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Clark AS, Hong F, Finn RS, DeMichele AM, Mitchell EP, Zwiebel J, Arnaldez FI, Gray RJ, Wang V, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Copur MS, Kasbari SS, Thind R, Conley BA, Arteaga CL, O'Dwyer PJ, Harris LN, Chen AP, Flaherty KT. Phase II Study of Palbociclib (PD-0332991) in CCND1, 2, or 3 Amplification: Results from the NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocol Z1B. Clin Cancer Res 2023; 29:1477-1483. [PMID: 36853016 PMCID: PMC10102836 DOI: 10.1158/1078-0432.ccr-22-2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Cyclin D/CDK4/6 is critical in controlling the G1 to S checkpoint. CCND, the gene encoding cyclin D, is known to be amplified in a variety of solid tumors. Palbociclib is an oral CDK4/6 inhibitor, approved in advanced breast cancer in combination with endocrine therapy. We explored the efficacy of palbociclib in patients with nonbreast solid tumors containing an amplification in CCND1, 2, or 3. PATIENTS AND METHODS Patients with tumors containing a CCND1, 2, or 3 amplification and expression of the retinoblastoma protein were assigned to subprotocol Z1B and received palbociclib 125 mg once daily for 21 days of a 28-day cycle. Tumor response was assessed every two cycles. RESULTS Forty patients were assigned to subprotocol Z1B; 4 patients had outside assays identifying the CCND1, 2, or 3 amplification and were not confirmed centrally; 3 were ineligible and 2 were not treated (1 untreated patient was also ineligible), leaving 32 evaluable patients for this analysis. There were no partial responses; 12 patients (37.5%) had stable disease as best response. There were seven deaths on study, all during cycle 1 and attributable to disease progression. Median progression-free survival was 1.8 months. The most common toxicities were leukopenia (n = 21, 55%) and neutropenia (n = 19, 50%); neutropenia was the most common grade 3/4 event (n = 12, 32%). CONCLUSIONS Palbociclib was not effective at treating nonbreast solid tumors with a CCND1, 2, or 3 amplification in this cohort. These data do not support further investigation of single-agent palbociclib in tumors with CCND1, 2, or 3 amplification.
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Affiliation(s)
- Amy S. Clark
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fangxin Hong
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Richard S. Finn
- University of California, Los Angeles, Los Angeles, California
| | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - James Zwiebel
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Fernanda I. Arnaldez
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Robert J. Gray
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Victoria Wang
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Lisa M. McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Larry V. Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - David Patton
- Center for Biomedical Informatics and Information Technology, NCI, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | - Alice P. Chen
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
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Copur MS, Wedel W, Cushman-Vokoun AM, Delaney A, Padussis J, Lauer S, Talmon GA. Locally Advanced Gastrointestinal Stromal Tumor in a 33-Year-Old Woman Seeking to Conceive. Oncology (Williston Park) 2021; 34:307-312. [PMID: 32785925 DOI: 10.46883/onc.2020.3408.0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. They commonly present with nonspecific symptoms and thus are often discovered incidentally. They are best identified by CT scan, and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. Several risk stratification classification systems have been developed based on tumor size, mitotic rate, location, and perforation. Traditional chemotherapy and radiation therapy have been very ineffective, making surgery the mainstay of treatment. The discovery of mutations associated with these tumors has revolutionized the treatment approach. Imatinib mesylate, a selective tyrosine kinase receptor inhibitor, used as adjuvant or neoadjuvant therapy, has greatly improved the morbidity and mortality associated with GISTs. As the survival of patients has increased with the long-term use of targeted therapies, quality-of-life issues now have become much more relevant and have come to the forefront of care. We present a young woman who was successfully treated for GIST but now faces associated long-term adverse effects of imatinib, including the challenge of preserving fertility and the potential for childbearing.
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Affiliation(s)
- Mehmet S Copur
- Morrison Cancer Center, Mary Lanning Healthcare, Hastings, NE.,University of Nebraska Medical Center, Omaha, NE
| | | | | | - Abigail Delaney
- Omaha Reproductive Health Specialists, Women's Methodist Hospital
| | - James Padussis
- Department of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Scott Lauer
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Geoffrey A Talmon
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
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Affiliation(s)
- Mehmet S Copur
- Morrison Cancer Center-Mary Lanning Healthcare, Hastings, NE
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4
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Dasari A, Morris VK, Allegra CJ, Atreya C, Benson AB, Boland P, Chung K, Copur MS, Corcoran RB, Deming DA, Dwyer A, Diehn M, Eng C, George TJ, Gollub MJ, Goodwin RA, Hamilton SR, Hechtman JF, Hochster H, Hong TS, Innocenti F, Iqbal A, Jacobs SA, Kennecke HF, Lee JJ, Lieu CH, Lenz HJ, Lindwasser OW, Montagut C, Odisio B, Ou FS, Porter L, Raghav K, Schrag D, Scott AJ, Shi Q, Strickler JH, Venook A, Yaeger R, Yothers G, You YN, Zell JA, Kopetz S. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper. Nat Rev Clin Oncol 2020; 17:757-770. [PMID: 32632268 PMCID: PMC7790747 DOI: 10.1038/s41571-020-0392-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chloe Atreya
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Ki Chung
- Division of Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet S Copur
- CHI Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan B Corcoran
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dustin A Deming
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J George
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stanley R Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MD, USA
| | - Federico Innocenti
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Division of Surgery, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburgh, PA, USA
| | - Hagen F Kennecke
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clara Montagut
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fang-Shu Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Porter
- Patient Advocate, NCI Colon Task Force, Boston, MA, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah Schrag
- Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Zell
- Department of Epidemiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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5
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Sohal DPS, Kennedy EB, Cinar P, Conroy T, Copur MS, Crane CH, Garrido-Laguna I, Lau MW, Johnson T, Krishnamurthi S, Moravek C, O'Reilly EM, Philip PA, Pant S, Shah MA, Sahai V, Uronis HE, Zaidi N, Laheru D. Metastatic Pancreatic Cancer: ASCO Guideline Update. J Clin Oncol 2020; 38:3217-3230. [PMID: 32755482 DOI: 10.1200/jco.20.01364] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this work was to provide an update to the ASCO guideline on metastatic pancreatic cancer pertaining to recommendations for therapy options after first-line treatment. METHODS ASCO convened an Expert Panel and conducted a systematic review to update guideline recommendations for second-line therapy for metastatic pancreatic cancer. RESULTS One randomized controlled trial of olaparib versus placebo, one report on phase I and II studies of larotrectinib, and one report on phase I and II studies of entrectinib met the inclusion criteria and inform the guideline update. RECOMMENDATIONS New or updated recommendations for germline and somatic testing for microsatellite instability high/mismatch repair deficiency, BRCA mutations, and TRK alterations are provided for all treatment-eligible patients to select patients for recommended therapies, including pembrolizumab, olaparib, larotrectinib, or entrectinib, or potential clinical trials. The Expert Panel continues to endorse the remaining recommendations for second-line chemotherapy, as well as other recommendations related to treatment, follow-up, and palliative care from the 2018 version of this guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | - Pelin Cinar
- University of California, San Francisco, San Francisco, CA
| | - Thierry Conroy
- Université de Lorraine and Institut de Cancérologie de Lorraine, Lorraine, France
| | | | | | | | | | | | | | | | | | | | | | - Manish A Shah
- New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | | | | | | | - Daniel Laheru
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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6
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Abstract
Phosphatidylinositol 3-kinase (PI3K) catalytic subunit p110α (PIK3CA) mutations occur in approximately 40% of patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Alpelisib, a selective oral inhibitor of PI3K, with inhibitory activity predominantly against PIK3CA, has shown synergistic antitumor activity with endocrine therapy against hormone receptor-positive PIK3CA-mutated breast cancer cells in preclinical and early-phase clinical trials. The combination of alpelisib with fulvestrant or an aromatase inhibitor such as letrozole is safe and effective with reversible toxicities. Although clinical activity has been observed independently of PIK3CA mutation status, clinical improvement has been mostly seen in a higher proportion of patients with PIK3CA-mutated tumors. In this review I share current data on alpelisib in breast cancer treatment.
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Affiliation(s)
- M S Copur
- Morrison Cancer Center, Mary Lanning Healthcare, Hastings, Nebraska, USA. .,Professor, University of Nebraska Medical Center, Adjunct Faculty, Omaha, Nebraska, USA
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7
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Copur MS, Wedel W. 76-Year-Old Woman With a Bluish-Purple Lump in her Left Upper Medial Leg. Oncology (Williston Park) 2020; 34:181-182. [PMID: 32644179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A woman, aged 76 years, presented with a bluish-purple lump in her mid- to upper medial left thigh. It started initially as a flat rash, and over a 2-month period, it turned into a mass measuring 2.5 cm by 3.1 cm. Work-up, including a PET-CT scan, showed the soft tissue mass on the inner thigh to have a Standardized Uptake Value of 4; there were no other sites of disease. A biopsy of the lesion was performed.
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Affiliation(s)
| | - Whitney Wedel
- Department of Pathology, Mary Lanning Healthcare, Hastings, NE
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8
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Islam KM, Anggondowati T, Deviany PE, Ryan JE, Fetrick A, Bagenda D, Copur MS, Tolentino A, Vaziri I, McKean HA, Dunder S, Gray JE, Huang C, Ganti AK. Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer. BMC Cancer 2019; 19:835. [PMID: 31455252 PMCID: PMC6712837 DOI: 10.1186/s12885-019-6054-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 01/24/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background In the U.S., lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Since no cure exists for advanced lung cancer, the main treatment goal is to prolong survival. Chemotherapy regimens produce side effects with different profiles. Coupling this with individual patient’s preferred side effects could result in patient-centered choices leading to better treatment outcomes. There are apparently no previous studies of or tools for assessing and utilizing patient chemotherapy preferences in clinical settings. The long-term goal of the study was to facilitate patients’ treatment choices for advanced-stage lung cancer. A primary aim was to determine how preferences for chemotherapy side effects relate to chemotherapy choices. Methods An observational, longitudinal, open cohort study of patients with advanced-stage non-small cell lung cancer (NSCLC) was conducted. Data sources included patient medical records and from one to three interviews per subject. Data were analyzed using Chi-square, Fisher’s Exact and McNamara’s test, and logistic regression. Results Patients identified the top three chemotherapy side effects that they would most like to avoid: shortness of breath, bleeding, and fatigue. These side effects were similar between first and last interviews, although the rank order changed after patients experienced chemotherapy. Conclusions Patients ranked drug side effects that they would most like to avoid. Patient-centered clinical care and patient-centered outcomes research are feasible and may be enhanced by stakeholder commitment. The study results are limited to patients with advanced NSCLC. Most of the subjects were White, since patients were drawn from the U.S. Midwest, a predominantly White population.
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Affiliation(s)
- K M Islam
- Medical College of Augusta, Augusta University, 1120 15th Street, CJ 2326, Augusta, GA, 30912, USA.
| | - T Anggondowati
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - P E Deviany
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - J E Ryan
- Nebraska Cancer Coalition, Lincoln, NE, USA
| | - A Fetrick
- Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - D Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - M S Copur
- Marry Lanning Healthcare System, Hastings, NE, USA
| | - A Tolentino
- Avera Cancer Institute, Sioux Falls, SD, USA.,Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - I Vaziri
- Callahan Cancer Center, North Platte, NE, USA
| | - H A McKean
- Avera Cancer Institute, Sioux Falls, SD, USA
| | - S Dunder
- Southeast Nebraska Cancer Center, Lincoln, NE, USA
| | - J E Gray
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - C Huang
- Department of Veterans Affairs Medical Center, Kansas City, MO, USA
| | - A K Ganti
- Veterans Administration Health Care Systems Medical Center, Omaha, NE, USA.,Department of Internal Medicine, School of Medicine, University of Nebraska Medical Center Division of Oncology-Hematology, Omaha, NE, USA
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9
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Islam KM, Deviany PE, Anggondowati T, Ryan JE, Fetrick A, Bagenda D, Copur MS, Tolentino A, Vaziri I, McKean HA, Dunder S, Gray JE, Huang CMD, Ganti AK. Patient-Defined Treatment Success: Perspectives of Patients With Advanced-Stage Lung Cancer. J Oncol Pract 2019; 15:e758-e768. [PMID: 31322990 DOI: 10.1200/jop.18.00734] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the United States, lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Because no cure exists for advanced lung cancer, the primary treatment goal is to prolong survival. OBJECTIVES The study aim was to determine whether individual preferences, characteristics, and treatment experiences affect the meaning of treatment success. MATERIALS AND METHODS A quantitative study using an observational, longitudinal cohort of patients with advanced stage non-small-cell lung cancer was conducted. Data sources included medical records and patient interviews. Data were analyzed using χ2, Fisher's exact, and McNemar's tests, as well as logistic regressions. RESULTS At the first interview of 235 individuals, 12% considered survival alone as their definition of treatment success; others defined treatment success as survival plus other aspects, such as quality of life and reaching an important personal goal. As they moved through chemotherapy, 47% of the patients changed their definition of treatment success. Bivariate analysis showed that patients with lower incomes tended to be more likely to change their definition of treatment success compared with their counterparts with higher income (P = .0245). CONCLUSION By taking chemotherapy, patients expect to increase their odds of survival and want to maintain the quality of life and functionality. A patient's definition of treatment success is often changing as treatment continues, making it appropriate to ensure patient-provider communication throughout their clinical care. The study results are limited to patients with advanced non-small-cell lung cancer and drawn from a predominantly white patient population, mainly from the US Midwest.
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Affiliation(s)
- K M Islam
- Augusta University Georgia Medical College, Augusta, GA
| | - Poppy E Deviany
- University of Nebraska Medical Center College of Public Health, Omaha, NE
| | | | | | - Ann Fetrick
- University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - Danstan Bagenda
- University of Nebraska Medical Center College of Medicine, Omaha, NE
| | | | - Addison Tolentino
- Avera Cancer Institute, Sioux Falls, SD.,St Luke's Hospital of Kansas City, Kansas City, MO
| | | | | | | | | | - Chao M D Huang
- Kansas City VA Medical Center-Kansas City Veterans Administration Health Care System, Kansas City, MO
| | - Apar Kishor Ganti
- University of Nebraska Medical Center College of Medicine, Omaha, NE.,Omaha VA Medical Center-Nebraska-Western Iowa Veterans Administration Health Care System, Omaha, NE
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10
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Leon-Ferre RA, Le-Rademacher J, Terstriep S, Glaser R, Novotni P, Giuliano A, Copur MS, Jones C, Page S, Mitchell W, Birrell SN, Loprinzi CL. Abstract P4-16-01: A randomized, double-blind, placebo-controlled trial of testosterone (T) for aromatase inhibitor-induced arthralgias (AIA) in postmenopausal women: Alliance A221102. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors are a mainstay hormone receptor-positive breast cancer treatment. AIA occur in up to 50% of patients (pts), adversely affecting quality of life and treatment compliance. A small phase II clinical trial of oral testosterone unedeconate appeared to improve AIA over placebo (P), with no significant androgenic side effects. The current study was performed to confirm these findings.
Methods: This randomized P-controlled trial enrolled postmenopausal women on adjuvant anastrozole or letrozole and experiencing moderate-to-severe AIA (≥5 on 0-10 scale). Pts were initially randomized to receive a subcutaneous pellet containing T 120 mg + anastrozole 8 mg (T+AIpellet) or P at the end of the first week on study (after obtaining baseline hot flash data) and at 3 months (mo). Due to slow accrual, the protocol was amended to change the route of delivery to topical T or P applied to the skin once daily for 6 mo. Baseline and monthly questionnaires were administered, including: Modified Brief Pain Inventory for aromatase arthralgia (BPI-AIA), prolife of mood states (POMS), the menopause specific quality of life questionnaire (MENQOL), a hot flash diary, the hot flash related daily interference scale (HFRDIS) and a symptom experience questionnaire. The primary endpoint was intra-patient change in joint pain at 3 mo, compared using a two-sample t-test.
Results: 227 pts were accrued between 9/1/2013-11/29/2017. 55 pts were randomized prior to the protocol amendment and received T+AIpellet or P. Baseline characteristics were balanced between arms, with the exceptions of median weight, BMI, hemoglobin (all higher in T arm), and breast tenderness, dissatisfaction with personal life/depression, and skin changes (all higher in P arm). Compared to baseline, there were no significant differences between T and P in average pain or joint stiffness at 3 (p=0.483) or 6 mo (p=0.573). Average pain was significantly lower each month compared to baseline, irrespective of treatment arm. There were no significant differences in any other items evaluated by BPI-AIA, POMS, MENQOL, hot flash diary or HFRDIS. Similarly, there were no substantial differences in toxicity. A subset analysis of the 55 pts randomized to receive T+AIpellet or P identified significant reductions in average pain scores with T+AIpellet during the first month (p=0.038), but not thereafter. T+AIpellet pts had significantly more reduction in reported % of baseline hot flash frequency (p=0.034) and score (p=0.031), nausea (p=0.019), fatigue (p=0.042), mood swings (p=0.026), hand/feet swelling (p=0.009), stress urinary incontinence (p=0.039) and changes in appearance, texture or tone of their skin (p=0.0083), than pts on P.
Conclusions: Overall, T did not improve AIA or menopausal symptoms compared to P. While there was significant improvement in AIA over the study period, T did not facilitate this process. However, T+AIpellet was associated with improvement in short-term AIA and several menopausal symptoms compared to P, suggesting that subcutaneous T combined with anastrozole may be superior to transdermal T alone.
Support: UG1CA189823, U10CA180820, U10CA189809; ClinicalTrials.gov Identifier: NCT01573442
Citation Format: Leon-Ferre RA, Le-Rademacher J, Terstriep S, Glaser R, Novotni P, Giuliano A, Copur MS, Jones C, Page S, Mitchell W, Birrell SN, Loprinzi CL. A randomized, double-blind, placebo-controlled trial of testosterone (T) for aromatase inhibitor-induced arthralgias (AIA) in postmenopausal women: Alliance A221102 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-01.
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Affiliation(s)
- RA Leon-Ferre
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - J Le-Rademacher
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - S Terstriep
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - R Glaser
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - P Novotni
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - A Giuliano
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - MS Copur
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - C Jones
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - S Page
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - W Mitchell
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - SN Birrell
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
| | - CL Loprinzi
- Mayo Clinic, Rochester, MN; Sanford Broadway Medical Center, Fargo, ND; Wright State University, Dayton, OH; Cedars-Sinai Medical Center, Los Angeles, CA; Saint Francis Cancer Treatment Center, Grand Island, NE; Georgia Cancer Specialists PC, Macon, GA; Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, KS; Novant Health Presbyterian Medical Center, Charlotte, NC; Havah Therapeutics Pty Ltd, Toorak Gardens, South Australia, Australia
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Sohal DPS, Kennedy EB, Khorana A, Copur MS, Crane CH, Garrido-Laguna I, Krishnamurthi S, Moravek C, O'Reilly EM, Philip PA, Ramanathan RK, Ruggiero JT, Shah MA, Urba S, Uronis HE, Lau MW, Laheru D. Metastatic Pancreatic Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2018; 36:2545-2556. [PMID: 29791286 PMCID: PMC7504972 DOI: 10.1200/jco.2018.78.9636] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [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: 12/15/2022] Open
Abstract
Purpose In 2016, ASCO published a guideline to assist in clinical decision making in metastatic pancreatic cancer for initial assessment after diagnosis, first- and second-line treatment options, palliative and supportive care, and follow-up. The purpose of this update is to incorporate new evidence related to second-line therapy for patients who have experienced disease progression or intolerable toxicity during first-line therapy. Methods ASCO convened an Expert Panel to conduct a systematic review of the literature on second-line therapy published between June 2015 and January 2018. Recommendations on other topics covered in the 2016 Metastatic Pancreatic Cancer Guideline were endorsed by the Expert Panel. Results Two new studies were found that met the inclusion criteria. Recommendations For second-line therapy, gemcitabine plus nanoparticle albumin-bound paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin), an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1, and a favorable comorbidity profile; fluorouracil plus nanoliposomal irinotecan can be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, an ECOG PS of 0 to 1, and a favorable comorbidity profile; fluorouracil plus irinotecan or fluorouracil plus oxaliplatin may be offered when there is a lack of availability of fluorouracil plus nanoliposomal irinotecan; gemcitabine or fluorouracil should be offered to patients with either an ECOG PS of 2 or a comorbidity profile that precludes other regimens. Testing select patients for mismatch repair deficiency or microsatellite instability is recommended, and pembrolizumab is recommended for patients with mismatch repair deficiency or high microsatellite instability tumors. Endorsed recommendations from the 2016 version of this guideline for computed tomography, baseline performance status and comorbidity profile, defining goals of care, first-line therapy, and palliative care are also contained within the full guideline text. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
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Affiliation(s)
- Davendra P S Sohal
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Erin B Kennedy
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Alok Khorana
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Mehmet S Copur
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Christopher H Crane
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ignacio Garrido-Laguna
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Smitha Krishnamurthi
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Cassadie Moravek
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Eileen M O'Reilly
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Philip A Philip
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ramesh K Ramanathan
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Joseph T Ruggiero
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Manish A Shah
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Susan Urba
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Hope E Uronis
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Michelle W Lau
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Daniel Laheru
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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Copur MS, Gnewuch C, Schriner M, Tharnish M, Gonen M, McDonald M, Kezeor J, Ramaekers RC, Gauchan D, Clark D, Greenwalt L, Mickey M, Norvell M. Potential cost savings by dose down-rounding of monoclonal antibodies in a community cancer center. J Oncol Pharm Pract 2017; 24:116-120. [PMID: 29284380 DOI: 10.1177/1078155217692400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Increasing new cancer cases and approval of effective but expensive new drugs extending survival have led to unsustainable cancer care costs. Potential cost savings by a hypothetical dose down-rounding project of monoclonal antibodies at a community-based cancer center is presented. Methods From October 2014 through October 2015, metastatic cancer patients receiving monoclonal antibodies at CHI-Health St Francis Cancer Treatment Center in Grand Island, Nebraska, were identified through electronic health records. A total of 11 different types of monoclonal antibodies that were administered during the study period were identified. Trastuzumab, ofatumumab, and obinutuzumab did not require dose-rounding; thus, they were excluded from the analyses. Available vial size(s) and costs per milligram per average wholesale price for each monoclonal antibody were recorded. Costs of actual amounts prescribed were compared to the costs of theoretically reduced ≤5% and ≤10% doses rounded to the nearest vial sizes. Reduced doses resulting in a decreased number of opened vials qualified for meaningful dose down-rounding and were included in the analysis. Average actual dose reduction percentage resulting in cost savings for both groups was also calculated. Results A total of 728 doses of eight monoclonal antibodies suitable for dose down-rounding were identified. Vial sizes of pembrolizumab and ipilimumab did not allow for a meaningful dose down-rounding. At the ≤5% dose down-rounding, 255 of 728 doses (35%) qualified with a potential annual cost savings of $220,793.80. At the ≤10% dose down-rounding, 526 of 728 doses (72%) qualified with a potential annual cost savings of $454,461.00. The average actual dose reduction was 2.4% for the ≤5% dose reduction group and 4.9% for the ≤10% dose reduction group. Overall average cost savings per qualifying dose reduction was around $865.00. More doses qualified for cost savings in the ≤10% dose reduction group. Significant differences between different monoclonal antibodies for dose rounding at either ≤5% (p = 0.002) or ≤10% (p < 0.001) were observed. Conclusion A practical dose down-rounding procedure may allow significant cost reduction in metastatic cancer setting, where the cure is not the goal. Drug waste can be avoided by convenient vial sizes or can even be eliminated by lyophilized forms like in trastuzumab. Our data reflect the monoclonal antibody use and potential cost savings with the proposed dose down-rounding approach in a community-based cancer program.
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Affiliation(s)
- Mehmet S Copur
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | | | - Megan Schriner
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Mark Tharnish
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Mithat Gonen
- 3 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica McDonald
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Jami Kezeor
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan C Ramaekers
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Dron Gauchan
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Douglas Clark
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Lois Greenwalt
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Mary Mickey
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Max Norvell
- 1 CHI-Health St Francis Cancer Treatment Center, Grand Island, NE, USA
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Copur MS, Ramaekers R, Gauchan D, Norvell M, Clark D. Recent ASCO Guideline on the Use of Biomarkers for Adjuvant Systemic Therapy in Early-Stage Invasive Breast Cancer. J Clin Oncol 2016; 34:3943-3944. [DOI: 10.1200/jco.2016.68.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mehmet S. Copur
- Mehmet S. Copur, Ryan Ramaekers, Dron Gauchan, Max Norvell, and Douglas Clark, Saint Francis Cancer Treatment Center, Grand Island, NE
| | - Ryan Ramaekers
- Mehmet S. Copur, Ryan Ramaekers, Dron Gauchan, Max Norvell, and Douglas Clark, Saint Francis Cancer Treatment Center, Grand Island, NE
| | - Dron Gauchan
- Mehmet S. Copur, Ryan Ramaekers, Dron Gauchan, Max Norvell, and Douglas Clark, Saint Francis Cancer Treatment Center, Grand Island, NE
| | - Max Norvell
- Mehmet S. Copur, Ryan Ramaekers, Dron Gauchan, Max Norvell, and Douglas Clark, Saint Francis Cancer Treatment Center, Grand Island, NE
| | - Douglas Clark
- Mehmet S. Copur, Ryan Ramaekers, Dron Gauchan, Max Norvell, and Douglas Clark, Saint Francis Cancer Treatment Center, Grand Island, NE
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Sohal DPS, Mangu PB, Khorana AA, Shah MA, Philip PA, O'Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D. Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:2784-96. [PMID: 27247222 DOI: 10.1200/jco.2016.67.1412] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to oncologists and others for the treatment of patients with metastatic pancreatic cancer. METHODS American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts to conduct a systematic review of the literature from April 2004 to June 2015. Outcomes were overall survival, disease-free survival, progression-free survival, and adverse events. RESULTS Twenty-four randomized controlled trials met the systematic review criteria. RECOMMENDATIONS A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. Goals of care, patient preferences, treatment response, psychological status, support systems, and symptom burden should guide decisions for treatments. A palliative care referral should occur at first visit. FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin; favorable comorbidity profile) or gemcitabine plus nanoparticle albumin-bound (NAB) -paclitaxel (adequate comorbidity profile) should be offered to patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1 based on patient preference and support system available. Gemcitabine alone is recommended for patients with ECOG PS 2 or with a comorbidity profile that precludes other regimens; the addition of capecitabine or erlotinib may be offered. Patients with an ECOG PS ≥ 3 and poorly controlled comorbid conditions should be offered cancer-directed therapy only on a case-by-case basis; supportive care should be emphasized. For second-line therapy, gemcitabine plus NAB-paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX, an ECOG PS 0 to 1, and a favorable comorbidity profile; fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan should be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, ECOG PS 0 to 1, and favorable comorbidity profile, and gemcitabine or fluorouracil should be offered to patients with either an ECOG PS 2 or a comorbidity profile that precludes other regimens. Additional information is available at www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki.
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Affiliation(s)
- Davendra P S Sohal
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Pamela B Mangu
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Alok A Khorana
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Manish A Shah
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Philip A Philip
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Eileen M O'Reilly
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Hope E Uronis
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Ramesh K Ramanathan
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Christopher H Crane
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Anitra Engebretson
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Joseph T Ruggiero
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mehmet S Copur
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Michelle Lau
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Susan Urba
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Daniel Laheru
- Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Manish A. Shah, The Weill Cornell Medical Center; Philip A. Philip, Karmanos Cancer Institute, Detroit; Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY; Hope E. Uronis, Duke University, Durham, NC; Ramesh K. Ramanathan, Mayo Clinic, Scottsdale; Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Anitra Engebretson, Patient Representative, Portland, OR; Mehmet S. Copur, St Francis Medical Center, Grand Island, NE; and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Copur MS, Gauchan D, Brussow K, Clark D, Ramaekers R. Germline BRCA1/2 Mutations: Are They Good Enough to Determine Who Will Respond to Poly(ADP-Ribose) Polymerase Inhibitor Therapy in Advanced Cancer? J Clin Oncol 2015; 33:2582. [PMID: 26124479 DOI: 10.1200/jco.2015.61.0576] [Citation(s) in RCA: 2] [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)
| | - Dron Gauchan
- St Francis Cancer Treatment Center, Grand Island, NE
| | | | - Douglas Clark
- St Francis Cancer Treatment Center, Grand Island, NE
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Robert NJ, Saleh MN, Paul D, Generali D, Gressot L, Copur MS, Brufsky AM, Minton SE, Giguere JK, Smith JW, Richards PD, Gernhardt D, Huang X, Liau KF, Kern KA, Davis J. Sunitinib plus paclitaxel versus bevacizumab plus paclitaxel for first-line treatment of patients with advanced breast cancer: a phase III, randomized, open-label trial. Clin Breast Cancer 2011; 11:82-92. [PMID: 21569994 PMCID: PMC4617186 DOI: 10.1016/j.clbc.2011.03.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 07/16/2010] [Revised: 08/23/2010] [Accepted: 08/23/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A multicenter, open-label phase III study was conducted to test whether sunitinib plus paclitaxel prolongs progression-free survival (PFS) compared with bevacizumab plus paclitaxel as first-line treatment for patients with HER2(-) advanced breast cancer. PATIENTS AND METHODS Patients with HER2(-) advanced breast cancer who were disease free for ≥ 12 months after adjuvant taxane treatment were randomized (1:1; planned enrollment 740 patients) to receive intravenous (I.V.) paclitaxel 90 mg/m(2) every week for 3 weeks in 4-week cycles plus either sunitinib 25 to 37.5 mg every day or bevacizumab 10 mg/kg I.V. every 2 weeks. [corrected] RESULTS The trial was terminated early because of futility in reaching the primary endpoint as determined by the independent data monitoring committee during an interim futility analysis. At data cutoff, 242 patients had been randomized to sunitinib-paclitaxel and 243 patients to bevacizumab-paclitaxel. Median PFS was shorter with sunitinib-paclitaxel (7.4 vs. 9.2 months; hazard ratio [HR] 1.63 [95% confidence interval (CI), 1.18-2.25]; 1-sided P = .999). At a median follow-up of 8.1 months, with 79% of sunitinib-paclitaxel and 87% of bevacizumab-paclitaxel patients alive, overall survival analysis favored bevacizumab-paclitaxel (HR 1.82 [95% CI, 1.16-2.86]; 1-sided P = .996). The objective response rate was 32% in both arms, but median duration of response was shorter with sunitinib-paclitaxel (6.3 vs. 14.8 months). Bevacizumab-paclitaxel was better tolerated than sunitinib-paclitaxel. This was primarily due to a high frequency of grade 3/4, treatment-related neutropenia with sunitinib-paclitaxel (52%) precluding delivery of the prescribed doses of both drugs. CONCLUSION The sunitinib-paclitaxel regimen evaluated in this study was clinically inferior to the bevacizumab-paclitaxel regimen and is not a recommended treatment option for patients with advanced breast cancer.
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Copur MS, Norvell M, Obermiller A. Chemotherapy and immunotherapy in metastatic colorectal cancer. N Engl J Med 2009; 360:2135; author reply 2135-6. [PMID: 19445033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Copur MS. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359:2498; author reply 2498-9. [PMID: 19065701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Copur MS, Ledakis P, Bolton M, Morse AK, Werner T, Norvell M, Muhvic J, Chu E. An adverse interaction between warfarin and capecitabine: a case report and review of the literature. Clin Colorectal Cancer 2001; 1:182-4. [PMID: 12450435 DOI: 10.3816/ccc.2001.n.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation.
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Affiliation(s)
- M S Copur
- Saint Francis Cancer Center, Medical and Radiation Oncology Department, 2116 W. Faidley Avenue, Grand Island, Nebraska, USA.
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Copur MS, Capadano M, Lynch J, Goertzen T, McCowan T, Brand R, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. J Clin Oncol 2001; 19:2404-12. [PMID: 11331319 DOI: 10.1200/jco.2001.19.9.2404] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the objective response to a short course of hepatic arterial infusion (HAI) using temporary, percutaneously placed catheters alternating with systemic prolonged continuous infusion fluorouracil (ci 5-FU) and daily oral leucovorin (L). PATIENTS AND METHODS Eligible patients were previously untreated (except for adjuvant therapy) adults with liver-predominant metastases, with Eastern Cooperative Oncology Group performance status of 0 to 2. Treatment regimen included HAI with fluorodeoxyuridine (FUDR) 60 mg/m2/d and L 15 mg/m2/d continuously infused daily for 4 days. After a 1-week rest, ci 5-FU was administered through a central venous access device using a dose of 180 mg/m2/d with a fixed dose of oral L at 5 mg/m2/d for 21 out of 28 days. Cycles were repeated every 6 weeks. After four cycles of therapy, patients were maintained on ci 5-FU and daily oral L until evidence of progression. RESULTS Forty-three patients were enrolled onto this trial. One patient was ineligible. The objective response rate for all patients (17 partial, zero complete) was 41% (95% confidence interval [CI], 26% to 56%). Five patients were not able to receive at least one complete cycle of HAI. Among patients who received at least one complete cycle of HAI, the response rate was 46% (95% CI, 30% to 62%). Five patients underwent a liver resection after enrolling onto the protocol. At the time of analysis, estimated median time to progression was 6 months, and estimated median overall survival was 13 months. CONCLUSION The objective response rate was comparable to that achieved with more prolonged and more frequent HAI using FUDR. This approach should be studied as an acceptable alternative to surgically placed hepatic arterial catheters/pumps and may have a role as neoadjuvant therapy for liver metastases that are unresectable, as well as an adjuvant role for patients with resected hepatic metastatic colorectal cancer.
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Affiliation(s)
- M S Copur
- University of Nebraska Medical Center, Omaha, and Saint Francis Cancer Center, Grand Island, NE, USA
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Copur MS, Ledakis P, Bolton M, Norvell M, Muhvic J. Is anastrozole superior to tamoxifen as first-line therapy for advanced breast cancer? J Clin Oncol 2001; 19:2578; author reply 2580-2. [PMID: 11331343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Copur MS, Ledakis P, Muhvic J. Fludarabine for chronic lymphocytic leukemia. N Engl J Med 2001; 344:1166; author reply 1167-8. [PMID: 11302141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Copur MS, Ledakis P, Muhvic J. Patients 65 years of age or older in cancer-treatment trials. N Engl J Med 2000; 342:1531. [PMID: 10819658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Copur MS, Tasdemir I, Turgan C, Yasavul U, Caglar S. Effects of nitrendipine on blood pressure and blood ciclosporin A level in patients with posttransplant hypertension. Nephron Clin Pract 1989; 52:227-30. [PMID: 2662047 DOI: 10.1159/000185647] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In order to evaluate the antihypertensive effectiveness and interaction with ciclosporin A (CS-A) nitrendipine, a dihydropyridine derivative calcium entry blocking agent, was used in 16 (13 men, 3 women) hypertensive renal posttransplant patients followed by the Nephrology Department of Hacettepe University Hospital. The patients did not receive any antihypertensive drug for a 7-day period. They were then given 20 mg/day nitrendipine for 3 weeks. At the end of this period, mean (+/- SE) supine blood pressure fell from 163/108 +/- 3.6/1.87 to 141/87 +/- 3.8/2.2 mm Hg (p less than 0.01), while the heart rate was unchanged. 14 of 16 patients achieved full control of blood pressure levels with 20 mg/day nitrendipine, and only 2 patients needed a higher dosage of 30 mg/day (20 + 10 mg). After 3 weeks of treatment no significant variations in blood chemistry or renal functional parameters were noticed. There was also no difference between blood CS-A levels before and after treatment with nitrendipine (218.06 +/- 33 vs. 222.68 +/- 26 ng/ml, p greater than 0.05). We conclude that short-term therapy with nitrendipine in renal post-transplant patients does not appear to be harmful and longer term studies are needed to fully evaluate safety and efficacy of this drug. Because it influences neither blood chemistry nor renal functional parameters and blood CS-A level, it may be preferable to other calcium channel blocking agents in this group of patients.
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Affiliation(s)
- M S Copur
- Department of Nephrology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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