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Kaluarachchi DC, Gerday E, Bahr T, Zapata HA, Lasarev MR, Guthrie SO, Minton S. High vs low CPAP strategy with aerosolized calfactant in preterm infants with respiratory distress syndrome. J Perinatol 2024:10.1038/s41372-024-01959-7. [PMID: 38594414 DOI: 10.1038/s41372-024-01959-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Optimal CPAP strategy to prevent CPAP failure defined as need for endotracheal intubation is unknown. OBJECTIVE To evaluate the risk of CPAP failure in infants treated with high vs low CPAP strategy while receiving aerosolized calfactant in the AERO-02 clinical trial and AERO-03 expanded access program. METHODS Infants born between 29 0/7 to 36 6/7 weeks were included. Comparisons were made between low and high CPAP groups (Low, 4-7 cm H2O; High, 8-10 cm H2O). RESULTS CPAP failure and pneumothorax were not different between the groups. Odds of CPAP failure were not different after adjustment for baseline characteristics (OR = 0.61; 95% CI: 0.29, 1.24). CONCLUSION We found no difference in CPAP failure among infants who received aerosolized calfactant that were treated with high vs low CPAP strategy. Efficacy of high CPAP strategy with aerosolized surfactant treatment needs to be evaluated in future studies.
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Affiliation(s)
- D C Kaluarachchi
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.
| | - E Gerday
- Utah Valley Hospital, Provo, UT and Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - T Bahr
- Utah Valley Hospital, Provo, UT and Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - H A Zapata
- Department of Pediatrics, Division of Neonatology, University of Florida School of Medicine -Jacksonville, Jacksonville, FL, USA
| | - M R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - S O Guthrie
- Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Jackson-Madison County General Hospital, Jackson, TN, USA
| | - S Minton
- Utah Valley Hospital, Provo, UT and Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Zheng XQ, Guo JP, Yang H, Kanai M, He LL, Li YY, Koomen JM, Minton S, Gao M, Ren XB, Coppola D, Cheng JQ. Retraction Note: Aurora-A is a determinant of tamoxifen sensitivity through phosphorylation of ERα in breast cancer. Oncogene 2024; 43:1160. [PMID: 38396296 PMCID: PMC11036404 DOI: 10.1038/s41388-024-02983-9] [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: 02/25/2024]
Affiliation(s)
- X Q Zheng
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Departments of Thyroid and Neck Tumour, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, PR China
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, PR China
| | - J P Guo
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - H Yang
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - M Kanai
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - L L He
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Y Y Li
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - J M Koomen
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - S Minton
- Departments of Women's Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - M Gao
- Departments of Thyroid and Neck Tumour, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, PR China
| | - X B Ren
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, PR China
| | - D Coppola
- Departments of Women's Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - J Q Cheng
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Lambertini M, Moore HC, Leonard RC, Loibl S, Munster P, Bruzzone M, Boni L, Unger JM, Anderson RA, Mehta K, Minton S, Poggio F, Albain KS, Adamson DJ, Gerber B, Cripps A, Bertelli G, Seiler S, Ceppi M, Partridge AH, Del Mastro L. Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient-Level Data. J Clin Oncol 2018; 36:1981-1990. [PMID: 29718793 PMCID: PMC6804855 DOI: 10.1200/jco.2018.78.0858] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The role of temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy as a strategy to preserve ovarian function and fertility in premenopausal women remains controversial. This systematic review and meta-analysis using individual patient-level data was conducted to better assess the efficacy and safety of this strategy in patients with early breast cancer. Methods The trials in which premenopausal women with early breast cancer were randomly assigned to receive (neo)adjuvant chemotherapy alone or with concurrent GnRHa were eligible for inclusion. Primary end points were premature ovarian insufficiency (POI) rate and post-treatment pregnancy rate. Disease-free survival and overall survival were secondary end points. Because each study represents a cluster, statistical analyses were performed using a random effects model. Results A total of 873 patients from five trials were included. POI rate was 14.1% in the GnRHa group and 30.9% in the control group (adjusted odds ratio, 0.38; 95% CI, 0.26 to 0.57; P < .001). A total of 37 (10.3%) patients had at least one post-treatment pregnancy in the GnRHa group and 20 (5.5%) in the control group (incidence rate ratio, 1.83; 95% CI, 1.06 to 3.15; P = .030). No significant differences in disease-free survival (adjusted hazard ratio, 1.01; 95% CI, 0.72 to 1.42; P = .999) and overall survival (adjusted hazard ratio, 0.67; 95% CI, 0.42 to 1.06; P = .083) were observed between groups. Conclusion Our findings provide evidence for the efficacy and safety of temporary ovarian suppression with GnRHa during chemotherapy as an available option to reduce the likelihood of chemotherapy-induced POI and potentially improve future fertility in premenopausal patients with early breast cancer.
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Affiliation(s)
- Matteo Lambertini
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Halle C.F. Moore
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Robert C.F. Leonard
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Sibylle Loibl
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Pamela Munster
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Marco Bruzzone
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Luca Boni
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Joseph M. Unger
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Richard A. Anderson
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Keyur Mehta
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Susan Minton
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Francesca Poggio
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Kathy S. Albain
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Douglas J.A. Adamson
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Bernd Gerber
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Amy Cripps
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Gianfilippo Bertelli
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Sabine Seiler
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Marcello Ceppi
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Ann H. Partridge
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
| | - Lucia Del Mastro
- Matteo Lambertini, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Halle C.F. Moore, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Robert C.F. Leonard, Imperial College, London; Richard A. Anderson, University of Edinburgh, Edinburgh; Douglas J.A. Adamson, Ninewells Hospital, Dundee; Gianfilippo Bertelli, Sussex Cancer Centre, Brighton, United Kingdom; Sibylle Loibl, Keyur Mehta, and Sabine Seiler, German Breast Group, Neu-Isenburg; Bernd Gerber, University Hospital Rostock, Rostock, Germany; Pamela Munster, University of California, San Francisco, San Francisco, CA; Marco Bruzzone, Francesca Poggio, Marcello Ceppi, and Lucia Del Mastro, Ospedale Policlinico San Martino; Francesca Poggio and Lucia Del Mastro, University of Genova, Genova; Luca Boni, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Joseph M. Unger, SWOG Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Susan Minton, Moffitt Cancer Center, Tampa, FL; Kathy S. Albain, Loyola University Chicago Stritch School of Medicine, Maywood, IL; Amy Cripps, Nexgen Oncology, Dallas, TX; and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA
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Yee D, Paoloni M, van't Veer L, Sanil A, Yau C, Forero A, Chien AJ, Wallace AM, Moulder S, Albain KS, Kaplan HG, Elias AD, Haley BB, Boughey JC, Kemmer KA, Korde LA, Isaacs C, Minton S, Nanda R, DeMichele A, Lang JE, Buxton MB, Hylton NM, Symmans WF, Lyandres J, Hogarth M, Perlmutter J, Esserman LJ, Berry DA. Abstract P6-11-04: The evaluation of ganitumab/metformin plus standard neoadjuvant therapy in high-risk breast cancer: Results from the I-SPY 2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: I-SPY 2 is a multicenter, phase 2 trial using response-adaptive randomization within biomarker subtypes to evaluate novel agents when added to standard neoadjuvant therapy for women with high-risk stage II/III breast cancer - investigational agent(I) +paclitaxel(T) qwk, doxorubicin & cyclophosphamide(AC) q2-3 wk x 4 vs. T/AC (control arm). The primary endpoint is pathologic complete response (pCR) at surgery. The goal is to identify/graduate regimens that have ≥85% Bayesian predictive probability of success (statistical significance) in a 300-patient phase 3 neoadjuvant trial defined by hormone-receptor (HR) & HER2 status & MammaPrint (MP). Regimens may also leave the trial for futility (< 10% probability of success) or following accrual of maximum sample size (10%< probability of success <85%). We report the results for experimental arm Ganitumab, a type I insulin-like growth factor receptor (IGF1R) inhibitor. IGF1R inhibitors are known to induce insulin resistance and all patients assigned to Ganitumab received metformin.
Methods: Women with tumors ≥2.5cm were eligible for screening. MP low/HR+ and HER2+ tumors were ineligible for randomization. Hemoglobin A1C≥ 8.0% were ineligible. MRI scans (baseline, 3 cycles after start of therapy, at completion of weekly T and prior to surgery) were used in a longitudinal statistical model to improve the efficiency of adaptive randomization. Ganitumab was given at 12mg/kg q2 weeks and metformin at 850mg PO BID, while receiving ganitumab. Analysis was intention to treat with patients who switched to non-protocol therapy counted as non-pCRs. Ganitumab/metformin was open only to HER2- patients, and eligible for graduation in 3 of 10 pre-defined signatures: HER2-, HR+HER2- and HR-HER2-.
Results: Ganitumab/metformin did not meet the criteria for graduation in the 3 signatures tested. When the maximum sample size was reached, accrual to this arm stopped. Ganitumab/metformin was assigned to 106 patients; there were 128 controls. We report probabilities of superiority for Ganitumab/metformin over control and Bayesian predictive probabilities of success in a neoadjuvant phase 3 trial equally randomized between Ganitumab/metformin and control, for each of the 3 biomarker signatures, using the final pathological response data from all patients. Safety data will be presented.
SignatureEstimated pCR Rate (95% probability interval)Probability Ganitumab/ Metformin Is Superior to ControlPredictive Probability of Success in Phase 3 Ganitumab/ Metformin N = 106Control N = 128 All HER2-22% (13%-31%)16% (10%-23%)89%33%HR+/HER2-14% (4%-24%)12% (4%-19%)66%21%HR-/HER2-32% (17%-46%)21% (11%-32%)91%51%
Conclusion: The I-SPY 2 adaptive randomization study estimates the probability that investigational regimens will be successful in a phase 3 neoadjuvant trial. The value of I-SPY 2 is to give insight about the performance of an investigational agent's likelihood of achieving pCR. For Ganitumab/metformin, no subtype came close to the efficacy threshold of 85% likelihood of success in phase 3, and this regimen does not appear to impact upfront reduction of tumor burden. Our data do not support its continued development for the neoadjuvant treatment of breast cancer.
Citation Format: Yee D, Paoloni M, van't Veer L, Sanil A, Yau C, Forero A, Chien AJ, Wallace AM, Moulder S, Albain KS, Kaplan HG, Elias AD, Haley BB, Boughey JC, Kemmer KA, Korde LA, Isaacs C, Minton S, Nanda R, DeMichele A, Lang JE, Buxton MB, Hylton NM, Symmans WF, Lyandres J, Hogarth M, Perlmutter J, Esserman LJ, Berry DA. The evaluation of ganitumab/metformin plus standard neoadjuvant therapy in high-risk breast cancer: Results from the I-SPY 2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-04.
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Affiliation(s)
- D Yee
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - M Paoloni
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - L van't Veer
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - A Sanil
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - C Yau
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - A Forero
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - AJ Chien
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - AM Wallace
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - S Moulder
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - KS Albain
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - HG Kaplan
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - AD Elias
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - BB Haley
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - JC Boughey
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - KA Kemmer
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - LA Korde
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - C Isaacs
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - S Minton
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - R Nanda
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - A DeMichele
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - JE Lang
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - MB Buxton
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - NM Hylton
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - WF Symmans
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - J Lyandres
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - M Hogarth
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - J Perlmutter
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - LJ Esserman
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
| | - DA Berry
- University of Minnesota, Minneapolis, MN; QuantumLeap Healthcare Collaborative, San Francisco, CA; University of California, San Francisco, San Francisco, CA; Berry Consultants, Austin, TX; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Loyola University, Chicago, IL; Swedish Medical Center, Seattle, WA; University of Denver, Denver, CO; UT Southwestern Medical Center, Dallas, TX; Mayo Clinic, Rochester, MN; Oregon Health & Sciences University, Portland, OR; University of Washington, Seattle, WA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Moffitt Cancer Center, Tampa, FL; University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; University of Arizona, AZ; University of California, Davis, Davis, CA; Gemini Group, Ann Arbor, MI
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Forero A, Yee D, Buxton MB, Symmans WF, Chien AJ, Boughey JC, Elias AD, DeMichele A, Moulder S, Minton S, Kaplan HG, Albain KS, Wallace AM, Haley BB, Isaacs C, Korde LA, Nanda R, Lang JE, Kemmer KA, Hylton NM, Paoloni M, van't Veer L, Lyandres J, Perlmutter J, Hogarth M, Yau C, Sanil A, Berry DA, Esserman LJ. Abstract P6-11-02: Efficacy of Hsp90 inhibitor ganetespib plus standard neoadjuvant therapy in high-risk breast cancer: Results from the I-SPY 2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Pathologic complete response(pCR) after neoadjuvant therapy is an established prognostic biomarker for high-risk breast cancer(BC). Improving pCR rates may identify new therapies that improve survival. I-SPY 2 uses response-adaptive randomization within biomarker subtypes to evaluate novel agents when added to standard neoadjuvant therapy for women with high-risk stage II/III breast cancer; the goal is to identify regimens that have ≥85% Bayesian predictive probability of success (statistical significance) in a 300-patient phase 3 neoadjuvant trial defined by hormone-receptor (HR), HER2 status and MammaPrint (MP). We report the results for Ganetespib, a selective inhibitor of Hsp90 that induces the degradation/deactivation of key drivers of tumor initiation, progression, angiogenesis, and metastasis.Ganetespib + taxanes previously have resulted in a superior therapeutic response compared to monotherapy in multiple solid tumor models including BC.
Methods:Women with tumors ≥2.5cm were eligible for screening and participation. MP low/HR+ tumors were ineligible for randomization. QTcF >470msec and HbA1C >8.0% were ineligible. MRI scans (baseline, +3 cycles, following weekly paclitaxel, T, and pre-surgery) were used in a longitudinal statistical model to improve the efficiency of adaptive randomization. Ganetespib was given with weekly T at 150 mg/m2 IV weekly (3 weeks on, 1 off). Patients were premedicated (dexamethasone 10mg and diphenhydramine HCl 25-50 mg, or therapeutic equivalents). Analysis was intention to treat with patients who switched to non-protocol therapy counted as non-pCRs. The Ganetespib regimen was open only to HER2- patients, and eligible for graduation in 3 of 10 pre-defined signatures: HER2-, HR+/HER2- and HR-/HER2-.
Results:Ganetespib did not meet the criteria for graduation in the 3 signatures tested. When the maximum sample size was reached, accrual stopped. Ganetespib was assigned to 93 patients; there were 140 controls. We report probabilities of superiority for Ganetespib over control and Bayesian predictive probabilities of success in a neoadjuvant phase 3 trial equally randomized between Ganetespib and control, for the 3 biomarker signatures, using the final pCR data from all patients. Safety data will be presented.
SignatureEstimated pCR Rate (95% probability interval)Probability Ganetespib Is Superior to ControlPredictive Probability of Ganetespib Success in a Phase 3 Trial Ganetespib N = 93Control N = 140 All HER2-26% (16%-37%)18% (8%-28%)91%47%HR+/HER2-15% (4%-27%)14% (4%-24%)60%19%HR-/HER2-38% (23%-53%)22% (9%-35%)96%72%
Conclusion:The I-SPY 2 adaptive randomization model efficiently evaluates investigational agents in the setting of neoadjuvant BC. The value of I-SPY 2 is that it provides insight as to the regimen's likelihood of success in a phase 3 neoadjuvant study. Although no signature reached the efficacy threshold of 85% likelihood of success in phase 3, we observed the most impact in HR-/HER2- patients, with a 16% improvement in pCR rate. While our data do not support the continued development of Ganetespib alone for neoadjuvant BC, combinations with Ganetespib, which could potentiate its effect, may be worth pursuing in I-SPY 2 or similar trials.
Citation Format: Forero A, Yee D, Buxton MB, Symmans WF, Chien AJ, Boughey JC, Elias AD, DeMichele A, Moulder S, Minton S, Kaplan HG, Albain KS, Wallace AM, Haley BB, Isaacs C, Korde LA, Nanda R, Lang JE, Kemmer KA, Hylton NM, Paoloni M, van't Veer L, Lyandres J, Perlmutter J, Hogarth M, Yau C, Sanil A, Berry DA, Esserman LJ. Efficacy of Hsp90 inhibitor ganetespib plus standard neoadjuvant therapy in high-risk breast cancer: Results from the I-SPY 2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-02.
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Affiliation(s)
- A Forero
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - D Yee
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - MB Buxton
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - WF Symmans
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - AJ Chien
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - JC Boughey
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - AD Elias
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - A DeMichele
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - S Moulder
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - S Minton
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - HG Kaplan
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - KS Albain
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - AM Wallace
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - BB Haley
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - C Isaacs
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - LA Korde
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - R Nanda
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - JE Lang
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - KA Kemmer
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - NM Hylton
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - M Paoloni
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - L van't Veer
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - J Lyandres
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - J Perlmutter
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - M Hogarth
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - C Yau
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - A Sanil
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - DA Berry
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
| | - LJ Esserman
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; University of California, San Francisco, San Francisco, CA; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Denver, Denver, CO; University of Pennsylvania, Philadelphia, PA; Moffitt Cancer Center, Tampa, FL; Swedish Medical Center, Seattle, WA; Loyola University, Chicago, IL; University of California, San Diego, San Diego, CA; UT Southwestern Medical Center, Dallas, TX; Georgetown Lomdbardi Comprehensive Cancer Center, Washington, DC; University of Washington, Seattle, WA; University of Chicago, Chicago, IL; University of Arizona, AZ; Oregon Health and Science University, Portland, OR; QuantumLeap Healthcare Collaborative, San Francisco, CA; Gemini Group, Ann Arbor, MI; University of California, Davis, Davis, CA; Berry Consultants, Austin, TX
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6
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Enriquez-Navas PM, Kam Y, Das T, Hassan S, Silva A, Foroutan P, Ruiz E, Martinez G, Minton S, Gillies RJ, Gatenby RA. Exploiting evolutionary principles to prolong tumor control in preclinical models of breast cancer. Sci Transl Med 2016; 8:327ra24. [PMID: 26912903 DOI: 10.1126/scitranslmed.aad7842] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Conventional cancer treatment strategies assume that maximum patient benefit is achieved through maximum killing of tumor cells. However, by eliminating the therapy-sensitive population, this strategy accelerates emergence of resistant clones that proliferate unopposed by competitors-an evolutionary phenomenon termed "competitive release." We present an evolution-guided treatment strategy designed to maintain a stable population of chemosensitive cells that limit proliferation of resistant clones by exploiting the fitness cost of the resistant phenotype. We treated MDA-MB-231/luc triple-negative and MCF7 estrogen receptor-positive (ER(+)) breast cancers growing orthotopically in a mouse mammary fat pad with paclitaxel, using algorithms linked to tumor response monitored by magnetic resonance imaging. We found that initial control required more intensive therapy with regular application of drug to deflect the exponential tumor growth curve onto a plateau. Dose-skipping algorithms during this phase were less successful than variable dosing algorithms. However, once initial tumor control was achieved, it was maintained with progressively smaller drug doses. In 60 to 80% of animals, continued decline in tumor size permitted intervals as long as several weeks in which no treatment was necessary. Magnetic resonance images and histological analysis of tumors controlled by adaptive therapy demonstrated increased vascular density and less necrosis, suggesting that vascular normalization resulting from enforced stabilization of tumor volume may contribute to ongoing tumor control with lower drug doses. Our study demonstrates that an evolution-based therapeutic strategy using an available chemotherapeutic drug and conventional clinical imaging can prolong the progression-free survival in different preclinical models of breast cancer.
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Affiliation(s)
- Pedro M Enriquez-Navas
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Yoonseok Kam
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Tuhin Das
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Sabrina Hassan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Ariosto Silva
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Parastou Foroutan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Epifanio Ruiz
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Gary Martinez
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. Department of Physics, University of South Florida, Tampa, FL 33620, USA
| | - Susan Minton
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. Cancer Biology and Evolution Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Robert A Gatenby
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. Cancer Biology and Evolution Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
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7
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DeMichele AM, Moulder S, Buxton M, Yee D, Wallace A, Chien J, Isaacs C, Albain K, Boughey J, Kemmer K, Haley B, Lang J, Kaplan H, Minton S, Forero A, Elias A, Nanda R, Korde L, Schwab R, Melisko M, Sanil A, Hogarth M, Hylton N, Paoloni M, Symmans F, Perlmutter J, Lyandres J, Yau C, Berry D, Esserman L. Abstract CT042: Efficacy of T-DM1+pertuzumab over standard therapy for HER2+ breast cancer: Results from the neoadjuvant I-SPY 2 TRIAL. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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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8
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Buxton M, DeMichele AM, Chia S, van't Veer L, Chien J, Wallace A, Kaplan H, Lang J, Yee D, Isaacs C, Moulder S, Albain K, Boughey J, Kemmer K, Haley B, Minton S, Forero A, Nanda R, Elias A, Korde L, Viscuzi R, Rugo H, Schwab R, Symmans F, Paoloni M, Hylton N, Hogarth M, Lyandres J, Perlmutter J, Sanil A, Yau C, Esserman L, Berry D. Abstract CT106: Efficacy of pertuzumab/trastuzumab/paclitaxel over standard trastuzumab/paclitaxel therapy for HER2+ breast cancer: Results from the neoadjuvant I-SPY 2 TRIAL. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-ct106] [Citation(s) in RCA: 6] [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: 11/16/2022]
Abstract
Abstract
Background: Pathologic complete response (pCR) is an established prognostic biomarker for aggressive HER2+ breast cancer (BC). Improving pCR rates may identify new therapies that improve survival. Pertuzumab (P) has established survival benefit in the metastatic setting, and received accelerated approval in the neoadjuvant setting when combined with trastuzumab (H) and docetaxel(D) as part of a complete treatment regimen for early breast cancer. We tested its ability, when combined with standard therapy (paclitaxel, T, and H) to improve pCR (ypT0ypN0) over TH in the adaptively randomized, phase II, I-SPY 2 neoadjuvant trial.
Methods: Enrolled patients (pts) had invasive BC ?2.5 cm in HER2-positive subsets. Pts were adaptively randomized to control (TH, qwk x 12) or THP (P, q3wk x 4) followed by doxorubicin/cyclophosphamide (AC) x 4 and surgery. To compare THP to TH we utilized all control pts accrued over the course of the trial, adjusting for potential differences due to time period treated, which were informed by the several other treatment arms that have been in the trial. Adaptive assignment to the experimental arms was based on current Bayesian probabilities of superiority over control. “Graduation” by signature and futility stopping were based upon Bayesian predictive probability of success in a 2-arm, N = 300 phase III randomized 1:1 trial of THP vs. TH with pCR endpoint.
Results: THP met the predictive probability criterion and graduated in 3 signatures: all HER2+, HER2+/HR+, and HER2+/HR- (See Table 1). Final accrual: 44 THP and 31 TH. Safety data will be shown.
Conclusions: I-SPY 2's standing platform trial efficiently evaluates agents in biomarker-defined pt subsets. THP -> AC substantially improves pCR rates over standard TH -> AC in all 3 HER2+ signatures, including HR+ and HR- subsets. APHINITY, a trial of adjuvant pertuzumab with a primary outcome of invasive disease-free survival, is ongoing. Table 1Signature*Estimated pCR Rate (95% probability interval)Signature*THPControl (TH)Probability THP Is Superior to ControlPredictive Probability of Success in Phase IIIHER2+54% (38%-70%)22% (5%-39%)99.8%96%HER2+/HR+44% (24%-63%)17% (0%-34%)99%91%HER2+/HR-74% (53%-95%)33% (6%-59%)99.8%98%*HR = Hormone Receptor
Citation Format: Meredith Buxton, Angela M. DeMichele, Stephen Chia, Laura van't Veer, Jo Chien, Anne Wallace, Henry Kaplan, Julie Lang, Douglas Yee, Claudine Isaacs, Stacy Moulder, Kathy Albain, Judy Boughey, Kathleen Kemmer, Barbara Haley, Susan Minton, Andres Forero, Rita Nanda, Anthony Elias, Larissa Korde, Rebecca Viscuzi, Hope Rugo, Richard Schwab, Fraser Symmans, Melissa Paoloni, Nola Hylton, Michael Hogarth, Julia Lyandres, Jane Perlmutter, Ashish Sanil, Christina Yau, Laura Esserman, Don Berry, I-SPY 2 TRIAL Investigators. Efficacy of pertuzumab/trastuzumab/paclitaxel over standard trastuzumab/paclitaxel therapy for HER2+ breast cancer: Results from the neoadjuvant I-SPY 2 TRIAL. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT106.
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Affiliation(s)
| | | | - Stephen Chia
- 3BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | | | - Jo Chien
- 1University of California, San Francisco, San Francisco, CA
| | - Anne Wallace
- 4University of California, San Diego, La Jolla, CA
| | | | - Julie Lang
- 6University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Andres Forero
- 15University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Hope Rugo
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | - Nola Hylton
- 1University of California, San Francisco, San Francisco, CA
| | | | - Julia Lyandres
- 1University of California, San Francisco, San Francisco, CA
| | - Jane Perlmutter
- 23Patient Centered Outcomes Research Institute, Washington, DC
| | | | - Christina Yau
- 1University of California, San Francisco, San Francisco, CA
| | - Laura Esserman
- 1University of California, San Francisco, San Francisco, CA
| | - Don Berry
- 9MD Anderson Cancer Center, Houston, TX
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9
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Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. Abstract OT3-02-14: A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-14] [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
Background: Nal-IRI (MM-398, nanoliposomal irinotecan) is designed for extended circulation relative to free irinotecan and to exploit leaky tumor vasculature for enhanced drug delivery to tumors. Tumor deposition of nal-IRI and subsequent conversion to SN-38 in both neoplastic cells and tumor associated macrophages (TAM) may positively correlate with response to therapy. In phase I studies of nal-IRI, activity has been shown in metastatic breast cancer (MBC), pancreatic and colorectal cancer. Ferumoxytol (FMX) is an iron-oxide superparamagnetic nanoparticle that has been used off-label for its MRI contrast properties. FMX has long-circulating pharmacokinetics and is taken up by TAMs with similar distribution patterns to nal-IRI in preclinical models. A single site pilot study established the feasibility of performing quantitative FMX MRI. Thirteen patients with advanced cancer (3 with ER/PR+ MBC) were imaged with FMX MRI and treated with nal-IRI. Median tumor lesion FMX uptake in the pilot study was 32.6 and 34.5 μg/mL at 1 h and 24 h, respectively. Lesions with FMX uptake above the median were associated with greater reductions in tumor size following treatment with nal-IRI as determined by CT lesion measurements. The relationship between FMX levels in tumor lesions and nal-IRI activity may serve as a potential biomarker for nal-IRI deposition and response in solid tumors. This study has been expanded to include additional MBC patients to further evaluate the technical feasibility of FMX MRI at multiple study sites, and to evaluate activity of nal-IRI in patients with MBC.
Trial Design: Three cohorts of 10 patients with MBC in the following categories will be enrolled: ER and/or PR positive/HER2-negative, triple negative (TNBC) and MBC with brain metastases. An imaging phase will be followed by a treatment phase. The imaging phase consists of a baseline MRI scan, FMX infusion, and follow-up MRI scans at 1-4 and 24 h after infusion. The treatment phase begins 1-6 days after imaging and consists of nal-IRI 80 mg/m2 q2w. A pretreatment biopsy is required for correlative studies.
Study Objectives: The primary objective of this multisite expansion is to investigate the feasibility of FMX quantitation in tumor lesions at multiple lesion sites in breast cancer. The secondary objective is to characterize the efficacy of nal-IRI in patients with metastatic breast cancer.
Eligibility Criteria: The key inclusion criteria include patients with MBC, ECOG 0 or 1 with adequate bone marrow reserve and no prior topoisomerase 1 inhibitor or anti-VEGF treatment. ER and/or PR positive/HER2-negative and TNBC patients must have had 1-3 prior lines of chemotherapy in the metastatic setting and have at least 2 measurable lesions. Patients with brain metastasis must be neurologically stable and have new or progressive brain metastases after prior radiation therapy with at least one lesion measuring ≥ 1 cm in longest diameter on gadolinium-enhanced MRI.
Status: This trial is currently recruiting patients.
Citation Format: Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-14.
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Affiliation(s)
- JC Sachdev
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RK Ramanathan
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - N Raghunand
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - C Anders
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - P Munster
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Minton
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - D Northfelt
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Blanchette
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - K Campbell
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - H Lee
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - SG Klinz
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - BS Hendriks
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - V Moyo
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - JB Fitzgerald
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RL Korn
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
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Kam Y, Das T, Minton S, Gatenby RA. Evolutionary strategy for systemic therapy of metastatic breast cancer: balancing response with suppression of resistance. ACTA ACUST UNITED AC 2015; 10:423-30. [PMID: 25259902 DOI: 10.2217/whe.14.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Conventional systemic therapy for disseminated breast cancer is based on the general assumption that the greatest patient benefit is achieved by killing the maximum number of tumor cells. While this strategy often achieves a significant reduction in tumor burden, most patients with metastatic breast cancer ultimately die from their disease as therapy fails because tumor cells evolve resistance. We propose that the conventional maximum dose/maximum cell kill cancer therapy, when viewed from an evolutionary vantage, is suboptimal and likely even harmful as it accelerates evolution and growth of the resistant phenotypes that ultimately cause patient death. As an alternative, we are investigating evolutionary therapeutic strategies that shift the treatment goal from killing the maximum number of cancer cells to maximizing patient survival. Here we introduce two novel approaches for systemic therapy for metastatic breast cancer, considering the evolutionary nature of tumor progression; adaptive therapy and double-bind therapy.
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Affiliation(s)
- Yoonseok Kam
- Department of Cancer Imaging & Metabolism, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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11
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Soliman HH, Jackson E, Neuger T, Dees EC, Harvey RD, Han H, Ismail-Khan R, Minton S, Vahanian NN, Link C, Sullivan DM, Antonia S. A first in man phase I trial of the oral immunomodulator, indoximod, combined with docetaxel in patients with metastatic solid tumors. Oncotarget 2015; 5:8136-46. [PMID: 25327557 PMCID: PMC4226672 DOI: 10.18632/oncotarget.2357] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Indoleamine 2,3-dioxygenase (IDO) is an enzyme that tumors use to create a state of immunosuppression. Indoximod is an IDO pathway inhibitor. Preclinical studies demonstrated that indoximod combined with chemotherapy was synergistic in a mouse model of breast cancer. A phase I 3+3 trial was designed to study the combination of docetaxel and indoximod. METHODS Docetaxel was administered at 60 mg/m2 intravenously every 3 weeks dose levels 1-4 and 75 mg/m2 for dose level 5. Indoximod was given at 300, 600, 1000, 2000, and 1200 mg PO twice daily continuously for levels 1-5, respectively. Serum drug levels were measured. RESULTS Twenty-seven patients were treated, with 22 evaluable for response. DLTs included grade 3 dehydration (level 1), hypotension(level 4), mucositis (level 4) and grade 5 enterocolitis (level 2). Dose level 5 is the recommended phase II dose. The most frequent adverse events were fatigue (58.6%), anemia (51.7%), hyperglycemia (48.3%), infection (44.8%), and nausea (41.4%). There were 4 partial responses (2 breast, 1 NSCLC, 1 thymic tumor). No drug-drug interactions were noted. CONCLUSIONS Docetaxel plus indoximod was well tolerated with no increase in expected toxicities or pharmacokinetic interactions. It was active in a pretreated population of patients with metastatic solid tumors.
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Affiliation(s)
- Hatem H Soliman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Tony Neuger
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - E Claire Dees
- University of North Carolina/Lineberger Cancer Center, Chapel Hill, NC
| | | | - Hyo Han
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Susan Minton
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Scott Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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12
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Jacobsen PB, Muchnick S, Marcus S, Amheiser P, Reiersen P, Gonzalez B, Gomez M, Jim HSL, Thompson LMA, Minton S, Bower J. Pilot study of Iyengar yoga for management of aromatase inhibitor-associated arthralgia in women with breast cancer. Psychooncology 2015; 24:1578-80. [PMID: 25631519 DOI: 10.1002/pon.3756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 12/03/2014] [Accepted: 12/18/2014] [Indexed: 11/08/2022]
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13
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Zheng XQ, Guo JP, Yang H, Kanai M, He LL, Li YY, Koomen JM, Minton S, Gao M, Ren XB, Coppola D, Cheng JQ. Aurora-A is a determinant of tamoxifen sensitivity through phosphorylation of ERα in breast cancer. Oncogene 2014; 33:4985-96. [PMID: 24166501 PMCID: PMC4002670 DOI: 10.1038/onc.2013.444] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/20/2013] [Accepted: 09/09/2013] [Indexed: 12/14/2022]
Abstract
Despite the clinical success of tamoxifen, its resistance remains a major challenge in breast cancer. Here we show that Aurora-A determines tamoxifen sensitivity by regulation of oestrogen receptor (ER)α. Ectopic expression of Aurora-A decreases and depletion of Aurora-A enhances tamoxifen sensitivity in ERα-positive breast cancer. Elevated Aurora-A was significantly associated with the recurrence of ERα-positive tumours. Notably, Aurora-A inhibitor MLN8237, which is currently in clinical trial, synergizes with tamoxifen and overcomes tamoxifen resistance. Furthermore, Aurora-A interacts with and phosphorylates ERα on serine-167 and -305, leading to increase in ERα DNA-binding and transcriptional activity. Elevated levels of Aurora-A are significantly associated with disease-free survival in ERα-positive but not ERα-negative breast cancers. These data suggest that Aurora-A has a pivotal role in tamoxifen resistance and ERα is a bona fide substrate of Aurora-A. Thus, Aurora-A represents a prognostic marker in ERα-positive tumour and a critical therapeutic target in tamoxifen-resistant breast cancer, and Aurora-A inhibitor could be used as either an independent or concurrent agent in tamoxifen-resistant tumour.
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Affiliation(s)
- XQ Zheng
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
- Department of Thyroid and Neck Tumour, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, P. R. China, 300060
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, P. R. China, 300060
| | - JP Guo
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - H Yang
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - M Kanai
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - LL He
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - YY Li
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - JM. Koomen
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - S. Minton
- Department of Women’s Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - M Gao
- Department of Thyroid and Neck Tumour, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, P. R. China, 300060
| | - XB Ren
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of cancer prevention and therapy, National Clinical Research Center of Cancer, Tianjin, P. R. China, 300060
| | - D Coppola
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - JQ Cheng
- Departments of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
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14
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Kam Y, Das T, Tian H, Foroutan P, Ruiz E, Martinez G, Minton S, Gillies RJ, Gatenby RA. Sweat but no gain: inhibiting proliferation of multidrug resistant cancer cells with "ersatzdroges". Int J Cancer 2014; 136:E188-96. [PMID: 25156304 DOI: 10.1002/ijc.29158] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 03/17/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 02/03/2023]
Abstract
ATP-binding cassette (ABC) drug transporters consuming ATPs for drug efflux is a common mechanism by which clinical cancers develop multidrug resistance (MDR). We hypothesized that MDR phenotypes could be suppressed by administration of "ersatzdroges," nonchemotherapy drugs that are, nevertheless, ABC substrates. We reasoned that, through prolonged activation of the ABC pumps, ersatzdroges will force MDR cells to divert limited resources from proliferation and invasion thus delaying disease progression. We evaluated ABC substrates as ersatzdroge by comparing their effects on proliferation and survival of MDR cell lines (MCF-7/Dox and 8226/Dox40) with the effects on the drug-sensitive parental lines (MCF-7 and 8226/s, respectively) in glucose-limited condition. The changes in glucose and energy demands were also examined in vitro and in vivo. MCF-7/Dox showed higher ATP demand and susceptibility to glucose resource limitation. Ersatzdroges significantly decreased proliferation of MCF-7/Dox when the culture media contained physiological glucose concentrations (1.0 g/L) or less, but had no effect on MCF-7. Similar evidence was obtained from 8226/Dox40 and 8226/s comparison. In vivo 18F-FDG-PET imaging demonstrated that glucose uptake was increased by systemic administration of an ersatzdroge in tumors composed of MDR. These results suggest that administration of ersatzdroges, by increasing the metabolic cost of resistance, can suppress proliferation of drug-resistance phenotypes. This provides a novel and relatively simple application model of evolution-based strategy, which can exploit the cost of resistance to delay proliferation of drug-resistant cancer phenotypes. Furthermore, suggested is the potential of ersatzdroges to identify tumors or regions of tumors that express the MDR phenotype.
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Affiliation(s)
- Yoonseok Kam
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Molife LR, Yan L, Vitfell-Rasmussen J, Zernhelt AM, Sullivan DM, Cassier PA, Chen E, Biondo A, Tetteh E, Siu LL, Patnaik A, Papadopoulos KP, de Bono JS, Tolcher AW, Minton S. Phase 1 trial of the oral AKT inhibitor MK-2206 plus carboplatin/paclitaxel, docetaxel, or erlotinib in patients with advanced solid tumors. J Hematol Oncol 2014; 7:1. [PMID: 24387695 PMCID: PMC3884022 DOI: 10.1186/1756-8722-7-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [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: 09/26/2013] [Accepted: 12/24/2013] [Indexed: 12/11/2022] Open
Abstract
Background Inhibition of AKT with MK-2206 has demonstrated synergism with anticancer agents. This phase 1 study assessed the MTD, DLTs, PK, and efficacy of MK-2206 in combination with cytotoxic and targeted therapies. Methods Advanced solid tumor patients received oral MK-2206 45 or 60 mg (QOD) with either carboplatin (AUC 6.0) and paclitaxel 200 mg/m2 (arm 1), docetaxel 75 mg/m2 (arm 2), or erlotinib 100 or 150 mg daily (arm 3); alternative schedules of MK-2206 135-200 mg QW or 90-250 mg Q3W were also tested. Results MTD of MK-2206 (N = 72) was 45 mg QOD or 200 mg Q3W (arm 1); MAD was 200 mg Q3W (arm 2) and 135 mg QW (arm 3). DLTs included skin rash (arms 1, 3), febrile neutropenia (QOD, arms 1, 2), tinnitus (Q3W, arm 2), and stomatitis (QOD, arm 3). Common drug-related toxicities included fatigue (68%), nausea (49%), and rash (47%). Two patients with squamous cell carcinoma of the head and neck (arm 1; Q3W) demonstrated a complete and partial response (PR); additional PRs were observed in patients (1 each) with melanoma, endometrial, neuroendocrine prostate, NSCLC, and cervical cancers. Six patients had stable disease ≥6 months. Conclusion MK-2206 plus carboplatin and paclitaxel, docetaxel, or erlotinib was well-tolerated, with early evidence of antitumor activity. Trial registration ClinicalTrials.gov: NCT00848718.
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Affiliation(s)
- L Rhoda Molife
- Drug Development Unit, The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
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16
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Phillips KM, McGinty HL, Gonzalez BD, Jim HSL, Small BJ, Minton S, Andrykowski MA, Jacobsen PB. Factors associated with breast cancer worry 3 years after completion of adjuvant treatment. Psychooncology 2012; 22:936-9. [PMID: 22419546 DOI: 10.1002/pon.3066] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/03/2012] [Accepted: 02/14/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables. RESULTS Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01). CONCLUSIONS The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease.
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Affiliation(s)
- Kristin M Phillips
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
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17
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Bardhan P, Bui MM, Minton S, Loftus L, Carter WB, Laronga C, Ismail-Khan R. HER2-positive male breast cancer with thyroid cancer: an institutional report and review of literature. Ann Clin Lab Sci 2012; 42:135-139. [PMID: 22585608] [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: 05/31/2023]
Abstract
We report a rare finding of two male breast cancer patients with HER2-positive breast cancer who also developed thyroid cancer. We reviewed 45 male breast cancer patients treated in our institution from 2003 to 2008. Only five male breast cancer patients were HER2-positive. In reviewing the published data, we found no cases of thyroid cancer and concurrent breast cancer in men. However, breast cancer and thyroid cancer have shown close association in women. This finding therefore provokes speculation as to whether we should investigate whether women with HER2-positive breast cancer are at a higher risk for thyroid cancer. Although this observation seems to be clinically prevalent, publications are sparse in clinical research areas linking thyroid cancer to breast cancer.
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Affiliation(s)
- Pooja Bardhan
- Department of Women’s Oncology, Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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18
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Haviland R, Eschrich S, Bloom G, Ma Y, Minton S, Jove R, Cress WD. Necdin, a negative growth regulator, is a novel STAT3 target gene down-regulated in human cancer. PLoS One 2011; 6:e24923. [PMID: 22046235 PMCID: PMC3203112 DOI: 10.1371/journal.pone.0024923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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] [Received: 08/21/2010] [Accepted: 08/24/2011] [Indexed: 12/30/2022] Open
Abstract
Cytokine and growth factor signaling pathways involving STAT3 are frequently constitutively activated in many human primary tumors, and are known for the transcriptional role they play in controlling cell growth and cell cycle progression. However, the extent of STAT3's reach on transcriptional control of the genome as a whole remains an important question. We predicted that this persistent STAT3 signaling affects a wide variety of cellular functions, many of which still remain to be characterized. We took a broad approach to identify novel STAT3 regulated genes by examining changes in the genome-wide gene expression profile by microarray, using cells expressing constitutively-activated STAT3. Using computational analysis, we were able to define the gene expression profiles of cells containing activated STAT3 and identify candidate target genes with a wide range of biological functions. Among these genes we identified Necdin, a negative growth regulator, as a novel STAT3 target gene, whose expression is down-regulated at the mRNA and protein levels when STAT3 is constitutively active. This repression is STAT3 dependent, since inhibition of STAT3 using siRNA restores Necdin expression. A STAT3 DNA-binding site was identified in the Necdin promoter and both EMSA and chromatin immunoprecipitation confirm binding of STAT3 to this region. Necdin expression has previously been shown to be down-regulated in a melanoma and a drug-resistant ovarian cancer cell line. Further analysis of Necdin expression demonstrated repression in a STAT3-dependent manner in human melanoma, prostate and breast cancer cell lines. These results suggest that STAT3 coordinates expression of genes involved in multiple metabolic and biosynthetic pathways, integrating signals that lead to global transcriptional changes and oncogenesis. STAT3 may exert its oncogenic effect by up-regulating transcription of genes involved in promoting growth and proliferation, but also by down-regulating expression of negative regulators of the same cellular processes, such as Necdin.
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Affiliation(s)
- Rachel Haviland
- Molecular Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Steven Eschrich
- Biomedical Informatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Gregory Bloom
- Biomedical Informatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Yihong Ma
- Molecular Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Susan Minton
- Breast Cancer Program, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Richard Jove
- Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
| | - W. Douglas Cress
- Molecular Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
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19
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Molife L, Minton S, Vitfell-Pedersen J, Chen E, Sullivan D, Yan L, Zernhelt A, Siu L, de Bono J, Tolcher A. 1202 ORAL A Phase I Study of the Potent AKT Inhibitor MK-2206 in Combination With Carboplatin and Paclitaxel, Docetaxel or Erlotinib in Patients With Advanced Solid Tumours. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70814-0] [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: 11/28/2022]
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Abstract
National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but similar guidelines on male breast cancers are less recognized. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer compared to established guidelines for female patients. After Institutional Review Board approval, a prospective breast database from 1990 to 2009 was queried for male patients. Medical records were examined for clinico-pathological factors and follow-up. The 5-year survival rates with 95% confidence intervals were estimated using Kaplan-Meier method and Greenwood formula. Of the 19,084 patients in the database, 73 (0.4%) were male patients; 62 had complete data. One patient had bilateral synchronous breast cancer. The median age was 68.8 years (range 29-85 years). The mean/median invasive tumor size was 2.2/1.6 cm (range 0.0-10.0 cm). All cases had mastectomy (29 with axillary node dissection, 23 with sentinel lymph node biopsy only, 11 with sentinel node biopsy followed by completion axillary dissection). Lymph node involvement occurred in 25/63 (39.7%). Based on NCCN guidelines, chemotherapy, hormonal therapy, and radiation are indicated in 34 cases, 62 cases, and 14 cases, respectively. Only 20/34 (59%) received chemotherapy, 51/62 (82%) received hormonal therapy, and 10/14 (71%) received post-mastectomy radiation. Median follow-up was 26.2 months (range: 1.6-230.9 months). The 5-year survival estimates for node positive and negative diseases were 68.5% and 87.5%, respectively (p = 0.3). Despite the rarity of male breast cancer, treatment options based on current female breast tumors produce comparable results to female breast cancer. Increased awareness and a national registry for patients could help improve outcomes and tailor treatment recommendations to the male variant.
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Affiliation(s)
- John V Kiluk
- Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida 33612, USA.
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21
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Faul LA, Jim HS, Minton S, Fishman M, Tanvetyanon T, Jacobsen PB. Relationship of exercise to quality of life in cancer patients beginning chemotherapy. J Pain Symptom Manage 2011; 41:859-69. [PMID: 21330097 PMCID: PMC3779914 DOI: 10.1016/j.jpainsymman.2010.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/16/2010] [Accepted: 07/29/2010] [Indexed: 01/06/2023]
Abstract
CONTEXT Cancer diagnosis and treatment, particularly chemotherapy, has well-established adverse effects on individuals. Exercise has been found to confer benefits to patients, although the current evidence base is limited primarily to patients assessed during or after treatment. Although exercise has been a target of intervention efforts, its relationship to quality of life in patients about to begin chemotherapy has not fully been examined. OBJECTIVES To examine the relationship of pre-treatment exercise rates to patient's quality of life. METHODS One hundred ninety-two adults diagnosed with Stages I-IV cancer and Eastern Cooperative Oncology Group performance status ≤ 2, provided data on exercise, distress (anxiety and depression), and health-related quality of life prior to their initial chemotherapy infusion. RESULTS As predicted, higher rates of exercise activity were associated with lower levels of anxiety and depression, and better overall mental and physical quality of life. These relationships were independent of demographic variables (i.e., body mass index and age) also associated with quality of life in the present analyses. CONCLUSION These findings further highlight the importance of assessing exercise before the start of chemotherapy as part of broader efforts to link patients to appropriate interventions aimed at enhancing quality of life. Findings also raise the possibility that assessing exercise rates could be useful in matching patients to the type of intervention most likely to benefit them. Future research should use prospective longitudinal designs to further explore this association.
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Affiliation(s)
- Leigh Anne Faul
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA.
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22
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Munster P, Lacevic M, Thomas S, Ismail-Khan R, Rugo H, Melisko M, Minton S. Clinical Phase II Study of Vorinostat, a Hydroxamic Type Histone Deacetylase Inhibitor, in Combination with Tamoxifen To Reverse Acquired Hormone Resistance in Breast Cancer Patients Who Progressed on Hormone Therapy. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-6100] [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
Background: Primary or acquired resistance to hormonal therapy remains a major clinical challenge in patients with breast cancer. The most commonly used approach to modulate estrogen receptor signaling includes the use of a selective estrogen receptor modulator or down-regulator, or an aromatase inhibitor. Recently, inhibition of histone deacetylases (HDAC) has emerged as a novel strategy to modulate the estrogen and progesterone receptors by a different mechanism. This study seeks to test whether the addition of an HDAC inhibitor to tamoxifen may reverse acquired hormone resistance.Methods: Patients with estrogen receptor (ER) positive metastatic breast cancer who progressed on prior hormonal therapy with one or two aromatase inhibitors, and up to three chemotherapy regimens for metastatic cancer were treated with 400 mg vorinostat daily for 21 of 28 days and 20 mg tamoxifen daily, continuously. Patients previously treated with tamoxifen in the adjuvant, but not in the metastatic setting, were eligible. Bone only disease was permissible if at least one lesion measured 1 cm by MRI.Results: The study enrolled 43 female patients with a median age of 56 years (range 34-71). To date 42 patients with ER-positive breast cancer completed at least 1 cycle of therapy with a median number of 4 (1-24) cycles and a median duration of response of 8 months. Prior hormonal therapy included at least one aromatase inhibitor in 41 (98%) patients and two aromatase inhibitors in 22 (52%) of the patients; 21 (50%) of the patients received at least one chemotherapy regimen for metastatic disease, and 22 (52%) patients had received adjuvant tamoxifen. Of the 34 patients evaluable for response to date, 7 (21%) had a confirmed partial response and one additional patient with bone only disease had a response by PET/CT, another 4 (12%) patients had stable disease for ≥ 6 months. Dose reductions from 400 mg to 300 mg vorinostat were required in 30% of patients and to 200 mg in 18%. Major grade 3/4 toxicities included fatigue (5 pts, 12%), anorexia/weight loss (2 pts, 5%), nausea/vomiting (2 pts, 5%), hypokalemia (1 pt, 2%), liver enzyme elevations (1 pt, 2%), lymphopenia (7 pts, 16%), thrombocytopenia (3 pts, 7%) and neutropenia (6 pts, 14%). Pulmonary emboli were observed in 2 (5%) patients. Common grade 2 toxicities were fatigue (14%), nausea/vomiting/diarrhea (21%), hyperglycemia (19%), anorexia (12%), and myelosuppression (19%). Histone H3 and H4 acetylation was seen at day 8 suggesting adequate vorinostat plasma levels in the majority of patients.Conclusions: These findings suggest that the addition of the HDAC inhibitor, vorinostat to tamoxifen in patients who have progressed on prior hormonal therapy and including prior adjuvant tamoxifen is tolerable and demonstrates efficacy.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6100.
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Affiliation(s)
- P. Munster
- 1University of California, San Francisco, CA,
| | - M. Lacevic
- 2Moffitt Cancer Center and Research Institute, FL,
| | - S. Thomas
- 1University of California, San Francisco, CA,
| | | | - H. Rugo
- 1University of California, San Francisco, CA,
| | - M. Melisko
- 1University of California, San Francisco, CA,
| | - S. Minton
- 2Moffitt Cancer Center and Research Institute, FL,
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Minton S, Gabrilovich D, Lacevic M, Laronga C, Lee M, Kiluk J, Khakpour N, Bui M, Soliman H, Ismail-khan R, Han H, Munster P, Janssen W, Cowan K, Talmadge J, Reed E. Neoadjuvant Intratumoral Injection of Dendritic Cells in Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4128] [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
Backround: Autologous intratumoral dendritic cell injections were used to modulate the tumor reduction effects of standard neoadjuvant chemotherapy. Dendritic cells are important in the regulation of T cell immunity and have been shown to have activity in cancer patients. The neoadjuavant combination therapy was designed to expose dendritic cells to tumor cell apoptosis leading to induction of tumor antigen-specific responses.Methods: Seventeen women with stage II or III breast cancer with breast tumors at least 3 cm in size and had a confirmed initial breast biopsy were entered into this trial from August 2007 through 2009. All patients participating in the clinical trial had tumors that expressed either carcinoembryonic antigen (CEA) or survivin and were HER2-neu negative. They received 4 cycles of paclitaxel at 175 mg/m2 followed by 4 cycles of doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 (AC) in a bi-weekly dose dense fashion. Pegfilgrastim 6 mg subcutaneous injection was administered 24 hours after each cycle of chemotherapy. Autologous intratumoral dendritic cell injections were administered one week following the first three paclitaxel treatments. All patients consented to a pre-treatment biopsy and a second tumor biopsy after 4 cycles of paclitaxel to evaluate responses to the intratumoral dendritic cell injections. The endpoints of this trial included assessment of clinical and pathologic response in the breast, safety of the intratumoral dendritic cell injection, evaluation of tumor response, and induction of T cell responses to tumor antigens.Results: Fourteen patients are evaluable for response. The median age was 51.5, the median tumor size was 5.6 cm, and 64 % were estrogen receptor positive. A complete clinical response was observed in 57%, a partial response in 36%, and one stable disease response. A pathologic complete response with no evidence of tumor in the breast was confirmed in 2 patients (14 %). Treatment was well tolerated with no incidence of toxicity observed related to the intratumoral dendritic cell injections. Grade 3/4 hematologic toxicity was as expected for the chemotherapy. Other grade 3/4 toxicity related to the chemotherapy included fatigue, hand-foot, infection, mucositis, and hypocalcemia.Discussion: Combination neoadjuvant therapy with dose-dense paclitaxel followed by AC and autologous intratumoral dendritic cell injections administered between the first three cycles of paclitaxel is safe with no toxicity observed related to the intratumoral dendritic cell injections. Immune response to the treatment is being evaluated by proliferation and interferon-gamma production by peripheral blood mononuclear cells in response to tumor cell lysates, survivin, and CEA. Initial evaluation indicates that treatment resulted in generation of tumor specific responses in more than half of all treated patients.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4128.
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Affiliation(s)
| | | | | | | | - M. Lee
- 1Moffitt Cancer Center, FL,
| | | | | | - M. Bui
- 1Moffitt Cancer Center, FL,
| | | | | | - H. Han
- 1Moffitt Cancer Center, FL,
| | | | | | - K. Cowan
- 2University of Nebraska Medical Center, NE,
| | | | - E. Reed
- 2University of Nebraska Medical Center, NE,
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24
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Munster PN, Marchion D, Thomas S, Egorin M, Minton S, Springett G, Lee JH, Simon G, Chiappori A, Sullivan D, Daud A. Phase I trial of vorinostat and doxorubicin in solid tumours: histone deacetylase 2 expression as a predictive marker. Br J Cancer 2009; 101:1044-50. [PMID: 19738609 PMCID: PMC2768109 DOI: 10.1038/sj.bjc.6605293] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Histone deacetylase inhibitors (HDACi) can sensitise cancer cells to topoisomerase inhibitors by increasing their access and binding to DNA. Methods: This phase I trial was designed to determine the toxicity profile, tolerability, and recommended phase II dose of escalating doses of the HDACi vorinostat, with weekly doxorubicin. Results: In total, 32 patients were treated; vorinostat was dosed at 400, 600, 800, or 1000 mg day−1 on days 1–3, followed by doxorubicin (20 mg m−2) on day 3 for 3 of 4 weeks. Maximal tolerated dose was determined to be 800 mg day−1 of vorinostat. Dose-limiting toxicities were grade 3 nausea/vomiting (two out of six) and fatigue (one out of six) at 1000 mg day−1. Non-dose-limiting grade 3/4 toxicities included haematological toxicity and venous thromboembolism. Antitumor activity in 24 evaluable patients included two partial responses (breast and prostate cancer). Two patients with melanoma had stable disease for ⩾8 months. Histone hyperacetylation changes in peripheral blood mononuclear and tumour cells were comparable. Histone hyperacetylation seemed to correlate with pre-treatment HDAC2 expression. Conclusion: These findings suggest that vorinostat can be combined with weekly doxorubicin in this schedule at a dose of 800 mg day−1. The HDAC2 expression may be a marker predictive of HDAC inhibition. Antitumor activity of this regimen in breast cancer, prostate cancer, and melanoma seems interesting.
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Affiliation(s)
- P N Munster
- Division of Hematology and Oncology, University of California, San Francisco, CA 94143, USA.
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Munster P, Marchion D, Bicaku E, Lacevic M, Kim J, Centeno B, Daud A, Neuger A, Minton S, Sullivan D. Clinical and biological effects of valproic acid as a histone deacetylase inhibitor on tumor and surrogate tissues: phase I/II trial of valproic acid and epirubicin/FEC. Clin Cancer Res 2009; 15:2488-96. [PMID: 19318486 DOI: 10.1158/1078-0432.ccr-08-1930] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim was to study the biological and molecular effects of the histone deacetylase (HDAC) inhibitor, valproic acid, in patients with solid tumor malignancies. EXPERIMENTAL DESIGN A phase I dose escalation of valproic acid given on days 1 to 3 followed by epirubicin (day 3) was followed by a dose expansion of valproic acid combined with 5-fluorouracil, epirubicin, and cyclophosphamide (FEC100). Pharmacodynamic and pharmacokinetic studies entailed valproic acid and epirubicin plasma levels and their interaction, the effects of valproic acid on histone acetylation in peripheral blood mononuclear cells (PBMC) and tumor cells at baseline and day 3, and baseline expression of HDAC2 and HDAC6 as therapeutic targets. RESULTS Forty-four patients were enrolled in the phase I part, with a disease-specific cohort expansion of 15 breast cancer patients (median age, 55 years; range, 28-66 years) receiving 120 mg/kg/day valproic acid followed by FEC100. Partial responses were seen in 9 of 41 (22%) patients during the phase I part. Objective responses were seen in 9 of 14 (64%) evaluable patients at the dose expansion with a median number of 6 administered cycles. Predominant toxicities were valproic acid-associated somnolence and epirubicin-induced myelosuppression. Valproic acid plasma levels were associated with short-term, reversible depletion of WBC and neutrophils within 48 hours. Histone acetylation in tumor samples and in PBMCs correlated with valproic acid levels and was further linked to baseline HDAC2 but not to HDAC6 expression. CONCLUSION Valproic acid is a clinically relevant HDAC inhibitor, and PBMCs may serve as a surrogate for tumor histone acetylation in solid tumor malignancies. HDAC2 should be further considered as a relevant therapeutic target.
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Affiliation(s)
- Pamela Munster
- Division of Hematology Oncology, University of California, San Francisco, Divisadero, San Francisco, California 94143-1711, USA.
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Laronga C, Lee MC, Park CK, Kiluk J, Meade T, Boulware D, Minton S, Harris E. Male breast cancer: follow-up recommendations after surgery. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4130] [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
Abstract #4130
Introduction: National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but data on male breast cancers are not collected. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer.
 Methods: After IRB approval, a prospective breast database from 1990-2008 was queried for male patients. Medical records were examined for traditional factors (TNM, receptor status, treatment, gynecomastia) and follow-up practices such as mammogram use. Survival analysis was performed using the Kaplan-Meier method with 95% confidence intervals (CI) generated for 5-yr estimates. The logrank test was used to compare node positive/negative cohorts.
 Results: Of the 19,132 patients in the database, 71 (0.4%) were male; 64 had complete data. The median age for the 64 patients was 68.8yrs (range 29-85yrs). 89.1% presented with a palpable mass. 12.5% had gynecomastia in the cancer breast and 9.4% had contralateral gynecomastia. 18/64 (28.1%) had a familial history of breast, ovarian or colon cancer. One patient had bilateral synchronous breast cancer. Seven (10.9%) had previous prostate cancer and 4 (6.25%) had other synchronous cancers (2 papillary thyroid, 2 lung). Genetic testing was offered to all 64; 3 accepted. Two men had contralateral prophylactic mastectomy years later. The mean/median invasive tumor size was 2.0/1.6cm (range 0.0-10.0cm) and all but 2 tumors were ductal. 63 had a mastectomy (65.1% with axillary node dissection; 34.9% with sentinel lymph node biopsy). Lymph node involvement occurred in 25/64 (39.1%). Under NCCN guidelines, 49/64 (76.6%) should receive chemotherapy and chest wall radiation should be given to 27/64 (42.2%) based on tumor size and nodal status. Chemotherapy was offered to 50.0%; 35.9% received chemotherapy. Chest wall radiation was given in 59.3%. 63/64 were ER positive; 49 (77.8%) received hormone therapy. Follow-up annual mammograms were obtained in 27/64 (42.2%)[all BIRADs 1 or 2], not obtained in 28/64 (43.8%), and unknown in 9/64 (14.0%). Median follow-up was 26.1mos (range: 0.26-377.8mos). The 5-yr survival estimates and 95% CI for node positive and negative diseases were 75% (95% CI=46-90%) and 93% (95% CI=74-98%) respectively. For comparison, 5-yr survival rates from the NSABP B-04 trial were 60% in node-positive and 75% in node-negative disease. Four patients (6.3%) died of disease; 10 (15.6%) are alive with distant disease; 47 (73.4%) have no evidence of disease; and 3 (4.7%) are unknown or dead of other causes. There were 2 local recurrences (3.1%) [1 chest wall, 1 in-breast] and no metachronous contralateral breast cancer development. Conclusions: Male breast cancer is uncommon, as is contralateral breast cancer. Men were less likely to receive/accept chemotherapy/hormone therapy/genetic testing/annual mammograms and more likely to receive radiation based on NCCN guidelines, but survival compared to historic females was no worse. Creation of follow-up guidelines for males may be different than females.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4130.
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Affiliation(s)
- C Laronga
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - MC Lee
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - CK Park
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - J Kiluk
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - T Meade
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - D Boulware
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - S Minton
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
| | - E Harris
- 1 Comprehensive Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
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Moulder S, Valkov N, Neuger A, Choi J, Lee JH, Minton S, Munster P, Gump J, Lacevic M, Lush R, Sullivan D. Phase 2 study of gemcitabine and irinotecan in metastatic breast cancer with correlatives to determine topoisomerase I localization as a predictor of response. Cancer 2008; 113:2646-54. [PMID: 18823053 DOI: 10.1002/cncr.23916] [Citation(s) in RCA: 13] [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: 11/05/2022]
Abstract
BACKGROUND Gemcitabine incorporation into DNA enhances cleavage complexes in vitro when combined with topoisomerase I inhibitors and demonstrates synergy in cancer cells when given with irinotecan. Topoisomerase I inhibitors require that topoisomerase I interacts with DNA to exert activity. METHODS Patients who had received previous anthracycline therapy or were not candidates for anthracycline therapy received gemcitabine at a dose of 1000 mg/m2 intravenously over 30 minutes followed by irinotecan at a dose of 100 mg/m2 over 90 minutes on Days 1 and 8 of a 21-day cycle. The primary endpoint was improvement in response from that historically observed with gemcitabine (from 25% to 45%) as measured by Response Evaluation Criteria in Solid Tumors. Correlative studies included characterization of cellular levels and nuclear distribution of topoisomerase I and pharmacokinetic analysis of gemcitabine and irinotecan. RESULTS Forty-nine patients were assessed for response. The response rate was approximately 25% (all partial responses [PRs], 12 patients; 95% confidence interval [95% CI], 13-39). Six patients had stable disease (SD) for > or =6 months for a clinical benefit rate (PR + SD) of 39%. The median time to disease progression was 3.7 months (95% CI, 2.5 months-4.6 months), and median survival was 11.6 months (95% CI, 8.9 months-15 months). Toxicities included neutropenia, nausea, and vomiting. Seven of 9 tissue biopsies were assessable for topoisomerase I. Tumors with the 2 lowest nuclear to cytoplasmic ratios demonstrated no response to irinotecan. CONCLUSIONS Gemcitabine and irinotecan are active in metastatic breast cancer, but response did not meet predetermined response parameters, and the null hypothesis was accepted. Topoisomerase I localization can be measured in metastatic breast cancer. Further validation is needed to determine whether this assay can predict response.
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Affiliation(s)
- Stacy Moulder
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Munster PN, Lacevic M, Schmitt M, Bicaku E, Marchion D, Stephens A, Sullivan L, Minton S. Phase II trial of vorinostat, a histone deacetylase inhibitor to restore the hormone sensitivity to the anti-estrogen tamoxifen in patients with advanced breast cancer having failed prior aromatase inhibitor therapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ismail-Khan R, Minton S, Cox C, Sims I, Lacevic M, Gross-King M, Xu P, Carter B, Munster PN. Preservation of ovarian function in young women treated with neoadjuvant chemotherapy for breast cancer: A randomized trial using the GnRH agonist (triptorelin) during chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.524] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Munster PN, Marchion DC, Schmitt M, Bicaku E, Lacevic M, Minton S, Carter W, Daud A. Phase I/II trial combining the HDAC inhibitor, valproic acid (VPA) and FEC100 (5-fluorouracil, epirubicin and cyclophosphamide) in locally advanced/metastatic breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1065 Background: Cell culture and xenograft studies suggest a synergistic interaction between histone deacetylase inhibitors (HDACi) and topoisomerase (topo) inhibitors, as well as other DNA targeting agents. Methods: In this phase I/II study, we determined the effects of escalating doses of VPA on the clinical efficacy and tolerability of epirubicin. The phase I part was open to patients will all solid tumors. A limited phase II part at the maximum tolerated dose (MTD) of VPA enrolled 10 breast cancer patients and incorporated the breast cancer regimen FEC100 (5-fluorouracil, epirubicin, cyclophosphamide (600/100/600 mg/m2)). VPA was given on days 1–3 prior to epirubicin/FEC100 in 3-week cycles. HDAC expression, histone acetylation and topo II expression were evaluated in pre-and post-VPA peripheral blood mononuclear cells and tumor samples. Results: Fifty-four (44 in phase I and 10 in phase II) patients [median age 55 (39–78)] received VPA (mg/kg/day): 15, 30, 45, 60, 75, 90, 100, 120, 140 and 160. Tumor types included: breast (10+10), melanoma (11), lung (6), sarcoma (2), GYN (2), GI (5) and others (8). Dose-limiting toxicities included somnolence, confusion and febrile neutropenia. No exacerbation of FEC100/epirubicin-related toxicities was observed. Objective responses in the phase I part 9/41 (22%) were seen across different tumor types despite a median number of 3 (0–6) prior regimens with stable disease/minor response in 16/41 (39%). In the breast-specific phase II part, partial responses to date were seen in 4/8 (50%) and stable disease in 2/8 (25%), progression in 1/8 (12.5%), 1/8 (12.5%) patients withdrew consent. All breast cancer patients with a response/stable disease received the maximal number of seven cycles. VPA plasma concentrations correlated with VPA dose. There was a positive correlation between histone acetylation and VPA dose as well as plasma levels in PBMC and further correlated with those in tumors. Conclusion: A sequence-specific combination of VPA and FEC100 in breast cancer is highly active without exacerbation of chemotherapy-induced toxicities. A neoadjuvant phase II trial using VPA (120 mg/kg) -> FEC100 in patients with early stage breast cancer is ongoing. [Table: see text]
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Affiliation(s)
| | | | - M. Schmitt
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - E. Bicaku
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - M. Lacevic
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - S. Minton
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - W. Carter
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - A. Daud
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
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Daud A, Schmitt M, Marchion D, Bicaku E, Minton S, Egorin M, Zwiebel J, Chiappori A, Sullivan D, Munster P. Phase I trial of a sequence-specific combination of the HDAC inhibitor, vorinostat (SAHA) followed by doxorubicin in advanced solid tumor malignancies. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3502 Background: Preclinical cell culture and xenograft studies suggest that pre-exposure of cancer cells to a histone deacetylase inhibitor (HDACi) may potentiate topoisomerase (topo) inhibitors. The HDACi-induced histone acetylation and chromatin modulation facilitates DNA access and target recruitment for topo II inhibitors. Methods: This Phase I trial explores the safety, tolerability and maximum tolerated dose (MTD) of a weekly schedule of escalating vorinostat doses (twice daily days 1–3) followed by doxorubicin (20 mg/m2) on day 3 (3 out of 4 weeks). Histone acetylation and topo II expression are evaluated in pre-and post-vorinostat peripheral blood mononuclear cells and in tumor cells of the 30 patients treated at the MTD. Results: To date, 15 patients [median age 54 (38–73)] have been treated in 4 vorinostat cohorts: 200, 300, 400, 500 mg bid. Tumor types included: breast (3), melanoma (3), pancreatic (2) and one each of SCLC, sarcoma, endometrial, colon, prostate, renal cell and bladder cancer. Dose-limiting toxicities included a grade 3 thrombocytopenia (1/6) at the 400 mg bid dose. Non-dose limiting Grade 3 and 4 toxicities include neutropenia, thrombocytopenia, fatigue, pulmonary embolus, and anemia (1 pt each). Currently, vorinostat doses of 500 mg bid are being evaluated. One confirmed partial response in a breast cancer patient, as well as minor responses in a melanoma and a prostate cancer patient were seen in 10 evaluable patients. Patients received a median number of 2 (1–9+) treatment cycles. Doxorubicin is stopped after 6 cycles and patients continue on vorinostat alone. H3 and H4 histone acetylation and topo II expression will be correlated with vorinostat dose, plasma concentration and response. Conclusion: A sequence-specific combination of vorinostat and doxorubicin is active without exacerbation of doxorubicin toxicity. The tolerated vorinostat dose exceeds the proposed single agent dose for vorinostat derived from patients with hematological malignancies. Histone hyperacetylation occurs in peripheral blood mononuclear cells at all levels. The anti-tumor activity in breast cancer and melanoma will be further explored. No significant financial relationships to disclose.
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Affiliation(s)
- A. Daud
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - M. Schmitt
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - D. Marchion
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - E. Bicaku
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - S. Minton
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - M. Egorin
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - J. Zwiebel
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - A. Chiappori
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - D. Sullivan
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - P. Munster
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
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Münster P, Marchion D, Bicaku E, Schmitt M, Lee JH, DeConti R, Simon G, Fishman M, Minton S, Garrett C, Chiappori A, Lush R, Sullivan D, Daud A. Phase I trial of histone deacetylase inhibition by valproic acid followed by the topoisomerase II inhibitor epirubicin in advanced solid tumors: a clinical and translational study. J Clin Oncol 2007; 25:1979-85. [PMID: 17513804 DOI: 10.1200/jco.2006.08.6165] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To determine the safety, toxicity, and maximum-tolerated dose of a sequence-specific combination of the histone deacetylase inhibitor (HDACi), valproic acid (VPA), and epirubicin in solid tumor malignancies and to define the clinical feasibility of VPA as an HDACi. PATIENTS AND METHODS Patients were treated with increasing doses of VPA (days 1 through 3) followed by epirubicin (day 3) in 3-week cycles. The study evaluated pharmacokinetic and pharmacodynamic end points, toxicities, and tumor response. RESULTS Forty-eight patients were enrolled, and 44 received at least one cycle of therapy. Patients (median age, 54 years; range, 39 to 78 years) received the following doses of VPA: 15, 30, 45, 60, 75, 90, 100, 120, 140, and 160 mg/kg/d. Dose-limiting toxicities were somnolence (n = 1), confusion (n = 3), and febrile neutropenia (n = 1). No exacerbation of epirubicin-related toxicities was observed. Partial responses were seen across different tumor types in nine patients (22%), and stable disease/minor responses were seen in 16 patients (39%), despite a median number of three prior regimens (range, zero to 10 prior regimens). Patients received a median number of four treatment cycles (range, one to 10 cycles), and treatment was stopped after reaching maximal epirubicin doses rather than progression in 13 (32%) of 41 patients patients. Total and free VPA plasma concentrations increased linearly with dose and correlated with histone acetylation in peripheral-blood mononuclear cells. CONCLUSION The maximum-tolerated dose and recommended phase II dose was VPA 140 mg/kg/d for 48 hours followed by epirubicin 100 mg/m2. Sustained plasma concentrations of VPA exceeding those required for in vitro synergy were achieved with acceptable toxicity. Noteworthy antitumor activity was observed in heavily pretreated patients and historically anthracycline-resistant tumors.
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Affiliation(s)
- Pamela Münster
- Experimental Therapeutics, Breast Medical Oncology Program, Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
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Abstract
Active learners alleviate the burden of labeling large amounts of data by detecting and asking the user to label only the most informative examples in the domain. We focus here on active learning for multi-view domains, in which there are several disjoint subsets of features (views), each of which is sufficient to learn the target concept. In this paper we make several contributions. First, we introduce Co-Testing, which is the first approach to multi-view active learning. Second, we extend the multi-view learning framework by also exploiting weak views, which are adequate only for learning a concept that is more general/specific than the target concept. Finally, we empirically show that Co-Testing outperforms existing active learners on a variety of real world domains such as wrapper induction, Web page classification, advertisement removal, and discourse tree parsing.
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Moulder SL, Valkov N, Minton S, Munster P, Gump J, Lacevic M, Rocha-Lima C, Horton J, Lush R, Sullivan D. A single arm phase II trial of gemcitabine (G) and irinotecan (I) in metastatic breast cancer: Can localization of topoisomerase I (topo I) predict response to topo I inhibitors? J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
661 Background: The incorporation of G into DNA enhances cleavage complexes in vitro when combined with a topo I inhibitor. Topo I poisons require enzyme interaction with DNA to exert activity. Methods: Two stage accrual design, primary endpoint: response (RR) using RECIST criteria. Inclusion criteria: male and female patients (pts) with MBC, prior anthracycline therapy, measurable disease, ECOG PS of ≤ 2, adequate organ function, and ≤ 3 prior chemotherapy regimens for MBC. 51 eligible pts received therapy with G at 1000mg/m2 and I at 100mg/m2 on days 1 and 8 of a 21-day cycle. Optional tumor biopsies were obtained in 9 pts (18%) prior to therapy to determine localization of topo I using immunofluorescence. PK: Irinotecan: A validated limited sampling strategy was used. Gemcitabine: Serial blood samples were collected over 24 hrs following the first dose. Intracellular nucleotides were quantitated in PBMCs. Results: 45 pts have been evaluated with a RR of 27% (CR=0, PR=12; 95% CI 13–37%). 4 pts had SD for ≥6 months for a clinical benefit rate (PR+SD) of 36%. 3 pts received < 1 cycle of therapy before protocol withdrawal and were not evaluable for RR. RR for the final 3 patients will be available at the time of presentation. 7/9 tissue biopsies were assessable for topo I with results listed below. PK and toxicity data will be available at presentation.Conclusion: GI is active in MBC. Topo I localization can be measured in MBC. In this limited data set, the two lowest nuclear to cytoplasmic (N/C) ratios were associated with lack of response to irinotecan. Further validation is needed. [Table: see text] [Table: see text]
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Affiliation(s)
- S. L. Moulder
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - N. Valkov
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - S. Minton
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - P. Munster
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - J. Gump
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - M. Lacevic
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - C. Rocha-Lima
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - J. Horton
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - R. Lush
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - D. Sullivan
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
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Cox CE, Cox JM, White LB, Stowell NG, Clark JD, Allred N, Meyers M, Dupont E, Furman B, Minton S. Sentinel Node Biopsy Before Neoadjuvant Chemotherapy for Determining Axillary Status and Treatment Prognosis in Locally Advanced Breast Cancer. Ann Surg Oncol 2006; 13:483-90. [PMID: 16523361 DOI: 10.1245/aso.2006.03.592] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 10/19/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment of locally advanced breast cancer with neoadjuvant chemotherapy assesses an in vivo tumor response while increasing breast conservation. Axillary clearance of nodal disease after treatment defines prognostic stratification. Our study objective was to show that sentinel node staging before treatment can optimize posttreatment prognostic stratification in clinically N0 patients. METHODS Eighty-nine patients with locally advanced breast cancer were treated with neoadjuvant chemotherapy. Of these, 42 (47%) clinically palpable or image-detected nodes (cN+) were histologically confirmed before treatment (group 1), and 47 (53%) patients without palpable lymph nodes (cN0) had a sentinel lymph node (SLN) biopsy before treatment (group 2). Survival analysis was conducted with the Kaplan-Meier method. RESULTS In groups 1 and 2, 82 (92%) of 89 patients had node-positive disease before treatment. Seven (8%) of 89 had negative SLNs and no completion axillary lymph node dissection, 24 (27%) patients had a complete pathologic axillary response (pCRAX; 11 [26%] of 42 in group 1 and 13 [33%] of 40 in group 2), and 58 (65%) of 89 had residual disease in the axilla. Breast-conserving therapy was applied to 27 (30%) of 89 patients. The seven SLN-negative patients had no axillary recurrence at 25 months, and pCRAX patients had a significantly higher overall survival than patients with residual disease. CONCLUSIONS This study validates the prognostic stratification of patients with a complete pathologic axillary response to neoadjuvant chemotherapy. The addition of SLN biopsy to cN0 patients before treatment increased accurate nodal staging by 53%, eliminated completion axillary lymph node dissection in 15%, and demonstrated an improved prognosis in 28% of pCRAX patients. SLN biopsy before treatment provides accurate staging of cN0 patients; allows acquisition of standard treatment markers, prognostic biomarkers, and microarray analysis; and affords prognostic stratification after treatment.
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Affiliation(s)
- Charles E Cox
- Department of Surgery, Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 Magnolia Drive, Tampa, Florida 33612, USA.
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Gritsko T, Williams A, Turkson J, Kaneko S, Bowman T, Huang M, Nam S, Eweis I, Diaz N, Sullivan D, Yoder S, Enkemann S, Eschrich S, Lee JH, Beam CA, Cheng J, Minton S, Muro-Cacho CA, Jove R. Persistent activation of stat3 signaling induces survivin gene expression and confers resistance to apoptosis in human breast cancer cells. Clin Cancer Res 2006; 12:11-9. [PMID: 16397018 DOI: 10.1158/1078-0432.ccr-04-1752] [Citation(s) in RCA: 415] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Signal transducer and activator of transcription 3 (Stat3) protein is persistently activated in breast cancer and promotes tumor cell survival. To gain a better understanding of the role of constitutive Stat3 signaling in breast cancer progression, we evaluated the expression profile of potential Stat3-regulated genes that may confer resistance to apoptosis. EXPERIMENTAL DESIGN Stat3 signaling was blocked with antisense oligonucleotides in human MDA-MB-435s breast cancer cells and Affymetrix GeneChip microarray analysis was done. The candidate Stat3 target gene Survivin was further evaluated in molecular assays using cultured breast cancer cells and immunohistochemistry of breast tumor specimens. RESULTS Survivin, a member of the inhibitor of apoptosis protein family, was identified as a potential Stat3-regulated gene by microarray analysis. This was confirmed in Survivin gene promoter studies and chromatin immunoprecipitation assays showing that Stat3 directly binds to and regulates the Survivin promoter. Furthermore, direct inhibition of Stat3 signaling blocked the expression of Survivin protein and induced apoptosis in breast cancer cells. Direct inhibition of Survivin expression also induced apoptosis. Increased Survivin protein expression correlates significantly (P = 0.001) with elevated Stat3 activity in primary breast tumor specimens from high-risk patients who were resistant to chemotherapy treatment. CONCLUSIONS We identify Survivin as a direct downstream target gene of Stat3 in human breast cancer cells that is critical for their survival in culture. Our findings suggest that activated Stat3 signaling contributes to breast cancer progression and resistance to chemotherapy by, at least in part, inducing expression of the antiapoptotic protein, Survivin.
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Affiliation(s)
- Tanya Gritsko
- Molecular Oncology, H. Lee Moffitt Cancer Center and Research Institute Department of Interdisciplinary Oncology, University of South Florida College of Medicine, Tampa, Florida, USA
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Diaz N, Minton S, Cox C, Bowman T, Gritsko T, Garcia R, Eweis I, Wloch M, Livingston S, Seijo E, Cantor A, Lee JH, Beam CA, Sullivan D, Jove R, Muro-Cacho CA. Activation of stat3 in primary tumors from high-risk breast cancer patients is associated with elevated levels of activated SRC and survivin expression. Clin Cancer Res 2006; 12:20-8. [PMID: 16397019 DOI: 10.1158/1078-0432.ccr-04-1749] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Constitutive activation of signal transducer and activator of transcription 3 (Stat3) protein has been observed in a wide variety of tumors, including breast cancer, and contributes to oncogenesis at least in part by prevention of apoptosis. In a study of 45 patients with high-risk breast cancer enrolled in a phase II neoadjuvant chemotherapy trial with docetaxel and doxorubicin, we evaluated the levels of Stat3 activation and potentially associated molecular biomarkers in invasive breast carcinoma compared with matched nonneoplastic tissues. EXPERIMENTAL DESIGN Using immunohistochemistry and image analysis, we quantified the levels of phospho-Stat3 (pY-Stat3), phospho-Src (pY-Src), epidermal growth factor receptor, HER2/neu, Ki-67, estrogen receptor, Bcl-2, Bcl-xL, Survivin, and apoptosis in formalin-fixed, paraffin-embedded sections from invasive carcinomas and their paired nonneoplastic parenchyma. The levels of molecular biomarkers in nonneoplastic and tumor tissues were analyzed as continuous variables for statistically significant correlations. RESULTS Levels of activated pY-Stat3 and pY-Src measured by immunohistochemistry were significantly higher in invasive carcinoma than in nonneoplastic tissue (P < 0.001). In tumors, elevated levels of pY-Stat3 correlated with those of pY-Src and Survivin. Levels of pY-Stat3 were higher in partial pathologic responders than in complete pathologic responders. In partial pathologic responders, pY-Stat3 levels correlated with Survivin expression. CONCLUSIONS Our findings suggest important roles for elevated activities of Stat3 and Src, as well as Survivin expression, in malignant progression of breast cancer. Furthermore, elevated Stat3 activity correlates inversely with complete pathologic response. These findings suggest that specific Stat3 or Src inhibitors could offer clinical benefits to patients with breast cancer.
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Affiliation(s)
- Nills Diaz
- Pathology, H. Lee Moffitt Cancer Center and Research Institute, Department of Interdisciplinary Oncology, University of South Florida College of Medicine, Tampa, Florida, USA
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Moulder SL, Munster P, Minton S, Diaz N, Horton J, Rocha Lima C, Hutson L, Sullivan D. Results of a planned efficacy and safety analysis for a National Comprehensive Cancer Network sponsored phase II study of gemcitabine and irinotecan (GI) in metastatic breast cancer (MBC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. L. Moulder
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - P. Munster
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - S. Minton
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - N. Diaz
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - J. Horton
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - C. Rocha Lima
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - L. Hutson
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
| | - D. Sullivan
- H. Lee Moffitt Cancer Ctr & Research Inst, Tampa, FL; Univ of Miami and Sylvester Cancer Ctr, Miami, FL
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Munster P, Tolcher A, Britten C, Gelmon K, Moulder S, Minton S, Mita M, Noe D, Pierce K, Letrent S. 334 First-in-human study of the safety, tolerability, pharmacokinetics, and pharmacodynamics of oral cp-724, 714, a selective, small molecule inhibitor of her2 in patients with advanced cancer. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80341-0] [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: 11/30/2022] Open
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Munster PN, Mita M, Britten C, Minton S, Moulder S, Noe D, Roedig B, Denis L, Slamon D, Tolcher A. Phase I and pharmacokinetic (PK) Study of CP-724,714, an oral human epidermal growth factor receptor-2 (HER-2) selective tyrosine kinase inhibitor. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3082] [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)
- P. N. Munster
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - M. Mita
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - C. Britten
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - S. Minton
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - S. Moulder
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - D. Noe
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - B. Roedig
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - L. Denis
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - D. Slamon
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
| | - A. Tolcher
- H. Lee Moffitt Cancer Center, Tampa, FL; Cancer Therapy and Research Center, San Antonio, TX; University of California, Los Angeles, Los Angeles, CA; Pfizer, Inc, New York, NY
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Weitzner MA, Moncello J, Jacobsen PB, Minton S. A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. J Pain Symptom Manage 2002; 23:337-45. [PMID: 11997203 DOI: 10.1016/s0885-3924(02)00379-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abrupt onset of hot flashes poses a significant problem for women treated with chemotherapy for breast cancer. Alternatives to hormone replacement, such as the use of the selective serotonin re-uptake inhibitor (SSRI) paroxetine hydrochloride, are being explored as therapies for hot flashes in this patient population. The present study investigated the efficacy of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. This study included 13 patients who were seen in the Psychosocial Clinic at Moffitt Cancer Center. They were referred by their medical oncologist after reporting complaints of significant difficulty with hot flashes. Baseline questionnaires were completed and a structured diagnostic interview for clinical depression was conducted, all of which were repeated 5 weeks after the paroxetine 20 mg daily was started. Significant improvements were seen in the ratings of hot flash severity (P = 0.002). In addition, significant improvements were observed in general, emotional, and mental fatigue. Rates of clinically significant depressive symptomatology also decreased and sleep quality improved significantly as well. Finally, the incidence of clinical depression improved from 39% at baseline to 8% after treatment. These preliminary data suggest that the antidepressant paroxetine can be helpful in the treatment of hot flashes and associated fatigue, sleep disturbance, and depression in women with breast cancer treated with chemotherapy. Further controlled studies are needed to more fully evaluate the efficacy of the SSRIs for hot flashes in women with breast cancer.
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Affiliation(s)
- Michael A Weitzner
- Psychosocial and Palliative Care Program, H. Lee Moffitt Cancer Center, Tampa, FL 33612-9497, USA
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Garcia R, Bowman TL, Niu G, Yu H, Minton S, Muro-Cacho CA, Cox CE, Falcone R, Fairclough R, Parsons S, Laudano A, Gazit A, Levitzki A, Kraker A, Jove R. Constitutive activation of Stat3 by the Src and JAK tyrosine kinases participates in growth regulation of human breast carcinoma cells. Oncogene 2001; 20:2499-513. [PMID: 11420660 DOI: 10.1038/sj.onc.1204349] [Citation(s) in RCA: 573] [Impact Index Per Article: 24.9] [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: 10/31/2000] [Revised: 02/01/2001] [Accepted: 02/05/2001] [Indexed: 01/13/2023]
Abstract
Constitutive activation of signal transducer and activator of transcription (STAT) proteins has been detected in a wide variety of human primary tumor specimens and tumor cell lines including blood malignancies, head and neck cancer, and breast cancer. We have previously demonstrated a high frequency of Stat3 DNA-binding activity that is constitutively-induced by an unknown mechanism in human breast cancer cell lines possessing elevated EGF receptor (EGF-R) and c-Src kinase activities. Using tyrosine kinase selective inhibitors, we show here that Src and JAK family tyrosine kinases cooperate to mediate constitutive Stat3 activation in the absence of EGF stimulation in model human breast cancer cell lines. Inhibition of Src or JAKs results in dose-dependent suppression of Stat3 DNA-binding activity, which is accompanied by growth inhibition and induction of programmed cell death. In addition, transfection of a dominant-negative form of Stat3 leads to growth inhibition involving apoptosis of breast cancer cells. These results indicate that the biological effects of the Src and JAK tyrosine kinase inhibitors are at least partially mediated by blocking Stat3 signaling. While EGF-R kinase activity is not required for constitutive Stat3 activation in breast cancer cells, EGF stimulation further increases STAT DNA-binding activity, consistent with an important role for EGF-R in STAT signaling and malignant progression. Analysis of primary breast tumor specimens from patients with advanced disease revealed that the majority exhibit elevated STAT DNA-binding activity compared to adjacent non-tumor tissues. Our findings, taken together, suggest that tyrosine kinases transduce signals through Stat3 protein that contribute to the growth and survival of human breast cancer cells in culture and potentially in vivo.
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Affiliation(s)
- R Garcia
- Molecular Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Florida, FL 33612 USA
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Sinibaldi D, Garcia R, Bloom G, Mane S, Geiser P, Minton S, Muro-Cacho C, Lazaridis E, Jove R. Defining a molecular fingerprint of STAT3-regulated genes associated with oncogenesis using microarray technology and novel statistical methods. Nat Genet 2001. [DOI: 10.1038/87296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lyman GH, Kuderer NM, Lyman SL, Debus M, Minton S, Balducci L, Horton J, Reintgen D, Cox C. Menopausal Status and the Impact of Early Recurrence on Breast Cancer Survival. Cancer Control 1997; 4:335-341. [PMID: 10763039 DOI: 10.1177/107327489700400405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND: Breast cancer represents the leading form of invasive cancer among American women, killing nearly 50,000 annually. Several prognostic factors that are associated with survival include age, race, menopausal status, and the stage of disease at presentation. METHODS: Patient characteristics were collected based on a systematic chart audit of demographic features and medical, family, and social histories. We studied the survival of 220 patients with recurrent disease out of 1,429 consecutive patients with breast cancer seen over a 15-year period. RESULTS: Patients with a disease-free interval following diagnosis of less than 24 months were more frequently premenopausal and hormone receptor-negative than those with a disease-free interval of 24 months or greater. Patients with early recurrence had a shorter survival than patients with late recurrence. Menopausal status, nodal involvement, receptor status, and the site of recurrent disease were independent predictors of survival following recurrence. CONCLUSIONS: Premenopausal women with early recurrence of breast cancer experience a significantly shorter survival than those with late recurrence, even after adjustment for hormone receptor status and site of recurrence. This effect was not seen in postmenopausal women.
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Affiliation(s)
- GH Lyman
- Department of Internal Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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Lassen AA, Fosbinder DM, Minton S, Robins MM. Nurse/physician collaborative practice: improving health care quality while decreasing cost. Nurs Econ 1997; 15:87-91, 104. [PMID: 9146258] [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: 02/04/2023]
Abstract
Significant variations and inconsistency in both the physician's and nurse's approach to the treatment of neonates with a "rule-out sepsis" (R/O sepsis) diagnosis is seen as both high cost and low quality. Because R/O sepsis is seen as a diagnostic dilemma for practicing clinicians, there has been a widespread tendency to readily initiate antibiotic treatment, without adequate consideration of the high financial and morbidity costs associated with the complications of treating the noninfected infant. This study demonstrates that the use of an agreed upon risk profile facilitated the collaborative standardization of diagnosis and treatment of the R/O sepsis patient, improved quality, and reduced costs (by minimizing over treatment) without increasing risk. This collaborative approach enhanced nurse-physician relationships, resulting in significant cost savings as well as diminished anxiety and confusion among the parents of neonates diagnosed with R/O sepsis.
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Affiliation(s)
- A A Lassen
- Hospital Cottonwood Hospital Medical Center, Alta View Hospital, Salt Lake City, UT., USA
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Abstract
For many years, the intuitions underlying partial-order planning were largely taken for granted. Only in the past few years has there been renewed interest in the fundamental principles underlying this paradigm. In this paper, we present a rigorous comparative analysis of partial-order and total-order planning by focusing on two specific planners that can be directly compared. We show that there are some subtle assumptions that underly the wide-spread intuitions regarding the supposed efficiency of partial-order planning. For instance, the superiority ofpartial-order planning can depend critically upon the search strategy and the structure of the search space. Understanding the underlying assumptions is crucial for constructing efficient planners.
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