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Lheureux S, Matei D, Konstantinopoulos PA, Block MS, Jewell A, Gaillard S, McHale MS, McCourt CK, Temkin S, Girda E, Backes FJ, Werner TL, Duska LR, Kehoe SM, Wang L, Wildman R, Wang BX, Ohashi PS, Wright JJ, Fleming GF. A randomized phase II study of cabozantinib and nivolumab versus nivolumab in recurrent endometrial cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6010 Background: The efficacy of treatment for recurrent endometrial cancer (EC) remains limited. Vascular endothelial growth factor and inflammatory chemokines are proangiogenic factors and immune modulators involved in immune suppression. Reprogramming the tumor microenvironment by combining antiangiogenic and immunotherapy (IO) could enhance antitumor responses. Methods: A 2:1 randomized phase 2 trial compared the combination of cabozantinib and nivolumab (Arm A) versus nivolumab (Arm B) in recurrent EC. Primary endpoint was progression free survival (PFS) assessed by RECIST 1.1 (NCT03367741). Women with recurrent measurable EC were eligible. There were no limits on prior therapy, but at least one prior platinum-based chemotherapy was required. Patients (pts) were stratified according to MSI status and assessed by CT every 8 weeks. Cabozantinib was given at 40 mg daily (Arm A) and nivolumab at 240 mg, on D1 and D15 of a 28-day cycle for 4 cycles, followed by 480 mg every 4 weeks (Arms A & B). Pts with carcinosarcoma or prior IO were enrolled in an exploratory cohort and received combination treatment (Arm C). A baseline biopsy was required for all pts. CyTOF analysis was performed on fresh biopsies. Results: 76 evaluable pts were enrolled (Arm A: 36, Arm B: 18, Arm C: 9 carcinosarcoma, and 20 post IO including 7 pts crossed over from Arm B). 55% of pts had received ≥3 prior lines of therapy. Two pts were MSI high in Arm A and none in Arm B. The Kaplan-Meier estimated median PFS was 5.3 (95% CI: 3.5-9.5) months in Arm A and 1.9 (95% CI: 1.6-3.8) months in Arm B, with a log-rank p = 0.07, which met the significance level of 0.1 used for sample size calculation. Objective response rate (ORR) was 25% for Arm A and 16.7% for Arm B; stable disease (SD) was seen in 44.4% vs 11.1%, respectively. Clinical benefit (ORR+SD) was significantly higher in arm A vs B (p < 0.001). In Arm C-carcinosarcoma, one patient had a partial response (11.9 months duration) and four SD. In Arm C-prior IO, six pts responded and eight had SD. The most common related AEs in Arm A were diarrhea (47.2%), elevated liver enzymes (44.4%), fatigue (38.9%), anorexia, hypertension, and nausea (30.6%), mainly grade 1/2. Preliminary CyTOF analysis across treatment arms identified multiple immune subsets for further interrogation including activated CD8+ and CD4+ T cells. Conclusions: Cabozantinib plus nivolumab demonstrates improved PFS compared to nivolumab in heavily pre-treated women with recurrent EC. In-depth CyTOF analysis of the tumor microenvironment to identify predictive immune biomarkers of response is ongoing. Clinical trial information: NCT03367741.
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Affiliation(s)
| | - Daniela Matei
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | - Carolyn K McCourt
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | | | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ben X Wang
- Princess Margaret-University Health Network, Toronto, ON, Canada
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Birewar S, Thomas M, McHale MS. DVT: Factor V Leiden, a case report. S D J Med 2003; 56:225-7. [PMID: 12827938] [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: 03/03/2023]
Abstract
We report a case of a 33-year old male admitted to our hospital with extensive lower extremity deep venous thrombosis (DVT). This patient was several days post knee arthroscopy and had a family history strongly positive for DVT. Upon testing, he was found positive for the homozygous presence of Factor V gene R506Q mutation. In inherited thrombophillia, especially in homozygous Factor V Leiden, lifelong anticoagulation treatment and screening for asymptomatic family members is controversial. Upon review and consultation, however, we recommended oral anticoagulation for life, along with genetic counseling and screening for Factor V Leiden of his three children and younger brother.
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Johnson VP, Storm CA, Skorey-Solberg P, McHale MS. Familial breast cancer risk assessment. S D J Med 1996; 49:217-21. [PMID: 8755457] [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: 02/02/2023]
Abstract
A family, with a strong history of dominant breast and ovarian cancer, is described. Using highly polymorphic microsatellite markers within the BRCA1 breast cancer gene on chromosome 17q21; three affected sisters, their father and a paternal second cousin once removed, are shown to share the same "abnormal" haplotype. Because of this informative linkage, the carrier status of the unaffected siblings can be established by determining whether they inherited their father's "normal" or "abnormal" haplotype. Presymptomatic diagnosis is important in decisions regarding prophylactic surgery or follow-up care. However, the widespread general population presymptomatic DNA testing of breast cancer is currently not recommended because of inherent problems in the sensitivity and specificity of DNA testing.
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Affiliation(s)
- V P Johnson
- Departments of OB/Gyn, Pediatrics and Lab Medicine, USD School of Medicine, Vermillion, USA
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Morton RF, Creagan ET, Schaid DJ, Kardinal CG, McCormack GW, McHale MS, Wiesenfeld M. Phase II trial of recombinant leukocyte A interferon (IFN-alpha 2A) plus 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and the combination cimetidine with BCNU in patients with disseminated malignant melanoma. Am J Clin Oncol 1991; 14:152-5. [PMID: 2028922 DOI: 10.1097/00000421-199104000-00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sixty-two patients with biopsy-proven, measurable disseminated malignant melanoma received either the combination IFN-alpha 2A with BCNU (30 patients) or the combination cimetidine with BCNU (32 patients) in parallel noncomparative Phase II trials. From patients receiving IFN-alpha 2A plus BCNU, we observed a 7% response rate: 1 complete response (CR) and 1 partial response (PR) (soft tissue disease with durations of 6.9 and 11.5+ months, respectively). Median time to progression (MTP) was 1.8 months and median survival time (MST) was 3.8 months. Myelosuppression and a flu-type illness were the most common toxicities. From patients receiving cimetidine plus BCNU, the response rate was 16%: 4 PRs (soft tissue disease, 3.8 months; visceral, 2.1, 4.0+, and 9.7 months) and 1 CR (soft tissue, 14.3+ months). MTP and MST were 1.9 and 5.5 months, respectively. Myelosuppression and nausea/vomiting were the most common side effects. Although each of these regimens had great conceptual allure, neither offered any durable impact on the natural history of disseminated malignant melanoma. Nevertheless, alternative combinations of biological response modifiers (BRMs) and BRMs with biochemical modulators or cytotoxic agents may provide some useful alternatives for further clinical investigations.
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Affiliation(s)
- R F Morton
- Iowa Oncology Research Association CCOP, Des Moines
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Crider MK, Jansen J, Norins AL, McHale MS. Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation. Arch Dermatol 1986; 122:1023-7. [PMID: 3527075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chemotherapy-induced acral erythema is an uncommon and distinctive syndrome of intense macular erythema of the palms and fingers seen in patients treated with high-dose chemotherapy. It is painful, may form bullae, and heals uneventfully with desquamation. The incidence (35%) of this complication in patients receiving bone marrow transplantation at our institution is quite high and probably reflects the exceptional doses of chemotherapy and concomitant total body irradiation these patients receive. Biopsy specimens showed vacuolar change, spongiosis, necrotic keratinocytes, and epidermal atypia. These findings probably result from direct toxic effect and mimic those of acute graft-vs-host disease. Awareness of chemotherapy-induced acral erythema is important to avoid its misdiagnosis as a cutaneous sign of acute graft-vs-host disease. This distinction can usually be made on clinical grounds. If necessary, serial skin biopsy specimens are helpful.
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