1
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Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Jacobus S, Weiss M, Cella D, Zhao F, Ip EH, O'Connell N, Hong F, Peipert DJ, Gareen IIF, Timsina LR, Gray R, Wagner LI, Carlos RC. Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients. Blood Cancer J 2022; 12:53. [PMID: 35365604 PMCID: PMC8975964 DOI: 10.1038/s41408-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and baseline allostatic load (AL) and clinical trial endpoints in patients enrolled in the E1A11 therapeutic trial in multiple myeloma (MM). Study endpoints were symptom burden (pain, fatigue, and bother) at baseline and 5.5 months, non-completion of induction therapy, overall survival (OS) and progression-free survival (PFS). Multivariable logistic and Cox regression examined associations between nSES, AL and patient outcomes. A 1-unit increase in baseline AL was associated with greater odds of high fatigue at baseline (adjusted OR [95% CI] = 1.21 [1.08–1.36]) and a worse OS (adjusted hazard ratio, [95% CI] = 1.21 [1.06–1.37]). High nSES was associated with worse baseline bother (middle OR = 4.22 [1.11–16.09] and high 4.49 [1.16–17.43]) compared to low nSES. There was no association between AL or nSES and symptom burden at 5.5 months, non-completion of induction therapy or PFS. Additionally, there was no association between nSES and OS. AL may have utility as a predictive marker for OS among patients with MM and may allow individualization of treatment. Future studies should standardize and validate AL patients with MM.
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Affiliation(s)
| | - Noah Graham
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Susanna Jacobus
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Edward H Ip
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nathaniel O'Connell
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Devin J Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - IIana F Gareen
- Brown University Department of Epidemiology and Center for Statistical Sciences, Providence, RI, USA
| | - Lava R Timsina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert Gray
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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2
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Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O'Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized Trial of Lenalidomide Versus Observation in Smoldering Multiple Myeloma. J Clin Oncol 2019; 38:1126-1137. [PMID: 31652094 DOI: 10.1200/jco.19.01740] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Observation is the current standard of care for smoldering multiple myeloma. We hypothesized that early intervention with lenalidomide could delay progression to symptomatic multiple myeloma. METHODS We conducted a randomized trial that assessed the efficacy of single-agent lenalidomide compared with observation in patients with intermediate- or high-risk smoldering multiple myeloma. Lenalidomide was administered orally at a dose of 25 mg on days 1 to 21 of a 28-day cycle. The primary end point was progression-free survival, with disease progression requiring the development of end-organ damage attributable to multiple myeloma and biochemical progression. RESULTS One hundred eighty-two patients were randomly assigned-92 patients to the lenalidomide arm and 90 to the observation arm. Median follow-up is 35 months. Response to therapy was observed in 50% (95% CI, 39% to 61%) of patients in the lenalidomide arm, with no responses in the observation arm. Progression-free survival was significantly longer with lenalidomide compared with observation (hazard ratio, 0.28; 95% CI, 0.12 to 0.62; P = .002). One-, 2-, and 3-year progression-free survival was 98%, 93%, and 91% for the lenalidomide arm versus 89%, 76%, and 66% for the observation arm, respectively. Only six deaths have been reported, two in the lenalidomide arm versus four in the observation arm (hazard ratio for death, 0.46; 95% CI, 0.08 to 2.53). Grade 3 or 4 nonhematologic adverse events occurred in 25 patients (28%) on lenalidomide. CONCLUSION Early intervention with lenalidomide in smoldering multiple myeloma significantly delays progression to symptomatic multiple myeloma and the development of end-organ damage.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jeffrey V Matous
- Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, CO
| | | | | | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, NC
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3
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McKay R, Mills H, Werner L, Choudhury A, Choueiri T, Jacobus S, Pace A, Polacek L, Pomerantz M, Prisby J, Sweeney C, Walsh M, Taplin ME. Evaluating a Video-Based, Personalized Webpage in Genitourinary Oncology Clinical Trials: A Phase 2 Randomized Trial. J Med Internet Res 2019; 21:e12044. [PMID: 31045501 PMCID: PMC6538310 DOI: 10.2196/12044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/27/2018] [Revised: 12/08/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Background The pace of drug discovery and approvals has led to expanding treatments for cancer patients. Although extensive research exists regarding barriers to enrollment in oncology clinical trials, there are limited studies evaluating processes to optimize patient education, oral anticancer therapy administration, and adherence for patients enrolled in clinical trials. In this study, we assess the feasibility of a video-based, personalized webpage for patients enrolled in genitourinary oncology clinical trials involving 1 or more oral anticancer therapy. Objective The primary objective of this trial was to assess the differences in the number of patient-initiated violations in the intervention arm compared with a control arm over 4 treatment cycles. Secondary objectives included patient satisfaction, frequently asked questions by patients on the intervention arm, patient-initiated calls to study team members, and patient-reported stress levels. Methods Eligible patients enrolling on a therapeutic clinical trial for a genitourinary malignancy were randomized 2:1 to the intervention arm or control arm. Patients randomized to the intervention arm received access to a video-based, personalized webpage, which included videos of patients’ own clinic encounters with their providers, instructional videos on medication administration and side effects, and electronic versions of educational documents. Results A total of 99 patients were enrolled (89 were evaluable; 66 completed 4 cycles). In total, 71% (40/56) of patients in the intervention arm had 1 or more patient-initiated violation compared with 70% (23/33) in the control arm. There was no difference in the total number of violations across 4 cycles between the 2 arms (estimate=−0.0939, 95% CI−0.6295 to 0.4418, P value=.73). Median baseline satisfaction scores for the intervention and control arms were 72 and 73, respectively, indicating high levels of patient satisfaction in both arms. Median baseline patient-reported stress levels were 10 and 13 for the intervention and control arms, respectively, indicating low stress levels in both arms at baseline. Conclusions This study is among the first to evaluate a video-based, personalized webpage that provides patients with educational videos and video recordings of clinical trial appointments. Despite not meeting the primary endpoint of reduced patient-initiated violations, this study demonstrates the feasibility of a video-based, personalized webpage in clinical trials. Future research assessing this tool might be better suited for realms outside of clinical trials and might consider the use of an endpoint that assesses patient-reported outcomes directly. A major limitation of this study was the lack of prior data for estimating the null hypothesis in this population.
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Affiliation(s)
- Rana McKay
- University of California San Diego, La Jolla, CA, United States
| | - Hannah Mills
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Lillian Werner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Atish Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Susanna Jacobus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Amanda Pace
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura Polacek
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Judith Prisby
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghara Walsh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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4
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Ailawadhi S, Jacobus S, Sexton R, Stewart AK, Dispenzieri A, Hussein MA, Zonder JA, Crowley J, Hoering A, Barlogie B, Orlowski RZ, Rajkumar SV. Disease and outcome disparities in multiple myeloma: exploring the role of race/ethnicity in the Cooperative Group clinical trials. Blood Cancer J 2018; 8:67. [PMID: 29980678 PMCID: PMC6035273 DOI: 10.1038/s41408-018-0102-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM) is an incurable hematologic malignancy with disparities in outcomes noted among racial-ethnic subgroups, likely due to disparities in access to effective treatment modalities. Clinical trials can provide access to evidence-based medicine but representation of minorities on therapeutic clinical trials has been dismal. We evaluated the impact of patient race-ethnicity in pooled data from nine large national cooperative group clinical trials in newly diagnosed MM. Among 2896 patients enrolled over more than two decades, only 18% were non-White and enrollment of minorities actually decreased in most recent years (2002-2011). African-Americans were younger and had more frequent poor-risk markers, including anemia and increased lactate dehydrogenase. Hispanics had the smallest proportion of patients on trials utilizing novel therapeutic agents. While adverse demographic (increased age) and clinical (performance status, stage, anemia, kidney dysfunction) factors were associated with inferior survival, patient race-ethnicity did not have an effect on objective response rates, progression-free, or overall survival. While there are significant disparities in MM incidence and outcomes among patients of different racial-ethnic groups, this disparity seems to be mitigated by access to appropriate therapeutic options, for example, as offered by clinical trials. Improved minority accrual in therapeutic clinical trials needs to be a priority.
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Affiliation(s)
| | - Susanna Jacobus
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Rachael Sexton
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | | | | | | | - Jeffrey A Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - John Crowley
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | - Antje Hoering
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | | | - Robert Z Orlowski
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
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5
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Bullock A, Stuart K, Jacobus S, Abrams T, Wadlow R, Goldstein M, Miksad R. Capecitabine and oxaliplatin as first and second line treatment for locally advanced and metastatic pancreatic ductal adenocarcinoma. J Gastrointest Oncol 2017; 8:945-952. [PMID: 29299353 DOI: 10.21037/jgo.2017.06.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There are limited treatment options available for patients with advanced pancreatic ductal adenocarcinoma (PDAC). We conducted a phase II study evaluating the efficacy and safety of capecitabine/oxaliplatin (CAPOX) in patients with locally advanced and metastatic PDAC treated in the first and second lines. Methods Forty subjects with advanced PDAC and ECOG performance status ≥2 were enrolled. Treatment consisted of capecitabine 2,000 mg/m2 orally in two divided doses daily for 14 days and oxaliplatin 130 mg/m2 intravenously day 1 every 21 days. The primary endpoint was response rate (RR); secondary endpoints included safety analysis, progression free survival (PFS) and overall survival (OS). Results The overall RR was 12.5% (N=3); the disease control rate was 67% (N=16). Due to the protocol definition for eligibility of response evaluation, only 60% (N=24) were evaluable for the primary endpoint. Median progression free survival (mPFS) was 3.8 months (95% CI: 1.3, 6.2); median OS (mOS) was 7.4 months (95% CI: 4.8, 12.2). The most common grade 3/4 toxicities included: fatigue (19%), nausea (17%), and diarrhea (14%). Conclusions CAPOX is an active regimen in patients with advanced PDAC and is associated with acceptable toxicity. Careful consideration should be given to response endpoints and outcome measures when studying this characteristically ill population.
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Affiliation(s)
| | - Keith Stuart
- Lahey Hospital and Medical Center, Burlington, MA, USA
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6
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Tripathi A, Jacobus S, Feldman H, Choueiri TK, Harshman LC. Prognostic Significance of Increases in Hemoglobin in Renal Cell Carcinoma Patients During Treatment With VEGF-directed Therapy. Clin Genitourin Cancer 2016; 15:396-402. [PMID: 28040423 DOI: 10.1016/j.clgc.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increases in hemoglobin have been reported in renal cell carcinoma (RCC) patients treated with vascular endothelial growth factor (VEGF) pathway-targeted therapies and have been associated with increased progression-free survival (PFS). We retrospectively evaluated its significance as a predictive biomarker of clinical response in RCC. PATIENTS AND METHODS Patients with advanced RCC treated with VEGF receptor tyrosine kinase inhibitors (TKIs) or bevacizumab as a first-line therapy were identified. Hemoglobin levels were retrieved at baseline and then at monthly intervals for 6 months. Absolute and percentage increases over baseline were evaluated as predictors of objective response rate, PFS, time to treatment failure, and overall survival. Cox regression was used to estimate change status hazard ratios (HR) in univariate and multivariable models. RESULTS Among the 71 eligible patients, elevations in hemoglobin were observed in 83%, with a median time to increase of 2.4 weeks since treatment initiation. Changes in hemoglobin at time of response were not associated with objective response rate. Landmark analysis at 3 months showed that increases in hemoglobin were associated with worse PFS (8.0 vs. 19.4 months; HR = 2.29; 95% confidence interval, 1.01-5.16; P = .05) and time to treatment failure (6.4 vs. 18.1 months; HR = 2.14; 95% confidence interval, 0.99-4.60, P = .05). Patients with greater increases (15% or more) had significantly shorter PFS (5.5 vs. 13.6 months) and overall survival (20.8 vs. 30.4 months) compared to those with lesser degree of elevations. CONCLUSION Contrary to prior reports, elevation in hemoglobin on VEGF-directed therapy was associated with worse clinical outcomes, and the greater the degree of elevation, the poorer the prognosis.
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Affiliation(s)
- Abhishek Tripathi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Susanna Jacobus
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Hope Feldman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA.
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7
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Bellmunt J, Mullane S, Jacobus S, Polacek L, Takeda D, Harshman L, Choueiri T, Wagle N, Van Allen E, Kantoff P, Rosenberg J. Everolimus / pazopanib (E/P) benefits genomically selected patients (pts) with metastatic urothelial carcinoma (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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8
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Mahoney KM, Jacobus S, Bhatt RS, Song J, Carvo I, Cheng SC, Simpson M, Fay AP, Puzanov I, Michaelson MD, Atkins MB, McDermott DF, Signoretti S, Choueiri TK. Phase 2 Study of Bevacizumab and Temsirolimus After VEGFR TKI in Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2016; 14:304-313.e6. [PMID: 27036973 DOI: 10.1016/j.clgc.2016.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inhibiting VEGF and mammalian target of rapamycin (mTOR) pathways are standard treatment approaches for patients with metastatic renal cell carcinoma (mRCC). Here we report the activity and safety of the VEGF ligand inhibitor bevacizumab and the mTOR inhibitor temsirolimus combination in patients with clear cell (CC) and non-clear cell (NCC) mRCC whose disease had failed to respond to prior VEGF blockade. PATIENTS AND METHODS In this phase 2 investigator-initiated multicenter study, patients received bevacizumab and temsirolimus. The primary end point was 4-month progression-free survival (PFS) rate. Secondary end points included overall response rate, median overall survival (OS), toxicity, and correlative studies of biomarkers downstream of mTOR. RESULTS Forty patients received at least 1 dose of therapy. Thirty-three (82.5%) had favorable/intermediate risk disease according to International Metastatic Renal Cell Carcinoma Database Consortium criteria, 13 (32.5%) with nccRCC histology. Nineteen (48.7%) had primary vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI)-refractory disease. The 4-month PFS rate was 65%. Overall median PFS and OS were 5.6 and 12.2 months. Median PFS and OS were 6.5 and 9.6 months in patients with primary VEGFR TKI-refractory disease, and 5.6 months and 13.1 months in patients with nccRCC. Dose reductions were needed in 80% of patients. Most frequent toxicities included fatigue, hypertension, dyslipidemia, and proteinuria. Dose discontinuation due to adverse events occurred in 27.5% of patients. Baseline tumor immunohistochemistry for phospho-S6 protein was not associated with clinical benefit. CONCLUSION Combining bevacizumab and temsirolimus in patients previously treated with VEGFR TKI was possible but with dose reductions and treatment discontinuations. This combination resulted in modest activity, including in patients with primary VEGF-refractory disease and NCC histology.
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Affiliation(s)
- Kathleen M Mahoney
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Susanna Jacobus
- Department of Statistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Rupal S Bhatt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jiaxi Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ingrid Carvo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Su-Chun Cheng
- Department of Statistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mekailah Simpson
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - André P Fay
- PUCRS School of Medicine, Porto Alegre, Brazil
| | - Igor Puzanov
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - M Dror Michaelson
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael B Atkins
- Department of Medical Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC
| | - David F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sabina Signoretti
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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9
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Uno H, Claggett B, Tian L, Inoue E, Gallo P, Miyata T, Schrag D, Takeuchi M, Uyama Y, Zhao L, Skali H, Solomon S, Jacobus S, Hughes M, Packer M, Wei LJ. Moving beyond the hazard ratio in quantifying the between-group difference in survival analysis. J Clin Oncol 2014; 32:2380-5. [PMID: 24982461 DOI: 10.1200/jco.2014.55.2208] [Citation(s) in RCA: 452] [Impact Index Per Article: 45.2] [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
In a longitudinal clinical study to compare two groups, the primary end point is often the time to a specific event (eg, disease progression, death). The hazard ratio estimate is routinely used to empirically quantify the between-group difference under the assumption that the ratio of the two hazard functions is approximately constant over time. When this assumption is plausible, such a ratio estimate may capture the relative difference between two survival curves. However, the clinical meaning of such a ratio estimate is difficult, if not impossible, to interpret when the underlying proportional hazards assumption is violated (ie, the hazard ratio is not constant over time). Although this issue has been studied extensively and various alternatives to the hazard ratio estimator have been discussed in the statistical literature, such crucial information does not seem to have reached the broader community of health science researchers. In this article, we summarize several critical concerns regarding this conventional practice and discuss various well-known alternatives for quantifying the underlying differences between groups with respect to a time-to-event end point. The data from three recent cancer clinical trials, which reflect a variety of scenarios, are used throughout to illustrate our discussions. When there is not sufficient information about the profile of the between-group difference at the design stage of the study, we encourage practitioners to consider a prespecified, clinically meaningful, model-free measure for quantifying the difference and to use robust estimation procedures to draw primary inferences.
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Affiliation(s)
- Hajime Uno
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brian Claggett
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lu Tian
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eisuke Inoue
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul Gallo
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Toshio Miyata
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Deborah Schrag
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Masahiro Takeuchi
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yoshiaki Uyama
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lihui Zhao
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hicham Skali
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Scott Solomon
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Susanna Jacobus
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Hughes
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Milton Packer
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lee-Jen Wei
- Hajime Uno, Deborah Schrag, and Susanna Jacobus, Dana-Farber Cancer Institute; Brian Claggett, Hicham Skali, and Scott Solomon, Harvard Medical School, Brigham and Women's Hospital; Michael Hughes and Lee-Jen Wei, Harvard School of Public Health, Boston, MA; Lu Tian, Stanford University School of Medicine, Palo Alto, CA; Eisuke Inoue and Masahiro Takeuchi, Kitasato University; Toshio Miyata, Health and Global Policy Institute; Yoshiaki Uyama, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Paul Gallo, Novartis Pharmaceuticals, East Hanover, NJ; Lihui Zhao, Northwestern University Feinberg School of Medicine, Chicago, IL; and Milton Packer, University of Texas Southwestern Medical Center, Dallas, TX.
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10
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Choueiri TK, Jacobus S, Bellmunt J, Qu A, Appleman LJ, Tretter C, Bubley GJ, Stack EC, Signoretti S, Walsh M, Steele G, Hirsch M, Sweeney CJ, Taplin ME, Kibel AS, Krajewski KM, Kantoff PW, Ross RW, Rosenberg JE. Neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin with pegfilgrastim support in muscle-invasive urothelial cancer: pathologic, radiologic, and biomarker correlates. J Clin Oncol 2014; 32:1889-94. [PMID: 24821883 PMCID: PMC7057274 DOI: 10.1200/jco.2013.52.4785] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [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: 01/17/2023] Open
Abstract
PURPOSE In advanced urothelial cancer, treatment with dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) results in a high response rate, less toxicity, and few dosing delays. We explored the efficacy and safety of neoadjuvant ddMVAC with pegfilgrastim support in muscle-invasive urothelial cancer (MIUC). PATIENTS AND METHODS Patients with cT2-cT4, N0-1, M0 MIUC were enrolled. Four cycles of ddMVAC were administered, followed by radical cystectomy. The primary end point was pathologic response (PaR) defined by pathologic downstaging to ≤ pT1N0M0. The study used Simon's optimal two-stage design to evaluate null and alternative hypotheses of PaR rate of 35% versus 55%. Secondary end points included toxicity, disease-free survival (DFS), radiologic response (RaR), and biomarker correlates, including ERCC1. RESULTS Between December 2008 and April 2012, 39 patients (cT2N0, 33%; cT3N0, 18%; cT4N0, 3%; cT2-4N1, 43%; unspecified, 3%) were enrolled. Median follow-up was 2 years. Overall, 49% (80% CI, 38 to 61) achieved PaR of ≤ pT1N0M0, and we concluded this regimen was effective. High-grade (grade ≥ 3) toxicities were observed in 10% of patients, with no neutropenic fevers or treatment-related death. One-year DFS was 89% versus 67% for patients who achieved PaR compared with those who did not (hazard ratio [HR], 2.6; 95% CI, 0.8 to 8.1; P = .08) and 86% versus 62% for patients who achieved RaR compared with those who did not (HR, 4.1; 95% CI, 1.3 to 12.5; P = .009). We found no association between serum tumor markers or ERCC1 expression with response or survival. CONCLUSION In patients with MIUC, neoadjuvant ddMVAC was well tolerated and resulted in significant pathologic and radiologic downstaging.
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Affiliation(s)
- Toni K Choueiri
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Susanna Jacobus
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joaquim Bellmunt
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Angela Qu
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Leonard J Appleman
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christopher Tretter
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Glenn J Bubley
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Edward C Stack
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Sabina Signoretti
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Meghara Walsh
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Graeme Steele
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michelle Hirsch
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christopher J Sweeney
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mary-Ellen Taplin
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Adam S Kibel
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Katherine M Krajewski
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Philip W Kantoff
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Robert W Ross
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jonathan E Rosenberg
- Toni K. Choueiri, Susanna Jacobus, Joaquim Bellmunt, Angela Qu, Edward C. Stack, Sabina Signoretti, Meghara Walsh, Graeme Steele, Michelle Hirsch, Christopher J. Sweeney, Mary-Ellen Taplin, Adam S. Kibel, Katherine M. Krajewski, Philip W. Kantoff, Robert W. Ross, and Jonathan E. Rosenberg, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Christopher Tretter, Lahey Clinic, Burlington; Glenn J. Bubley, Beth Israel Deaconess Medical Center, Boston, MA; Leonard J. Appleman, University of Pittsburgh, Pittsburgh, PA; and Jonathan E. Rosenberg, Memorial Sloan-Kettering Cancer Center, New York, NY
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11
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Wagle N, Grabiner BC, Van Allen EM, Hodis E, Jacobus S, Supko JG, Stewart M, Choueiri TK, Gandhi L, Cleary JM, Elfiky AA, Taplin ME, Stack EC, Signoretti S, Loda M, Shapiro GI, Sabatini DM, Lander ES, Gabriel SB, Kantoff PW, Garraway LA, Rosenberg JE. Activating mTOR mutations in a patient with an extraordinary response on a phase I trial of everolimus and pazopanib. Cancer Discov 2014; 4:546-53. [PMID: 24625776 DOI: 10.1158/2159-8290.cd-13-0353] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Understanding the genetic mechanisms of sensitivity to targeted anticancer therapies may improve patient selection, response to therapy, and rational treatment designs. One approach to increase this understanding involves detailed studies of exceptional responders: rare patients with unexpected exquisite sensitivity or durable responses to therapy. We identified an exceptional responder in a phase I study of pazopanib and everolimus in advanced solid tumors. Whole-exome sequencing of a patient with a 14-month complete response on this trial revealed two concurrent mutations in mTOR, the target of everolimus. In vitro experiments demonstrate that both mutations are activating, suggesting a biologic mechanism for exquisite sensitivity to everolimus in this patient. The use of precision (or "personalized") medicine approaches to screen patients with cancer for alterations in the mTOR pathway may help to identify subsets of patients who may benefit from targeted therapies directed against mTOR.
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Affiliation(s)
- Nikhil Wagle
- Departments of 1Medical Oncology and 2Biostatistics and Computational Biology, 3Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute; Departments of 4Medicine and 5Pathology, Brigham and Women's Hospital, Harvard Medical School; 6Division of Hematology/Oncology, Massachusetts General Hospital, Boston; 7Broad Institute of Harvard and MIT; 8Department of Biology, Whitehead Institute for Biomedical Research; 9Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, Massachusetts; and 10Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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12
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Vesole DH, Oken MM, Heckler C, Greipp PR, Katz MS, Jacobus S, Morrow GR. Oral antibiotic prophylaxis of early infection in multiple myeloma: a URCC/ECOG randomized phase III study. Leukemia 2012; 26:2517-20. [PMID: 22678167 DOI: 10.1038/leu.2012.124] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multiple myeloma (MM) is a malignancy of clonal plasma cells, resulting in an increased production of ineffective immunoglobulins with suppression of non-involved immunoglobulins. Patients with MM are at increased risk of infectious complications, particularly streptococcal and staphylococcal infections. This study evaluated the impact of prophylactic antibiotics on the incidence of serious bacterial infections (SBIs) during the first 2 months of treatment in patients with newly diagnosed MM. Patients with MM receiving initial chemotherapy were randomized on a 1:1:1 basis to daily ciprofloxacin (C; 500 mg twice daily), trimethoprim-sulfamethoxazole (T; DS twice daily) or observation (O) and evaluated for SBI (Eastern Cooperative Oncology Group ≥grade 3) for the first 2 months of treatment. From July 1998 to January 2008, 212 MM patients were randomized to C (n=69), T (n=76) or O (n=67). The incidence of SBI was comparable among groups: C=12.5%, T=6.8% and O=15.9%; P=0.218. Further, any infection during the first 2 months was also comparable (20% vs 23% vs 22%, respectively, P=0.954). We demonstrate that prophylactic antibiotics did not decrease the incidence of SBI (≥grade 3) within the first 2 months of treatment. We conclude that routine use of prophylactic antibiotics should not be mandated for patients receiving induction chemotherapy.
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Affiliation(s)
- D H Vesole
- The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, USA.
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13
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Choueiri TK, Ross RW, Jacobus S, Vaishampayan U, Yu EY, Quinn DI, Hahn NM, Hutson TE, Sonpavde G, Morrissey SC, Buckle GC, Kim WY, Petrylak DP, Ryan CW, Eisenberger MA, Mortazavi A, Bubley GJ, Taplin ME, Rosenberg JE, Kantoff PW. Double-blind, randomized trial of docetaxel plus vandetanib versus docetaxel plus placebo in platinum-pretreated metastatic urothelial cancer. J Clin Oncol 2011; 30:507-12. [PMID: 22184381 DOI: 10.1200/jco.2011.37.7002] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Vandetanib is an oral once-daily tyrosine kinase inhibitor with activity against vascular endothelial growth factor receptor 2 and epidermal growth factor receptor. Vandetanib in combination with docetaxel was assessed in patients with advanced urothelial cancer (UC) who progressed on prior platinum-based chemotherapy. PATIENTS AND METHODS The primary objective was to determine whether vandetanib 100 mg plus docetaxel 75 mg/m(2) intravenously every 21 days prolonged progression-free survival (PFS) versus placebo plus docetaxel. The study was designed to detect a 60% improvement in median PFS with 80% power and one-sided α at 5%. Patients receiving docetaxel plus placebo had the option to cross over to single-agent vandetanib at progression. Overall survival (OS), overall response rate (ORR), and safety were secondary objectives. RESULTS In all, 142 patients were randomly assigned and received at least one dose of therapy. Median PFS was 2.56 months for the docetaxel plus vandetanib arm versus 1.58 months for the docetaxel plus placebo arm, and the hazard ratio for PFS was 1.02 (95% CI, 0.69 to 1.49; P = .9). ORR and OS were not different between both arms. Grade 3 or higher toxicities were more commonly seen in the docetaxel plus vandetanib arm and included rash/photosensitivity (11% v 0%) and diarrhea (7% v 0%). Among 37 patients who crossed over to single-agent vandetanib, ORR was 3% and OS was 5.2 months. CONCLUSION In this platinum-pretreated population of advanced UC, the addition of vandetanib to docetaxel did not result in a significant improvement in PFS, ORR, or OS. The toxicity of vandetanib plus docetaxel was greater than that for vendetanib plus placebo. Single-agent vandetanib activity was minimal.
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Sun T, Oh WK, Jacobus S, Regan M, Pomerantz M, Freedman ML, Lee GSM, Kantoff PW. The impact of common genetic variations in genes of the sex hormone metabolic pathways on steroid hormone levels and prostate cancer aggressiveness. Cancer Prev Res (Phila) 2011; 4:2044-50. [PMID: 21900597 DOI: 10.1158/1940-6207.capr-11-0283] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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
Our previous work suggested that there was no significant association between plasma steroid hormone levels and prostate cancer tumor grade at diagnosis. In this study, we systematically tested the hypothesis that inherited variations in the androgen and estrogen metabolic pathways may be associated with plasma levels of steroid hormones, or prostate cancer aggressiveness at diagnosis. Plasma hormone levels including total testosterone, total estradiol, and sex hormone-binding globulin were measured in a cohort of 508 patients identified with localized prostate cancer. D'Amico risk classification at diagnosis was also determined. A total of 143 single-nucleotide polymorphisms (SNPs) from 30 genes that are involved in androgen and estrogen metabolism were selected for analysis. The global association of genotypes with plasma hormone levels and prostate cancer aggressiveness (D'Amico risk classification) was statistically analyzed. Q values were estimated to account for multiple testing. We observed significant associations between plasma testosterone level and SNPs in HSD17B2 (rs1424151), HSD17B3 (rs9409407), and HSD17B1 (rs12602084), with P values of 0.002, 0.006, and 0.006, respectively. We also observed borderline significant associations between prostate aggressiveness at diagnosis and SNPs in AKR1C1 (rs11252845; P = 0.005), UGT2B15 (rs2045100; P = 0.007), and HSD17B12 (rs7932905; P = 0.008). No individual SNP was associated with both clinical variables. Genetic variants of genes in hormone metabolic pathways may influence plasma androgen levels or prostate cancer aggressiveness. However, it seems that the inherited variations affecting plasma hormone levels differ from those affecting disease aggressiveness.
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Affiliation(s)
- Tong Sun
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
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15
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Oh WK, Vargas R, Jacobus S, Leitzel K, Regan MM, Hamer P, Pierce K, Brown-Shimer S, Carney W, Ali SM, Kantoff PW, Lipton A. Elevated plasma tissue inhibitor of metalloproteinase-1 levels predict decreased survival in castration-resistant prostate cancer patients. Cancer 2010; 117:517-25. [PMID: 20862742 DOI: 10.1002/cncr.25394] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 03/12/2010] [Accepted: 03/23/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Tissue inhibitor of metalloproteinase-1 (TIMP-1) has paradoxical multifunctional roles in tumorigenesis: inhibition of the catalytic activity of matrix metalloproteinases and apoptosis as well as promotion of angiogenesis and tumor growth. Elevated TIMP-1 levels have been associated with a poorer prognosis in multiple cancers. METHODS Ethylenediaminetetraacetic acid plasma TIMP-1 was determined in 362 castration-resistant prostate cancer (PC) patients using a TIMP-1 enzyme-linked immunosorbent assay. All patients with castration-resistant PC and available plasma were identified from an institutional database. Overall survival was analyzed using the Kaplan-Meier method and Cox modeling on plasma TIMP-1 tertiles. RESULTS Patients were evaluated in pilot (n = 60) and primary (n = 302) sets. Median follow-up from diagnosis was 5.8 and 6.6 years, respectively. Median plasma TIMP-1 levels were 335 and 183 ng/mL in the pilot and primary sets, respectively. Overall survival was significantly shorter with each higher tertile of TIMP-1 in both datasets (P<.001). For the primary cohort, hazard ratio of (HR) death and median survival by plasma TIMP-1 tertile levels were: low, HR 1.0, 43 months; middle, HR 1.7, 27 months; high, HR 2.4, 19 months. In the primary set, significant covariates in the adjusted Cox regression model were: TIMP-1 level (mid or high vs low tertile), prostate-specific antigen (>20 vs ≤20 ng/mL), alkaline phosphatase (>102 vs ≤102 U/L), Eastern Cooperative Oncology Group performance status (1 + vs 0), and Gleason score (7 or 8 vs ≤6). CONCLUSIONS Elevated plasma TIMP-1 levels predicted decreased survival in metastatic castration-resistant PC patients, independent of known prognostic markers.
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Affiliation(s)
- William K Oh
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
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16
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Dispenzieri A, Jacobus S, Vesole DH, Callandar N, Fonseca R, Greipp PR. Primary therapy with single agent bortezomib as induction, maintenance and re-induction in patients with high-risk myeloma: results of the ECOG E2A02 trial. Leukemia 2010; 24:1406-11. [PMID: 20535147 PMCID: PMC2921007 DOI: 10.1038/leu.2010.129] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [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: 12/29/2022]
Abstract
Single agent bortezomib results in response rates of 51% in patients with newly diagnosed multiple myeloma (MM) and is touted to be especially effective in high-risk disease. We are the first to prospectively explore single agent bortezomib as primary therapy (response rate, maintenance and reinduction) without consolidative autologous stem cell transplant in a cohort selected to have high-risk MM. Patients received 8-cycles of induction followed by maintenance bortezomib every other week indefinitely. Patients relapsing on maintenance had full induction schedule resumed. On an intention to treat basis the response rate (>=PR) was 48%. Among 7 patients, who progressed on maintenance bortezomib and received reinduction, two responded. With a median follow-up of 48.2 months, 1- and 2-year OS probabilities were 88% (95%CI, 74–95%) and 76% (95%CI, 60–86%), respectively. Median PFS was 7.9 months (95%CI, 5.8–12.0). Twenty-three and 34 patients had >=grade 3 hematologic and non-hematologic toxicity, respectively with treatment emergent neuropathy in: 7%, motor grade 1–2; 56%, sensory grade 1–2 and 2%, grade 3; and 14%, neuropathic pain grade 1–2 in and 2%, grade 3. In high-risk patients, upfront bortezomib results in response rates comparable to those reported for unselected cohorts, but single agent bortezomib is not sufficient as primary therapy.
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Affiliation(s)
- A Dispenzieri
- Department of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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17
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Nakabayashi M, Oh WK, Jacobus S, Regan MM, Taplin ME, Kantoff PW, Rosenberg JE. Activity of ketoconazole after taxane-based chemotherapy in castration-resistant prostate cancer. BJU Int 2009; 105:1392-6. [PMID: 19863532 DOI: 10.1111/j.1464-410x.2009.08971.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy of the androgen-synthesis inhibitor ketoconazole as a secondary hormonal therapy in patients with castration-resistant prostate cancer (CRPC) previously treated with chemotherapy, as persistent androgens appear to play a role in the development and maintenance of CRPC. PATIENTS AND METHODS We retrospectively identified 34 patients with CRPC who were treated with ketoconazole as a secondary hormonal therapy after paclitaxel- or docetaxel-based chemotherapy for CRPC. They were treated with ketoconazole 200-400 mg three times daily with or without hydrocortisone. Patients with previous use of ketoconazole were excluded. Half the patients had received estramustine as part of their chemotherapy regimen. The primary endpoint was the proportion of patients with a decline of > or =50% in their prostate-specific antigen (PSA) level. PSA progression was defined by the PSA Working Group 1 Criteria. RESULTS Eight of the 32 evaluable patients (25%) had a PSA decline of > or =50%. The median time to progression (TTP) was 3 months (95% confidence interval, 1.2-5.4). A history of previous response to taxane-based chemotherapy was not associated with the response to ketoconazole. However, previous use of oestrogens for CRPC was significantly associated with a shorter TTP on ketoconazole (1.5 vs 10.2 months; P = 0.03). CONCLUSIONS Ketoconazole has moderate activity as secondary hormonal therapy in patients with CRPC previously treated with taxane-based chemotherapy, although the TTP was short. Previous treatment with oestrogenic therapy is associated with a shorter TTP.
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Affiliation(s)
- Mari Nakabayashi
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA
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18
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Kyle RA, Jacobus S, Friedenberg WR, Slabber CF, Rajkumar SV, Greipp PR. The treatment of multiple myeloma using vincristine, carmustine, melphalan, cyclophosphamide, and prednisone (VBMCP) alternating with high-dose cyclophosphamide and alpha(2)beta interferon versus VBMCP: results of a phase III Eastern Cooperative Oncology Group Study E5A93. Cancer 2009; 115:2155-64. [PMID: 19248045 DOI: 10.1002/cncr.24221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND A randomized controlled trial tested the hypothesis that aggressive initial therapy using high-dose cyclophosphamide (HiCy) and alpha(2)beta interferon (IFN) may be superior to standard combination alkylating agent regimens in the treatment of newly diagnosed myeloma. METHODS This Eastern Cooperative Oncology Group trial evaluated 268 previously untreated patients with active multiple myeloma randomized to vincristine, carmustine, melphalan, cyclophosphamide, and prednisone (VBMCP) or VBMCP plus HiCy and recombinant IFN. RESULTS The overall objective response was 62% in the VBMCP regimen and 68% in the VBMCP + HiCy + IFN group. The near complete response and complete response rates were 8.1% and 8.9%, respectively. Progression-free survival was 22.1 and 25.3 months, respectively. The median overall survival was 37.1 months for patients treated with VBMCP and 41.3 months for those treated with VBMCP + HiCy + IFN (P = .38). The 5-year overall survival rates were not significantly different between the 2 arms: 26.4% and 33%, respectively. Lethal toxicities occurred in 15 patients, including 10 from infection, but there was no significant difference in lethal toxicities between the 2 regimens. CONCLUSIONS The study showed no significant benefit with the addition of HiCy and IFN to VBMCP.
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Affiliation(s)
- Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
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19
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Lacy MQ, Jacobus S, Blood EA, Kay NE, Rajkumar SV, Greipp PR. Phase II study of interleukin-12 for treatment of plateau phase multiple myeloma (E1A96): a trial of the Eastern Cooperative Oncology Group. Leuk Res 2009; 33:1485-9. [PMID: 19243818 DOI: 10.1016/j.leukres.2009.01.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 12/01/2008] [Accepted: 01/18/2009] [Indexed: 11/26/2022]
Abstract
The Eastern Cooperative Oncology Group (ECOG) conducted a phase II trial of interleukin-12 (IL-12) for plateau phase multiple myeloma. Patients were initially treated with IL-12 250 ng/kg I.V. daily for 5 days every 3 weeks. The trial was modified due to toxicity after the first 16 patients. IL-12 was given 300 ng/kg subcutaneously twice weekly for 24 weeks. Of 48 eligible patients, there were 4 objective responses (8.3%), all CR. The median survival and progression-free survival were 42.8 and 11.4 months. Unacceptable grade 3 or 4 non-hematologic toxicity (31% with IL-12 subcutaneously and 63% with IL-12 intravenously) was observed.
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Affiliation(s)
- Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, United States.
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20
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Abstract
BACKGROUND Obesity is associated with prostate cancer (PCA) grade, but the mechanism behind this relationship is not understood. Adiponectin is an adipokine that has been linked with the development of hormonally sensitive carcinomas, including prostate cancer. We evaluated the relationship between serum adiponectin and Gleason score (GS) in a prospective series of patients seen in a single institution. METHODS Localized PCA patients evaluated at Dana-Farber Cancer Institute between 2001 and 2005 who enrolled in a prospective serum banking protocol were eligible for this study. Patients with prior hormonal therapy and/or metastatic disease were excluded. High-grade disease was defined as biopsy or radical prostatectomy (RP) GS of 7 or higher. Logistic regression models were used to assess the relationship between high-grade disease and adiponectin levels while adjusting for other potential prognostic variables. RESULTS There were 539 patients included in this study, of whom 199 had undergone RP. Median age was 60 years. Median PSA was 5.1 ng/dl. Biopsy GS of 7 or higher was seen in 46.9% of patients. For biopsy GS, higher PSA, older age, and higher BMI were significantly associated with increased odds of GS 7 or higher, but adiponectin was not. In men undergoing RP, there was a significant inverse relationship between pathologic GS and adiponectin dichotomized at the median, due to a significantly higher rate of upgrading in patients with lower adiponectin (P = 0.014). CONCLUSIONS Although there was no association between biopsy GS and adiponectin, in patients who had undergone RP, lower adiponectin was independently associated with high-grade prostate cancer.
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Affiliation(s)
- David J Sher
- Harvard Radiation Oncology Program, Boston, Massachusetts 02115, USA
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21
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Van Ness B, Ramos C, Haznadar M, Hoering A, Haessler J, Crowley J, Jacobus S, Oken M, Rajkumar V, Greipp P, Barlogie B, Durie B, Katz M, Atluri G, Fang G, Gupta R, Steinbach M, Kumar V, Mushlin R, Johnson D, Morgan G. Genomic variation in myeloma: design, content, and initial application of the Bank On A Cure SNP Panel to detect associations with progression-free survival. BMC Med 2008; 6:26. [PMID: 18778477 PMCID: PMC2553089 DOI: 10.1186/1741-7015-6-26] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 09/08/2008] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We have engaged in an international program designated the Bank On A Cure, which has established DNA banks from multiple cooperative and institutional clinical trials, and a platform for examining the association of genetic variations with disease risk and outcomes in multiple myeloma. We describe the development and content of a novel custom SNP panel that contains 3404 SNPs in 983 genes, representing cellular functions and pathways that may influence disease severity at diagnosis, toxicity, progression or other treatment outcomes. A systematic search of national databases was used to identify non-synonymous coding SNPs and SNPs within transcriptional regulatory regions. To explore SNP associations with PFS we compared SNP profiles of short term (less than 1 year, n = 70) versus long term progression-free survivors (greater than 3 years, n = 73) in two phase III clinical trials. RESULTS Quality controls were established, demonstrating an accurate and robust screening panel for genetic variations, and some initial racial comparisons of allelic variation were done. A variety of analytical approaches, including machine learning tools for data mining and recursive partitioning analyses, demonstrated predictive value of the SNP panel in survival. While the entire SNP panel showed genotype predictive association with PFS, some SNP subsets were identified within drug response, cellular signaling and cell cycle genes. CONCLUSION A targeted gene approach was undertaken to develop an SNP panel that can test for associations with clinical outcomes in myeloma. The initial analysis provided some predictive power, demonstrating that genetic variations in the myeloma patient population may influence PFS.
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Affiliation(s)
- Brian Van Ness
- Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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22
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Chng WJ, Gonzalez-Paz N, Price-Troska T, Jacobus S, Rajkumar SV, Oken MM, Kyle RA, Henderson KJ, Van Wier S, Greipp P, Van Ness B, Fonseca R. Clinical and biological significance of RAS mutations in multiple myeloma. Leukemia 2008; 22:2280-4. [PMID: 18528420 DOI: 10.1038/leu.2008.142] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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23
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Jacobus S, Sher DJ, Regan MM, Chamberland J, Oh WK, Mantzoros C. Association between serum adiponectin and prostate cancer risk. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Rajkumar SV, Jacobus S, Callander N, Fonseca R, Vesole D, Williams MV, Abonour R, Siegel DS, Katz M, Greipp PR. Randomized trial of lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed myeloma (E4A03), a trial coordinated by the Eastern Cooperative Oncology Group: Analysis of response, survival, and outcome wi. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8504] [Citation(s) in RCA: 33] [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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25
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Oh WK, Leitzel K, Jacobus S, Vargas R, Regan MM, Hamer PJ, Carney WP, Ali SM, Kantoff PW, Lipton A. Elevated plasma TIMP-1 and survival in metastatic castration-resistant prostate cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Nakabayashi M, Sartor O, Jacobus S, Regan MM, McKearn D, Ross RW, Kantoff PW, Taplin ME, Oh WK. Response to docetaxel/carboplatin-based chemotherapy as first- and second-line therapy in patients with metastatic hormone-refractory prostate cancer. BJU Int 2008; 101:308-12. [DOI: 10.1111/j.1464-410x.2007.07331.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ross RW, Beer TM, Jacobus S, Bubley GJ, Taplin ME, Ryan CW, Huang J, Oh WK. A phase 2 study of carboplatin plus docetaxel in men with metastatic hormone-refractory prostate cancer who are refractory to docetaxel. Cancer 2008; 112:521-6. [DOI: 10.1002/cncr.23195] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nakabayashi M, Sartor O, Jacobus S, Regan MM, McKearn DK, Ross RW, Kantoff PW, Taplin M, Oh WK. Response to docetaxel (D)/carboplatin (C)-based chemotherapy as first- and second-line therapy in patients with metastatic hormone-refractory prostate cancer (HRPC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5156] [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: 11/20/2022] Open
Abstract
5156 Background: Effective treatment options for HRPC patients are limited. We evaluated efficacy of D/C-based chemotherapy as first- and second-line chemotherapy. Methods: We retrospectively identified all patients with HRPC treated with D/C-based chemotherapy at DFCI. Regimens either included estramustine (EDC) or not (DC). Patients treated with EDC received D 20–70 mg/m2 q1–4 weeks, E 140mg TID and C AUC 4–6 q 3–4 weeks. Patients treated with DC received D 50–70 mg/m2 and C AUC 4–5 q 3–4 weeks. PSA declines and measurable response were assessed per PSA Working Group and RECIST criteria, respectively. Time to event from chemotherapy initiation based on Kaplan-Meier method. Results: 58 patients were included: 27 patients received EDC, 35 received DC, and 4 received both regimens. Median age and PSA at initiation of chemotherapy was 58 years (range: 42–78) and 132.6 ng/ml (range: 0.3–5352.5), respectively. Table shows median duration of PSA response and TTP, by regimen. Most patients received EDC as first-line chemotherapy (89%). PSA declines ≥ 50% were observed in 24 patients (88.9%, 95% C.I. 71–98) and PSA declined in all 27 patients by a median of 81.3 % (range 33–100). Of 8 patients with measurable disease (MD), 2 had confirmed PR and 4 had SD. Median survival was 17.5 months (95% C.I. 12.0–24.5). 34 out of 35 patients received DC as ≥ 2nd line chemotherapy. PSA declines ≥ 50% were seen in 7 DC patients (20%, 95%C.I. 8–37) and PSA declined in 24 patients with a median of 37.7 % (range 2.0–100). Of 15 patients with MD at baseline, one had confirmed CR, one had PR, and 6 patients had SD. Median survival was 14.8 months (95% C.I. 9–19). The most common reversible grade 4 toxicity with either regimen was neutropenia (6.9%). Conclusions: D/C-based chemotherapy is well tolerated and active in HRPC. As first line chemotherapy, EDC demonstrated PSA declines ≥50% in 88.9% of patients. DC was active as ≥ 2nd-line chemotherapy with PSA declines ≥50% seen in 20%. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
| | - O. Sartor
- Dana-Farber Cancer Institute, Boston, MA
| | - S. Jacobus
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - R. W. Ross
- Dana-Farber Cancer Institute, Boston, MA
| | | | - M. Taplin
- Dana-Farber Cancer Institute, Boston, MA
| | - W. K. Oh
- Dana-Farber Cancer Institute, Boston, MA
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Rajkumar SV, Jacobus S, Callander N, Fonseca R, Vesole D, Williams M, Abonour R, Siegel D, Greipp P. Phase III trial of lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed multiple myeloma (E4A03): A trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba8025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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
LBA8025 Background: We compared lenalidomide plus high (standard) dose Dex (R+HighD) versus lenalidomide plus low dose Dex (R+LowD) in newly diagnosed MM. Methods: Pts with untreated, symptomatic MM were eligible. Pts in both arms received lenalidomide 25 mg/day PO days 1–21 every 28 days. In addition, pts in the R+HighD arm received Dex 40 mg days 1–4, 9–12, and 17–20 PO every 28 days; pts in the R+LowD arm received Dex 40 mg days 1, 8, 15, and 22 PO every 28 days. The primary null hypothesis was that response rates at 4 months on the 2 arms are equivalent. Planned sample size was 196 eligible pts per arm with one-sided 0.10 Type I and 0.05 Type II error rate. Pre-planned interim analysis is performed by an independent DMC when full information is available on 25%, 50% and 75% of accrual. All analysis were intent to treat. Results: 445 pts (median age, 65 yrs) were accrued; 223 randomized to R+HighD, 222 to R+LowD. Arms were well balanced for age, gender, stage, bone lesions, hemoglobin, beta-2 microglobulin, performance status, bone marrow plasma cells, and M protein levels at baseline. Major grade 3 or higher toxicities included thromboembolism (22.1% with R+HighD vs 6.1% in R+LowD), infection/pneumonia (15.7% vs 7.5%) and hyperglycemia (9.7% vs 6.6%). Grade 3 or higher non-hematologic toxicities occurred in 65.9% (R+HighD) versus 54.9% (R+LowD) respectively; corresponding grade 4 or higher rates were 20.3% vs 13.1% respectively. Overall survival (OS) at first interim analysis was significantly superior with R+LowD, P<0.001; one year survival 96.5% (R+LowD) versus 86% (Rev+HighD). OS differences in favor of R+LowD were seen in pts <65 (P=0.015; one year rate 98% vs 90%) and pts 65 and older (P=0.004; one year rate 95% vs 83%), respectively. DMC recommended release of survival results, and recommended switching all pts to R+LowD. DMC also recommended closure of an expansion phase trial of R+HighD investigating optimal thromboprophylaxis. Conclusions: Lenalidomide plus low-dose dexamethasone is associated with superior OS compared to lenalidomide plus high-dose dexamethasone. This study has major implications for future use of high-dose dexamethasone in the treatment of MM. No significant financial relationships to disclose.
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Affiliation(s)
- S. V. Rajkumar
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - S. Jacobus
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - N. Callander
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - R. Fonseca
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - D. Vesole
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - M. Williams
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - R. Abonour
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - D. Siegel
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
| | - P. Greipp
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; St. Vincent's Hospital, New York, NY; University of Virginia, Charlottesville, VA; Indiana University, Indianapolis, IN; Hackensack University Medical Center, Hackensack, NJ
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Chng WJ, Price-Troska T, Gonzalez-Paz N, Van Wier S, Jacobus S, Blood E, Henderson K, Oken M, Van Ness B, Greipp P, Rajkumar SV, Fonseca R. Clinical significance of TP53 mutation in myeloma. Leukemia 2007; 21:582-4. [PMID: 17215851 DOI: 10.1038/sj.leu.2404524] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chng WJ, Santana-Dávila R, Van Wier SA, Ahmann GJ, Jalal SM, Bergsagel PL, Chesi M, Trendle MC, Jacobus S, Blood E, Oken MM, Henderson K, Kyle RA, Gertz MA, Lacy MQ, Dispenzieri A, Greipp PR, Fonseca R. Prognostic factors for hyperdiploid-myeloma: effects of chromosome 13 deletions and IgH translocations. Leukemia 2006; 20:807-13. [PMID: 16511510 DOI: 10.1038/sj.leu.2404172] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [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: 11/09/2022]
Abstract
Chromosomal hyperdiploidy is the defining genetic signature in 40-50% of myeloma (MM) patients. We characterize hyperdiploid-MM (H-MM) in terms of its clinical and prognostic features in a cohort of 220 H-MM patients entered into clinical trials. Hyperdiploid-myeloma is associated with male sex, kappa immunoglobulin subtype, symptomatic bone disease and better survival compared to nonhyperdiploid-MM (median overall survival 48 vs 35 months, log-rank P = 0.023), despite similar response to treatment. Among 108 H-MM cases with FISH studies for common genetic abnormalities, survival is negatively affected by the existence of immunoglobulin heavy chain (IgH) translocations, especially those involving unknown partners, while the presence of chromosome 13 deletion by FISH did not significantly affect survival (median overall survival 50 vs 47 months, log-rank P = 0.47). Hyperdiploid-myeloma is therefore a unique genetic subtype of MM associated with improved outcome with distinct clinical features. The existence of IgH translocations but not chromosome 13 deletion by FISH negatively impacts survival and may allow further risk stratification of this population of MM patients.
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Affiliation(s)
- W J Chng
- Division of Hematology-Oncology, Mayo Clinic Scottsdale, AZ 85259, USA
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Chng WJ, Price-Troska T, Van Wier S, Jacobus S, Blood E, Henderson K, Oken MM, Van Ness B, Greipp P, Fonseca R. Clinical and biological implication of defective p53 pathway in multiple myeloma (MM). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17516] [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: 11/20/2022] Open
Abstract
17516 Background: The p53 tumor suppressor is commonly inactivated by mutations. Even in tumors without mutations, there are defects in the response to p53 activation. In MM, the prognostic significance of p53 mutation is unknown, while there has been no systematic study of p53 function. We seek to address these issues in this study. Methods: p53 mutation was studied by conformation sensitive gel electrophoresis with primers encompassing exons 1 to 10 followed by sequencing of DNA fragments with altered electrophoretic pattern in newly diagnosed MM patients entered into ECOG E9486 trial where patients were randomized to receive variations of melphalan-based conventional chemotherapy (VBMCP). Fisher’s exact tests were used to compare variables between patients. Kaplan-Meier survival curves were compared using the log-rank test. To investigate p53 function, we analyzed the expression of p53, and 3 of its transcriptional targets, APAF1, p21 and MDM2, in a separate cohort of 15 normal plasma cells (PC), 14 MGUS, 13 smoldering myeloma (SMM) and 101 MM (73 new and 28 relapsed) from the Mayo Clinic who had gene expression profiling performed on the Affymetrix U133A chip (Santa Clara, Ca). Results: Two hundred and sixty-eight patients had enough materials for study and were included in the analysis. The prevalence of p53 mutation was 3% (n = 9). Five of the 9 patients (56%, p = 0.001) with mutations also had p53 deletion (studied by fluorescent in-situ hybridization) resulting in bi-allelic loss of p53. Soft tissue plasmacytomas (37% v 7%, p = 0.018), and among the common translocations, t(4;14) and t(14;16) (50% v 18%) were more common in patients with p53 mutations. Despite similar response to treatment, those with p53 mutation had very short OS (16.7 v 41.4 months, p < 0.001). There was induction of p53 expression in MGUS and SMM with concurrent induction of APAF1, p21 and MDM2 whereas loss of this pattern was frequent in MM (45% in new MM and 60% in relapse MM compared to 15% in MGUS/SMM (p = 0.03)). Conclusions: p53 mutations are relatively rare in newly diagnosed MM patients but portend a short survival. However, functional abnormalities of p53 are prevalent and may be important in progression from MGUS/SMM to MM. [Table: see text]
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Affiliation(s)
- W. J. Chng
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - T. Price-Troska
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - S. Van Wier
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - S. Jacobus
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - E. Blood
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - K. Henderson
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - M. M. Oken
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - B. Van Ness
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - P. Greipp
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
| | - R. Fonseca
- Mayo Clinic Scottsdale, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Minnesota, Minneapolis, MN
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Jacobus S, Schneeweiss S, Chan KA. Exposure misclassification as a result of free sample drug utilization in automated claims databases and its effect on a pharmacoepidemiology study of selective COX-2 inhibitors. Pharmacoepidemiol Drug Saf 2004; 13:695-702. [PMID: 15386727 DOI: 10.1002/pds.981] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Free drug samples are widely used in clinical practice. We were concerned about free sample drug utilization as a source of misclassification in pharmacoepidemiology research using claims data that may result in biased effect estimates. METHODS We investigated the magnitude of potential bias with sensitivity analyses based on a published study that examined cardiovascular risk associated with selective cyclooxygenase 2 (COX-2) inhibitors. We derived an estimate of free sample drug utilization with market data for rofexcoxib and calculated sensitivity of the exposure ascertainment method using claims data. We corrected the incidence rate ratio assuming the observed unexposed incidence rate was actually a weighted average rate of the truly unexposed and free sample drug users. The impact of exposure misclassification measured as the percentage change from a corrected to the reported crude incidence rate ratio was examined under a range of free sample drug utilization proportions and unexposed cohort sizes. RESULTS The proportion of free sample drug utilization of all rofecoxib use in our base case scenario was 15.48%, resulting in sensitivity of 84.52% for exposure ascertainment. The magnitude of bias was an underestimation of the unadjusted incidence rate ratio by 0.03%. With a free sample drug utilization proportion of 1.48% and the same unexposed cohort size of 237 975 person-years, the underestimation was 0.003%. If the unexposed cohort were 975 person-years given a 15.48% proportion, the underestimation was 8.82%. CONCLUSIONS In the pharmacoepidemiology study, we examined that uses claims data to ascertain drug exposure, our results suggest that adjustment for free sample drug utilization is probably not warranted.
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Affiliation(s)
- Susanna Jacobus
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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Abstract
The time required to induce two inducible hepatic enzymes, ornithine decarboxylase (ODC) and tyrosine aminotransferase (TAT), by growth hormone and dexamethasone, respectively, increases with age. Specific activity at the peak of induction is the same for all ages. On the other hand, for basal TAT the specific activity per unit of TAT antigen was found to decrease considerably with age. The half-life of ODC was determined after cycloheximide administration. The apparent half-life at the peak of ODC induction increases from 15 minutes in 3-4-month-old mice to 30 minutes in 24-month-old animals. Loss of efficiency in the protein degradation system is implicated in this phenomenon as no apparent differences could be observed in the susceptibility of ODC and TAT from young or old mice to chymotrypsin. ODC and TAT are activated by temperatures of up to 37 degrees C and 50 degrees C, respectively. ODC is inactivated at 50 degrees C while TAT is inactivated at 76 degrees C. "Young" ODC and TAT are more readily activated or inactivated by heating than the "old" enzymes.
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Jacobus S. Proceedings: Reaction of phenylmethanesulfonyl subtilisin with hydrogen peroxide. Isr J Med Sci 1975; 11:1168-9. [PMID: 1205728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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