ratio >1.0 may be associated with shorter survival in these patients. Further study is required to confirm the trend for increased recurrences with low p27 expression in early stage disease.
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Affiliation(s)
- John Farley
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Rose PG, Brady MF. EORTC 55971: Does it apply to all patients with advanced state ovarian cancer? Gynecol Oncol 2011; 120:300-1. [DOI: 10.1016/j.ygyno.2010.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/25/2022]
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Lacour RA, Westin SN, Meyer LA, Wingo SN, Schorge JO, Brooks R, Mutch D, Molina A, Sutphen R, Barnes M, Elder J, Teoh D, Powell CB, Choubey V, Blank S, Macdonald HR, Brady MF, Urbauer DL, Bodurka D, Gershenson DM, Lu KH. Improved survival in non-Ashkenazi Jewish ovarian cancer patients with BRCA1 and BRCA2 gene mutations. Gynecol Oncol 2011; 121:358-63. [PMID: 21276604 DOI: 10.1016/j.ygyno.2010.12.354] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 09/09/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Previous studies report a survival advantage in ovarian cancer patients with Ashkenazi Jewish (AJ) breast cancer gene (BRCA) founder mutations. The purpose of this study was to determine if this association exists in patients with non-Ashkenazi Jewish (non-AJ) BRCA mutations. We also sought to account for "survival bias" by minimizing lead time that may exist between diagnosis and genetic testing. METHODS Patients with stage III/IV ovarian cancer and a non-AJ BRCA mutation, seen between January 1996 and July 2007, were identified from eight institutions. Patients with sporadic ovarian cancer were compared to similar cases, matched by age, stage, year of diagnosis, and vital status at time interval to BRCA testing. Progression-free (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Multivariate Cox proportional hazards models were calculated for variables of interest. Fisher's exact test and chi-square were also used for analysis. RESULTS Ninety-five advanced stage ovarian cancer patients with non-AJ BRCA mutations and 183 sporadic controls were analyzed. Compared to sporadic ovarian cancer patients, non-AJ BRCA patients had longer PFS (27.9 months vs. 17.9 months, HR 0.61 [95% CI 0.43-0.86]) and OS (101.7 months vs. 54.3 months, HR 0.43 [95% CI 0.27-0.68]). BRCA status was an independent predictor of PFS and OS. CONCLUSIONS This multicenter study demonstrates a significant survival advantage in advanced stage ovarian cancer patients with non-AJ BRCA mutations, confirming the previous studies in the Jewish population. This improved survival was evident when accounting for the "survival bias" that coincides with genetic testing.
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Affiliation(s)
- Robin A Lacour
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-3721, USA.
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Dominguez M, Smith A, Luna G, Brady MF, Austin-Breneman J, Lopez S, Yataco R, Moore DAJ. The MIT D-lab electricity-free PortaTherm™ incubator for remote testing with the QuantiFERON®-TB Gold In-Tube assay. Int J Tuberc Lung Dis 2010; 14:1468-1474. [PMID: 20937189 PMCID: PMC3111905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Use of the QuantiFERON®-TB Gold In-Tube assay (QFT-GIT) in remote areas is limited by the need to incubate blood samples within 12 h of collection. PortaTherm™ is a portable, electricity-free, phase-change incubator previously used for field collection of microbiological samples. OBJECTIVE To determine whether the PortaTherm can be used for the reliable incubation of QFT-GIT samples, thus enabling QFT-GIT use in settings distant from laboratory facilities. METHODS In a prospective comparative study in Peru, blood samples were collected from 50 participants and processed in three parallel QFT-GIT tests per participant; two were incubated in a conventional incubator; the third was incubated in the PortaTherm. RESULTS All 150 QFT-GIT tests gave definitive results, and for 46 of the 50 participants all three tests were concordant, eight of which were positive. Four participants had one discordant result: two due to discordance of a conventional incubator QFT-GIT result, and two due to discordant PortaTherm QFT-GIT results. CONCLUSION The QFT-GIT inter-incubator variability between the PortaTherm and conventional incubator was no greater than the intra-incubator variability for the conventional incubator, indicating that the PortaTherm is a suitable tool for incubating QFT-GIT whole blood samples in remote settings where access to a laboratory or electricity is limited.
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Affiliation(s)
- M Dominguez
- Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru
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