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Brodsky A, McHale M, Plaxe S. Comparison of rates of vaginal brachytherapy vs. external beam radiation post-hysterectomy for endometrial cancer patients in rural vs. urban settings (459). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hom-Tedla M, Coakley K, Charo L, Jou J, Bondre I, McHale M, Eskander R, Binder P, Brodsky A, Plaxe S. Lymph node evaluation in endometrial cancer patients after the FIRES trial (534). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Charo LM, Eskander RN, Sicklick J, Kim KH, Lim HJ, Okamura R, Lee S, Subramanian R, Schwab R, Shatsky R, Plaxe S, Kato S, Kurzrock R. Real-World Data From a Molecular Tumor Board: Improved Outcomes in Breast and Gynecologic Cancers Patients With Precision Medicine. JCO Precis Oncol 2022; 6:e2000508. [PMID: 35005995 PMCID: PMC8769125 DOI: 10.1200/po.20.00508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Next-generation sequencing is increasingly used in gynecologic and breast cancers. Multidisciplinary Molecular Tumor Board (MTB) may guide matched therapy; however, outcome data are limited. We evaluate the effect of the degree of matching of tumors to treatment as well as compliance to MTB recommendations on outcomes. METHODS Overall, 164 patients with consecutive gynecologic and breast cancers presented at MTB were assessed for clinicopathologic data, next-generation sequencing results, MTB recommendations, therapy received, and outcomes. Matching score (MS), defined as percentage of alterations targeted by treatment over total pathogenic alterations, and compliance to MTB recommendations were analyzed in context of oncologic outcomes. RESULTS Altogether, 113 women were evaluable for treatment after MTB; 54% received matched therapy. Patients with MS ≥ 40% had higher overall response rate (30.8% v 7.1%; P = .001), progression-free survival (PFS; hazard ratio [HR] 0.51; 95% CI, 0.31 to 0.85; P = .002), and a trend toward improved overall survival (HR 0.64; 95% CI, 0.34 to 1.25; P = .082) in univariate analysis. The PFS advantage remained significant in multivariate analysis (HR 0.5; 95% CI, 0.3 to 0.8; P = .006). Higher MTB recommendation compliance was significantly associated with improved median PFS (9.0 months for complete; 6.0 months for partial; 4.0 months for no compliance; P = .004) and overall survival (17.1 months complete; 17.8 months partial; 10.8 months none; P = .046). Completely MTB-compliant patients had higher MS (P < .001). In multivariate analysis comparing all versus none MTB compliance, overall response (HR 9.5; 95% CI, 2.6 to 35.0; P = .001) and clinical benefit (HR 8.8; 95% CI, 2.4 to 33.2; P = .001) rates were significantly improved with higher compliance. CONCLUSION Compliance to MTB recommendations resulted in higher degrees of matched therapy and correlates with improved outcomes in patients with gynecologic and breast cancers.
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Affiliation(s)
- Lindsey M Charo
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA.,Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Ramez N Eskander
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA.,Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Jason Sicklick
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA.,Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, San Diego, CA
| | - Ki Hwan Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyo Jeong Lim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Ryosuke Okamura
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Suzanna Lee
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Rupa Subramanian
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Richard Schwab
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Rebecca Shatsky
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA
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Jou J, Charo L, Hom-Tedla M, Coakley K, Binder P, Saenz C, Eskander RN, McHale M, Plaxe S. Practice patterns and survival in FIGO 2009 stage 3B endometrial cancer. Gynecol Oncol 2021; 163:299-304. [PMID: 34561099 DOI: 10.1016/j.ygyno.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the practice patterns and outcomes of patients with stage 3B endometrial cancer. METHODS We queried the National Cancer Database for all surgically staged, stage 3 patients between 2012 and 2016. Patients who received any pre-operative therapy were excluded. Demographics, tumor factors, and adjuvant therapy for the stage 3 substages were compared. Logistic regression was used to identify factors associated with adjuvant therapy. Kaplan Meier curves were generated and compared using the log-rank test. Multivariable Cox Proportional Hazards Model was used to adjust for prognostic factors. Findings with p < 0.05 were considered significant. RESULTS Of 7363 patients with stage 3 disease, 478 (6%) had stage 3B; 1732 (23%) had stage 3A, 3457 (48%) had stage 3C1, and 1696 (23%) had stage 3C2 disease. Post-surgical treatment consisted of: combined chemotherapy (CT) and radiation (RT) (49%), CT alone (28%), RT alone (9%), 14% received no postoperative therapy. Among all stage 3 substages, patients with stage 3B disease were the least likely to receive any CT, and the most likely to receive RT alone. After adjusting for known prognostic factors, patients with stage 3A (Hazard ratio (HR) of death = 0.64) and 3C1 (HR of death = 0.79) disease had significantly worse overall survival compared to stage 3B; survival was not demonstrably different from patients with stage 3C2 disease. Patients with stage 3B disease who received CT + RT had the best overall survival. CONCLUSION Survival of patients with stage 3B disease is similar to that of patients with para-aortic node metastases and is inferior to all others with stage 3 endometrial cancer. Less frequent CT and a higher rate of post-operative RT alone, describes a distinct practice from that seen in other stage 3 patients.
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Affiliation(s)
- Jessica Jou
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA.
| | - Lindsey Charo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Marianne Hom-Tedla
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Katherine Coakley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Pratibha Binder
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Cheryl Saenz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Michael McHale
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
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Jou J, Binder P, Saenz C, Eskander R, McHale M, Plaxe S. Adjuvant radiation in stage 1 endometrioid endometrial cancer (EC), a National Cancer Database (NCDB) study of clinical decision making in practice. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hom M, Mowers E, Barrie A, Harrison T, Jou J, Koonings P, Saenz C, McHale M, Plaxe S, Binder P, Eskander R. Effect of mismatch repair protein status on outcomes in high intermediate risk endometrial cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jou J, Charo L, Hom M, Coakley K, Binder P, Saenz C, Eskander R, McHale M, Plaxe S. Patients with stage 3B endometrial cancer receive less chemotherapy, more radiation and have worse survival than other stage 3 EC patients. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Charo L, Eskander R, Sicklick J, Kim KH, Kim HJ, Okamura R, Schwab R, Lee S, Subramanian R, Shatsky R, Plaxe S, Kato S, Kurzrock R. Real-world data from a Molecular Tumor Board: improved outcomes in gynecologic and breast cancer patients with precision medicine. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jou J, Brodsky A, Charo L, Binder P, Saenz C, Eskander R, McHale M, Plaxe S. Trends and regional variation in women's representation as principal investigators (PI) in phase III gynecologic oncology clinical trials. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kato S, McFall T, Takahashi K, Bamel K, Ikeda S, Eskander RN, Plaxe S, Parker B, Stites E, Kurzrock R. KRAS-Mutated, Estrogen Receptor-Positive Low-Grade Serous Ovarian Cancer: Unraveling an Exceptional Response Mystery. Oncologist 2021; 26:e530-e536. [PMID: 33528846 PMCID: PMC8018312 DOI: 10.1002/onco.13702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/22/2021] [Indexed: 12/31/2022] Open
Abstract
We report on a woman with aggressive estrogen receptor‐positive, KRAS‐mutated ovarian cancer who achieved a remarkable response to combination therapy with the MEK inhibitor (trametinib) and the aromatase inhibitor (letrozole), even though the disease had failed to respond to a combination of a PI3K inhibitor and different MEK inhibitor, as well as to trametinib and the estrogen modulator, tamoxifen, and to letrozole by itself. The mechanism of action for exceptional response was elucidated by in vitro experiments that demonstrated that the fact that tamoxifen can have an agonistic effect in addition to antagonist activity, whereas letrozole results only in estrogen depletion was crucial to the response achieved when letrozole was combined with an MEK inhibitor. Our current observations indicate that subtle variations in mechanisms of action of outwardly similar regimens may have a major impact on outcome and that such translational knowledge is critical for optimizing a precision medicine strategy. Key Points This report describes the remarkable response of a patient with KRAS‐mutated, estrogen receptor‐positive low‐grade serous ovarian cancer treated with trametinib (MEK inhibitor) and letrozole (aromatase inhibitor), despite prior progression on similar agents including tamoxifen (estrogen modulator). In vitro investigation revealed that tamoxifen can have agonistic in addition to antagonistic effects, which could be the reason for the patient not responding to the combination of trametinib and tamoxifen. The current observations suggest that drugs with different mechanisms of action targeting the same receptor may have markedly different anticancer activity when used in combinations.
This article reports the case of a patient with aggressive estrogen receptor‐positive, KRAS‐mutated ovarian cancer who achieved a remarkable response to combination therapy with the MEK inhibitor trametinib and the aromatase inhibitor letrozole, despite earlier failures of treatment with other combination inhibitor treatment. This article focuses on the possibility that subtle variations in mechanisms of action of outwardly similar regimens may have major effects on patient outcomes.
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Affiliation(s)
- Shumei Kato
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Thomas McFall
- Integrative Biology Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Kenta Takahashi
- Cancer Center, Tokyo Medical and Dental University, Medical Hospital Bunkyo-ku, Tokyo, Japan
| | - Kasey Bamel
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Sadakatsu Ikeda
- Cancer Center, Tokyo Medical and Dental University, Medical Hospital Bunkyo-ku, Tokyo, Japan
| | - Ramez N Eskander
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Steven Plaxe
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Barbara Parker
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Edward Stites
- Integrative Biology Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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Jou J, Coulter E, Roberts T, Binder P, Saenz C, McHale M, Plaxe S, Mayadev J, Eskander RN. Assessment of malnutrition by unintentional weight loss and its implications on oncologic outcomes in patient with locally advanced cervical cancer receiving primary chemoradiation. Gynecol Oncol 2020; 160:721-728. [PMID: 33342621 DOI: 10.1016/j.ygyno.2020.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/09/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine the prevalence, risk factors for, and clinical implications of unintentional weight loss on oncologic outcomes in locally advanced cervical cancer (LACC) treated with concurrent chemotherapy and contemporary radiation techniques. METHODS This a single-institution, retrospective cohort study of patients with LACC who received definitive chemoradiation (CRT) from 2010 to 2015. Clinicopathologic factors were abstracted by chart review and characterized using descriptive statistics. Factors associated with severe weight loss (≥10% from baseline) were determined by Chi-square test. Time-to-event analysis was performed using the Kaplan Meier method and regression was performed using the Cox Proportional hazards model. RESULTS One hundred and eight patients comprised the cohort. The majority of patients were White, obese, and had squamous histology. Almost 80% of patients experienced at least some weight loss, with 14% of patients experiencing severe weight loss. Patients with FIGO 2009 stage 3 or 4 disease had a 3.4-fold increased risk of severe weight loss compared to those with earlier stage disease. Patients who had severe weight loss had a higher risk for death (HR = 2.37, 95% confidence interval [CI] 1.77, 7.37, p = 0.036) and a trend toward high risk for recurrence (HR = 1.43, 95% CI 0.46, 3.32, p = 0.107) compared to patients without severe weight loss. CONCLUSION Unintentional weight loss is a common symptom of patients with LACC receiving CRT that affects oncologic outcomes, yet it remains under-recognized. Increased awareness of weight loss and malnutrition may encourage interventions to improve this potentially modifiable risk factor for worse prognosis and quality of life.
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Affiliation(s)
- Jessica Jou
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America.
| | - Elizabeth Coulter
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Traci Roberts
- Nutrition Services, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Pratibha Binder
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Cheryl Saenz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Michael McHale
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Jyoti Mayadev
- Division of Clinical and Translational Research, Department of Radiation Medicine and Applied Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
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Jou J, Zimmer Z, Charo L, Yau C, Saenz C, Eskander R, McHale M, Veerapong J, Plaxe S, Binder P. HIPEC after neoadjuvant chemotherapy and interval debulking is associated with development of platinum-refractory or -resistant disease. Gynecol Oncol 2020; 161:25-33. [PMID: 33293046 DOI: 10.1016/j.ygyno.2020.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe our single-institution oncologic outcomes of patients who received neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS We compared clinicopathologic information and outcomes for all patients with advanced stage, high-grade serous ovarian cancer who received NACT and IDS with (N = 20) or without (N = 48) HIPEC at our institution from 2010 to 2019 RESULTS: Mean age (62 years with HIPEC and 60 years without HIPEC) and proportion of stage 4 disease (40% for both) did not differ between cohorts. HIPEC patients had higher rates of complete cytoreduction (95% vs 50%), longer mean duration of surgery (530 vs. 216 min), more grade 3 or 4 postoperative complications (65% vs. 4%), and longer mean length of hospital stay (8 vs. 5 days). HIPEC patients had significantly higher risk for platinum-refractory progression or platinum-resistance recurrence (50% vs 23%; RR = 2.18; 95% CI 1.11, 4.30, p = 0.024). Median progression free survival (11.5 vs. 12 months) and all-cause mortality (19.1 vs. 30.5 months) in the HIPEC and non-HIPEC cohorts, respectively, did not differ CONCLUSIONS: HIPEC was associated with increased risk for platinum refractory or resistant disease. Higher surgical complexity may contribute to higher complication rates without improving oncologic outcomes in our patients. Further investigations and long-term follow-up are needed to assess the utility of HIPEC in primary treatment of advanced stage ovarian cancer.
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Affiliation(s)
- Jessica Jou
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA.
| | - Zoe Zimmer
- Department of Obstetrics and Gynecology, Balboa Naval Hospital, San Diego, CA, USA
| | - Lindsey Charo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Christopher Yau
- Division of Body Imaging, Department of Radiology, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Cheryl Saenz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Ramez Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Michael McHale
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Jula Veerapong
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Pratibha Binder
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
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Charo LM, Jou J, Binder P, Hohmann SF, Saenz C, McHale M, Eskander RN, Plaxe S. Current status of hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer in the United States. Gynecol Oncol 2020; 159:681-686. [DOI: 10.1016/j.ygyno.2020.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
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Korenaga TR, Ward KK, Saenz C, McHale MT, Plaxe S. The elevated risk of ovarian clear cell carcinoma among Asian Pacific Islander women in the United States is not affected by birthplace. Gynecol Oncol 2020; 157:62-66. [DOI: 10.1016/j.ygyno.2020.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/25/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
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Coulter E, Barrie A, Saenz C, Plaxe S, Eskander R, Binder P, McHale M. Utilization of Genetic Counseling for Patients with Epithelial Ovarian Cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barrie A, McHale M, Saenz C, Taylor K, Plaxe S. Disparities and demographics in sentinel lymph node mapping for endometrial cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sicklick JK, Leyland-Jones B, Kato S, Williams C, De P, Heestand G, Plaxe S, Solomon B, Miller V, Benson A, Webster J, Ross J, Scur M, Porter R, Jepperson S, Fanta P, Kurzrock R. Abstract CT053: High rates of personalized molecular matching are achievable in a precision oncology navigation trial: the I-PREDICT study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Precision medicine has evolved as an individualized approach for treating cancer patients and has become standard in an ever-increasing number of clinical settings. It is predicated upon matching targeted-/immuno-therapy to genomic alterations detected in patients' tumors. However, widespread feasibility/adoption has been limited by: 1) high rates of insufficient tumor DNA (reaching 25%); 2) panels limited to few genes that are unable to detect multiple classes of genomic alterations; 3) testing patients late in the disease course; and 4) low molecular matching rates, which may be in part due to limited access to trials and the unpredictable nature of genomic alterations detected in each individual. We evaluated the feasibility of investigating molecular profile-related evidence for determining individualized cancer therapy (I-PREDICT) in patients with lethal tumors (NCT02534675). This navigation trial was performed under the auspices of 2 precision medicine programs (UCSD and Avera Cancer Institute) and an IRB-approved protocol. Treatment-naïve and previously treated patients with ECOG <2 and metastatic/unresectable malignancies were eligible if their cancer was associated with ≥50% mortality risk at 2 years. Patients’ tumors underwent comprehensive genomic profiling (CGP, Foundation Medicine; ≥315 genes), PD-(L)1 immunostaining, assessment of microsatellite instability, tumor mutational burden and circulating tumor DNA analyses (CLIA certified CAP-accredited laboratory). A molecular tumor board discussed results immediately upon receipt, and provided recommendations, emphasizing customized combinations, for the use of FDA-approved or experimental therapeutics. Final management decisions were at the treating physician’s discretion.To date, 135 patients have enrolled (2/2015-10/2016). CGP was evaluable in 107 participants (79.3%). In 5 patients (3.7%), the tumor sample was inadequate for CGP. The other 23 patients were excluded due to screen failure or dropout. All 107 tumors had ≥1 (in)activating genomic alterations (median 4, range: 1-20; variants of unknown significance excluded). Of the 135 participants, 81 (60%) were treated; 63 (46.7% of enrollees) received matched therapy. There are 19 (14.1%) patients currently awaiting CGP results or medications, while 14 (10.4%) patients received only best supportive care before death. Sixty-two of the 81 (76.5%) patients treated have had ≥1-restaging scan to date.With the use of more comprehensive DNA panels, inclusion of patients earlier in their disease course, just-in-time molecular tumor board discussions, and increasing availability of cognate drugs, we report: 1) low rates of inevaluable tumor tissue ( <5%); 2) high detection rates of ≥1 (in)activating alterations (100% with evaluable CGP); and 3) high molecular matching rates (approaching 50%). Response and survival assessments are ongoing.
Citation Format: Jason K. Sicklick, Brian Leyland-Jones, Shumei Kato, Casey Williams, Pradip De, Gregory Heestand, Steven Plaxe, Benjamin Solomon, Vincent Miller, Adam Benson, Jennifer Webster, Jeffrey Ross, Michael Scur, Robert Porter, Shelby Jepperson, Paul Fanta, Razelle Kurzrock. High rates of personalized molecular matching are achievable in a precision oncology navigation trial: the I-PREDICT study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT053. doi:10.1158/1538-7445.AM2017-CT053
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Anderson K, Davis MA, Bean L, Saenz C, Plaxe S, McHale M. Increasing Incidence of Primary Fallopian Tube Cancer in Association with Scientific Evidence for Histological Re-classification. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Simpson DR, Scanderbeg D, Carmona R, McMurtrie R, Einck J, Mell LK, McHale M, Saenz C, Plaxe S, Mundt AJ, Yashar CM. Clinical Outcomes of Computed Tomography-Based Volumetric Brachytherapy Planning for Cervical Cancer. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davis M, Ward K, Shah N, McHale M, Saenz S, Plaxe S. After screening what's next: Regional variation in the declining incidence of squamous cell carcinoma of the cervix (SCC) in the US, 1975–2009. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim J, Ward K, Shah N, Saenz C, McHale M, Plaxe S. Excess risk of Clostridium difficile enterocolitis in ovarian cancer is related to exposure to broad-spectrum antibiotics. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shah N, Ward K, McHale M, Alvarez E, Saenz C, Plaxe S. Estimated rate of decline in radical hysterectomies available for training in the US, 1998–2008. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ward K, McHale M, Alvarez E, Saenz C, Shah N, Plaxe S. Cardiac death is the most significant determinant of mortality for endometrial cancer patients and survivors. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McMeekin S, Patel R, Verschraegen C, Celano P, Burke J, Plaxe S, Ghatage P, Giurescu M, Stredder C, Wang Y, Schmelter T. Phase I/II study of sagopilone (ZK-EPO) plus carboplatin in women with recurrent platinum-sensitive ovarian cancer. Br J Cancer 2012; 106:70-6. [PMID: 22108514 PMCID: PMC3251849 DOI: 10.1038/bjc.2011.499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sagopilone is the first fully synthetic epothilone in clinical development and has demonstrated promising preclinical activity. This phase I/II, prospective, open-label trial investigated the efficacy and safety of sagopilone plus carboplatin in patients with recurrent platinum-sensitive ovarian cancer (OC). METHODS In phase I (dose-escalation stage), patients with OC recurring at least 6 months after platinum-containing chemotherapy received 3-h infusions of sagopilone (initial dose of 12 mg m(-2)) followed by carboplatin every 3 weeks, for 2-6 treatment courses. Patients enrolled in phase II received 3-h infusions of 16 mg m(-2) sagopilone. Efficacy was assessed using modified Response Evaluation Criteria in Solid Tumors (modRECIST) and Gynecologic Cancer InterGroup CA125 criteria. The safety and tolerability of sagopilone were also evaluated. RESULTS In all, 45 patients received sagopilone at 12 mg m(-2) or 16 mg m(-2). There were 29 confirmed tumour responses (21 modRECIST and 8 CA125) across both treatment groups, indicating that the primary objective of the study was reached. The main adverse events (AEs) reported were peripheral neuropathy (75.6%), fatigue (71.1%) and nausea (64.4%). Grade ≥3 AEs occurred in 35 patients (77.8%). No deaths related to the study drug were reported. CONCLUSION Sagopilone in combination with carboplatin was effective and toxicities were manageable in patients with recurrent platinum-sensitive OC.
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Affiliation(s)
- S McMeekin
- University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, 825 NE 10th Street, Oklahoma City, OK 73104, USA.
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Plaxe S, Prellwitz L. Relative impact of cost drivers on the increasing expense of inpatient gynecologic oncology care. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ward K, Roncancio A, Plaxe S. Residing in a county with higher percentage of language isolation is associated with increased incidence of invasive squamous cell carcinoma of the cervix among Hispanic women. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Scanderbeg D, Saenz C, Plaxe S, McHale M, Alvarez E, Yashar C. Novel brachytherapy device design for treatment of cervical and uterine carcinoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Earhart RH, Rosen L, Mendelson D, Plaxe S, Gold P, Yee L, Mansoor S, Verschraegen C, Phillips A, Houston S, De Jager R. Abstract B212: QTc study of picoplatin with emphasis on pharmacodynamics of cardiac repolarization. Mol Cancer Ther 2009. [DOI: 10.1158/1535-7163.targ-09-b212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Clinical studies have demonstrated that picoplatin (Pico), a new-generation platinum analogue designed to overcome platinum resistance, has activity when administered IV in solid tumors patients (pts); over 1,100 pts have received pico. The primary toxicity is hematological. Clinically significant nephro-, oto-, or neurotoxicity has rarely been observed (<1% grade 3 and 0% grade 4), even in platinum-pretreated patients. Pico (150 mg/m2) Q3W is currently being studied in a Phase 3 trial as 2nd-line monotherapy for SCLC. Pico is also being studied in Phase 2 trials in combination with other chemotherapy drugs for colorectal and prostate cancers. In preclinical studies in dogs, pico had no effect on cardiovascular function, including the QT interval. In clinical trials to date, drug-related serious ventricular arrhythmias have not been observed. The purpose of this study was to assess cardiac effects of Pico in patients with advanced solid tumors.
Methods: The effect of pico on the QT/QTc interval as measured by the ECG was evaluated. The correlation between the QTcF interval and platinum concentration in plasma and plasma ultrafiltrate (PUF) was evaluated. ECG was recorded continuously with a Holter monitor. Triplicate 20 second ECG readings were extracted at 3 times before (baseline reference) and at 8 times in the 24 hrs after pico administration in Cycle 1. Triplicate 12-lead ECGs were obtained at the end of the pico infusion in subsequent cycles. Blood samples were collected before study drug administration and immediately after each ECG timepoint in Cycle 1 for pharmacokinetic analysis. The primary endpoint was the Fredericia corrected QT (QTcF). Time-averaged and time point analyses for QTcF were performed. Heart rate, PR, QRS, QT, QTcB (Bazett's) and morphological changes were also evaluated.
Results: 45 pts (28 women and 17 men), age 44–79 years (median = 60) received 150 mg/m2 pico as a 1-hr IV infusion. The time-averaged mean change from baseline of QTcF duration during Cycle 1 was +2.2 ms, which is considered a nonsignificant increase. At each time point in Cycle 1 and in subsequent cycles, there were only minimal changes from baseline in QTcF duration. Other ECG changes from baseline were unremarkable: ST depression was noted in 9% of pts at baseline and new T-wave changes in 7% of pts in Cycle 1. Mean ± SD Cmax in plasma and PUF were 5566 ± 1079 ng/mL and 4034 ± 674 ng/mL, respectively. The change in QTcF vs. platinum concentration in plasma or PUF showed a Cmax effect of 5–6 ms with an upper confidence interval of 8–9 ms, suggesting no clear effect of picoplatin on QTcF.
Conclusions: Pico had no effect on the QTcF interval or any other ECG parameter, supporting the clinical data showing that Pico does not increase the risk of serious ventricular arrhythmias.
Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B212.
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Affiliation(s)
| | - Lee Rosen
- 2 Premiere Oncology of Santa Monica, Santa Monica, CA
| | | | | | - Philip Gold
- 5 Swedish Medical Center Cancer Institute, Seattle, WA
| | - Lorrin Yee
- 6 Northwest Medical Specialties, Tacoma, WA
| | | | - Claire Verschraegen
- 8 The University of New Mexico Cancer Research & Treatment Center, Albuquerque, NM
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Abstract
OBJECTIVE Late "recurrence" of ovarian cancer may result from either regrowth of dormant tumor cells or from development of a new cancer caused by the phenomenon of field cancerization. Clinically, some recurrent ovarian cancers show the same therapeutic sensitivities to chemotherapy and surgery as did the primary disease, whereas others are refractory to all therapy. We hypothesize that recurrent ovarian cancers are distinguishable on the basis of a molecular genetic fingerprint and that some are actually new primary cancers of the peritoneum rather than recurrent ovarian cancer. STUDY DESIGN We constructed molecular genetic fingerprints of 13 paired primary and late recurrent ovarian cancers to study their clonal relationships. The tumor pairs were analyzed for p53 mutations and allelotypes, patterns of X-chromosome inactivation, loss of heterozygosity, and microsatellite instability at 12 different loci on 6 different chromosomes. Techniques used included single-strand conformational polymorphism mutation screening and polymerase chain reaction-based sequence analysis of the p53 locus, restriction digestion of the androgen receptor locus to determine X-chromosome inactivation, and polyacrylamide gel electrophoresis of highly polymorphic dinucleotide, trinucleotide, and tetranucleotide repeats. RESULTS The average age at initial diagnosis for this cohort was 54.7 years (range 45.3 to 65.5). Mean interval to recurrence was 42.7 months (range 28 to 62). Molecular fingerprints were characterized for 4 to 8 informative loci per tumor pair. The fingerprints of 10 (77%) differed significantly, strongly suggesting that a second primary cancer had developed. The remaining 3 tumor pairs demonstrated identical allelotypes consistent with regrowth of dormant tumor cells. CONCLUSION Our results are consistent with the "field cancerization" hypothesis of ovarian carcinogenesis but could also be explained by a polyclonal tumor origin, which contrasts with the currently accepted monoclonal theory of ovarian carcinogenesis. Late development of a new primary cancer may herald the proband as a member of a familial cancer phenotype. These studies provide a molecular genetic rationale that both explains and prognosticates the clinical course of recurrent ovarian cancer.
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Affiliation(s)
- R E Buller
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, USA
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Abstract
We treated 16 patients in a phase I trial of escalating doses of intravenous cisplatin in combination with the chemoprotectant glutathione given every 21 days. Forty-three of 44 cycles (98%) were evaluable, 85% of cycles were given on time, and the median number of cycles per patient was 2. Dose-limiting nephrotoxicity was reached at a dose of 175 mg/M2 of cisplatin. Other toxicities included ototoxicity in 7 patients (44%) and grade 3 to 4 nausea and vomiting in 15 evaluable cycles (34.9%). Myelosuppression was infrequent. An increase to 175% of standard cisplatin dose intensity is attainable with the administration of glutathione; however, toxicity is substantial and the number of tolerated cycles is limited. Alternatives to the single bolus dose schedule studied in the present trial should be explored in order to better define the clinical utility of glutathione in combination with high-dose cisplatin.
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Affiliation(s)
- S Plaxe
- Division of Gynecologic Oncology, University of California, San Diego 92103-8433
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McClay EF, Goel R, Andrews P, Gorelick S, Kirmani S, Kim S, Braly P, Plaxe S, Hoff S, Alcaraz J. A phase I and pharmacokinetic study of intraperitoneal carboplatin and etoposide. Br J Cancer 1993; 68:783-8. [PMID: 8398708 PMCID: PMC1968622 DOI: 10.1038/bjc.1993.428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We attempted to determine the maximum tolerated dose and toxicity of etoposide (VP-16) when administered in combination with carboplatin (CBDCA) (300 mg m-2) and administered via the intraperitoneal (IP) route. METHODS AND MATERIALS A total of 26 patients were treated on this trial. CBDCA was administered at a fixed dose of 300 mg m-2) while VP-16 was started at a dose of 200 mg m-2 and escalated at 50 mg m-2 increments. Both agents were mixed together in 2 litres of 5% Dextrose and administered as quickly as possible into the peritoneal cavity. Pharmacokinetic studies were performed at the maximum tolerated dose (MTD). RESULTS The MTD for this regimen was CBDCA 300 mg m-2 and VP-16 350 mg m-2. Patients > or = 70 years of age or who had received more than six cycles of previous chemotherapy, tolerated this regimen poorly. The MTD for this group of patients was CBDCA 200 mg m-2 and VP-16 50 mg m-2. Neutropenia was the dose limiting toxicity for both groups. The mean peritoneal/plasma peak ratio was 18.3 for CBDCA and 12.7 for VP-16. The pharmacologic advantage (peritoneal/plasma AUC ratio) was 14.9 for CBDCA and 8.8 for VP-16. Although measurable disease was not a requirement for entrance into this study a response rate of 27% was noted in 15 patients with evaluable disease who had ovarian cancer. CONCLUSIONS A pharmacologic advantage exists for both CBDCA and VP-16 when administered together via the IP route.
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Affiliation(s)
- E F McClay
- Department of Medicine, University of California, San Diego 92103
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Bonetti A, Howell SB, McClay E, Kirmani S, Goel R, Plaxe S, Braly P, Kim S. High-dose biweekly intraperitoneal cisplatin: an effective way to increase cisplatin dose intensity. Gynecol Oncol 1993; 49:318-24. [PMID: 8314533 DOI: 10.1006/gyno.1993.1133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/29/2023]
Abstract
The amount of cisplatin (DDP) delivered per unit time (dose intensity, expressed in mg/m2/week) may be an important factor in determining the clinical outcome in tumors such as ovarian carcinoma. In this neoplasm, intraperitoneal chemotherapy is an effective form of treatment. In this trial we have explored the tactic of shortening the cycle interval as a way to increase the dose intensity of ip DDP. Sixteen patients with a variety of solid tumors received a total of 77 cycles of DDP 180 mg/m2 instilled ip concurrent with i.v. sodium thiosulfate at the dose of 4 g/m2 as loading dose, followed by 12 g/m2 over 6 hr. Each cycle was repeated every 2 weeks. The number of cycles delayed for 3 or more days was 28 (36%). The mean DDP dose intensity received by these patients was 77% of the planned dose or 69 mg/m2/week (confidence interval 95%, 60.5-77.5). The treatment was generally well tolerated: myelotoxicity was mild, only 1 patient had an increase in serum creatinine to > 2 mg/dl. Five patients (31%) developed symptoms of peripheral neuropathy. All patients were evaluable for response. The overall response rate (complete plus partial) in these heavily pretreated patients was 19%. When DDP is given in high doses by the ip route concurrently with systemic sodium thiosulfate, the dosing interval can be reduced to every 2 weeks permitting a marked increase in DDP dose intensity.
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Affiliation(s)
- A Bonetti
- Department of Medicine, University of California, San Diego, La Jolla 92093
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Abstract
PURPOSE Dose intensity (DI, expressed in mg/m2/wk) may be an important factor in the clinical use of cisplatin (DDP). We have explored the shortening of the cycle interval as a way to increase the DI of DDP. PATIENTS AND METHODS DDP 180 mg/m2 was given intravenously (i.v.) over 4 hours; sodium thiosulfate (STS) was given i.v. in the opposite arm at a loading dose of 4 g/m2, followed by 12 g/m2 over 6 hours. Each cycle was repeated every two weeks. Seventy-five cycles were administered to 28 patients in this clinical trial. RESULTS In 19 patients who received 2 or more cycles of chemotherapy, a delay of three or more days was required on 17/66 courses (26%); the mean DDP DI actually received by these patients was 83 mg/m2/wk (88% of the planned DI). The major side effect was ototoxicity; this occurred in 9 patients (33%), but none required a hearing aid. Myelosuppression was moderate with thrombocytopenia greater than neutropenia. Nephrotoxicity (creatinine > 2 mg/dl) occurred on only 2 cycles (3%). Three patients (11%) developed symptoms of peripheral neuropathy. In 23 evaluable patients, the overall response rate was 39%. CONCLUSION It is feasible to give 180 mg/m2 of DDP and STS every two weeks with tolerable nephrotoxicity but without blocking other types of toxicity, such as myelosuppression and ototoxicity. The shortening of cycle intervals resulted in a markedly increased DI.
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Affiliation(s)
- S Kim
- Department of Medicine, University of California, San Diego, La Jolla
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Howell SB, Kirmani S, McClay EF, Kim S, Braly P, Plaxe S. Intraperitoneal cisplatin-based chemotherapy for ovarian carcinoma. Semin Oncol 1991; 18:5-10. [PMID: 2003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ovarian carcinoma demonstrates a steep dose-response curve for cisplatin, but even very small levels of acquired resistance at the cellular level are sufficient to block the efficacy of intravenous (IV) cisplatin. The intraperitoneal (IP) route of administration produces a 12-fold to 15-fold greater exposure for the peritoneal cavity, and concurrent use of IV thiosulfate permits the safe IP injection of 200 mg/m2 cisplatin. In this study, two phase II trials of an IP regimen containing cisplatin 200 mg/m2 and etoposide 350 mg/m2 with IV thiosulfate were conducted; the first trial enrolled patients with residual disease less than 2 cm who had failed primary cisplatin-based IV chemotherapy and the second trial newly diagnosed ovarian carcinoma patients irrespective of the size of residual disease after primary surgery. As salvage therapy, the IP cisplatin/etoposide regimen produced a median survival of 26 months from the start of IP therapy and 51 months from diagnosis. As first-line therapy, the median survival has not yet been reached; projected survival is 68% at 27 months. In both studies the major toxicity was myelosuppression; the use of concurrent thiosulfate almost completely eliminated serious nephrotoxicity and neurotoxicity. The size of the largest tumor mass was an important determinant of efficacy in both settings. The results of these trials are consistent with the hypothesis that increased drug delivery will result in higher response rates and improved survival. Data are sufficiently encouraging to mandate phase III randomized trials of this program.
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Affiliation(s)
- S B Howell
- Department of Medicine, University of California San Diego, La Jolla 92093
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Dotting P, Johnston C, Plaxe S, Beddoe A, Cohen C. cis-Platinum and adriamycin in the treatment of patients with stage I ovarian cancer. Gynecol Oncol 1991. [DOI: 10.1016/0090-8258(91)90214-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brodman M, Friedman F, Dottino P, Janus C, Plaxe S, Cohen C. A comparative study of computerized tomography, magnetic resonance imaging, and clinical staging for the detection of early cervix cancer. Gynecol Oncol 1990; 36:409-12. [PMID: 2318454 DOI: 10.1016/0090-8258(90)90153-c] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [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: 12/31/2022]
Abstract
Sixteen patients with cervical cancer underwent radical surgery following standard clinical staging, MRI, and CT. The sensitivity of the CT scan was 14%, the specificity 100%. MRI had a sensitivity of 28% and a specificity of 64%. The clinical stage was correct in 10 of 16 patients (62%). CT and MRI are not individually or collectively better than clinical staging in predicting extent of disease, and currently should not be included in the FIGO staging for cervix cancer.
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Affiliation(s)
- M Brodman
- Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, New York 10029
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Brodman M, Friedman R, Dottino P, Janus C, Plaxe S, Cohen C. A comparison of clinical staging, computerized tomography, and magnetic resonance imaging in the staging of cervix cancer. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dottino P, Plaxe S, Cohen C. Combination chemotherapy and radiotherapy in the treatment of cervical cancer. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dottino P, Plaxe S, Cohen C. Neoadjuvant chemotherapy followed by radical surgery in cervical cancer. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plaxe S, Dottino P, Cohen C. Clinical features and implications of atypical metastatic disease spread of epithelial ovarian carcinoma. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plaxe S, Dottino P, Goodman H, Deligdisch L, Idelson M, Cohen C. Treatment of advanced ovarian mixed mesodermal tumors with postoperative doxorubicin and cis-platinum based chemotherapy. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plaxe S, Dottino P, Cohen C. Metabolic effects of high (>1 g/m2) systemic cumulative doses of cis-platinum. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)91009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Ten cases of extrauterine malignant mixed mesodermal tumors (MMMTs), nine ovarian, and one pelvic, are presented. One patient had a purely epithelial primary ovarian tumor and MMMT in her recurrent tumors. All the other patients had MMMT in their primary and recurrent tumors. Eight patients had heterologous MMMT including cartilage, striated muscle, and adipose tissue in one case. Two patients had homologous MMMT. All cases presented with metastases involving abdominal organs that were either MMMT or epithelial neoplasms and MMMT. Five patients had recurrent tumors, one extensively involving the spleen. In all recurrent tumors, the mesenchymal components were considerably more abundant than in the primary tumors. Immunohistologic studies of intermediate filaments were performed in seven cases, revealing cytokeratin-positive epithelial structures, vimentin-positive mesenchymal (including cartilaginous) structures, as well as coexpression of cytokeratin and vimentin in anaplastic and giant tumor cells in some cases. Some anaplastic spindle cells, which on routine stains were suggestive of stromal cells, stained positive for cytokeratin, thus identifying their epithelial nature. Desmin staining performed in five cases showed positive staining of rhabdomyoblasts in only one case. Myoglobin staining performed in seven cases was positive in four. The histogenesis from primitive müllerian structures and the natural history of these uncommon neoplasms are discussed in light of the pathological and immunohistochemical data presented.
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Affiliation(s)
- L Deligdisch
- Department of Pathology, Mount Sinai Medical Center, New York, NY 10029
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Bruckner HW, Lavin P, Plaxe S, Storch JA, Livstone E. Routine clinical chemistries as improved determinates of prognosis for patients with metastatic cancer of the stomach. Oncology 1983; 40:31-5. [PMID: 6337363 DOI: 10.1159/000225686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pretreatment total serum protein of less than 6 g%, serum glumatic oxaloacetic transaminase (SGOT) greater than 40 mU/ml or a total serum bilirubin greater than 0.6 mg% predicted a bad prognosis for patients with metastatic gastric cancer. If two of these objective laboratory tests predicted a good prognosis, partially nonambulatory patients lived an additional 20 weeks (median survival 27.9 vs 8.7, p less than 0.001) and patients with no clinically recognized liver metastases lived an additional 22 weeks (median survival 34.2 vs. 12.4, p less than 0.001). Patients with liver metastases lived an additional 11 weeks (median survival 20.9 vs. 9.6, p less than 0.001). These objective laboratory tests improve the assessment of patients in clinical trials. The model corrected a false assessment of a poor prognosis for 38% of all patients and 64% of patients with liver metastases.
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