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Ryu HJ, Lee JH, Park CK, Kim TM, Choi SH, Lee ST. Distribution and Failure Patterns of Primary Central Nervous System Lymphoma Related to Hippocampus. Int J Radiat Oncol Biol Phys 2023; 117:S160-S161. [PMID: 37784403 DOI: 10.1016/j.ijrobp.2023.06.253] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Hippocampus (HC) injury by conventional whole brain radiotherapy (C-WBRT) contributes to the neurocognitive decline in primary central nervous system lymphoma (PCNSL). Hippocampal avoidance (HA-WBRT) could minimize neurocognitive impairment by reducing the radiation dose to HC. However, its feasibility in PCNSL has not been examined regarding the incidence of HC involvement and failures. In this retrospective study, we assessed the risk of hippocampal area involvement at diagnosis and after treatments in PCNSL patients. MATERIALS/METHODS We identified 278 immunocompetent PCNSL patients diagnosed between 2000 and 2020. After high dose methotrexate-based induction chemotherapy, patients were observed or given consolidation therapy including RT, cytarabine alone, or autologous stem cell transplantation (ASCT). HC was contoured on T1 MRI image and expanded with a 5mm margin, generating hippocampal avoidance region (HAR). The extent of initial and recurrent lesions was evaluated using pre-induction and post-consolidation T1 contrast-enhanced MRI images. HC failure was defined as recurrence or progression at HAR and those who progressed after induction were excluded. The median follow up was 38.7 months (3.1-239.4). RESULTS Of 278 patients diagnosed with PCNSL, 39.9% of them had initial lesions at HAR (Figure 1a). After induction therapy, 212 evaluable patients received following treatments: RT (n = 145, 68.4%) consisting of C-WBRT (n = 114), HA-WBRT (n = 23), and focal RT (n = 8), observation (n = 38, 17.9%), cytarabine only (24, 11.3%), and ASCT (n = 5, 2.4%). Intracranial failures occurred in 47.6% (n = 101) of patients, with 33.7% (n = 34) of them in HAR (Figure 1b). The multivariate analysis identified multifocal disease (HR 3.86, 95% CI 1.15-9.73, p = 0.004) as the only factor associated with the risk of HC failure. Those with unifocal lesion outside HAR showed the lowest HC failure rate, 7.0%, while the highest HC failure rate, 25.4% was observed in the subgroup with multifocal disease within HAR at diagnosis (Figure 2a). In the lowest risk group (unifocal lesion outside HAR, n = 66), C-WBRT was not significantly associated with HC failure (HR 0.57, CI 0.09-3.33, P = .572, Figure 2b) or intracranial failure (HR 0.88, CI 0.40-1.91, P = .748). CONCLUSION Our data suggest the HA-WBRT could be explored in patients whose lesion is unifocal and located outside HAR. For patients without initial HAR involvement, hippocampal including WBRT did not significantly change HC failure. Further prospective study will be warranted to assess the feasibility of HA-WBRT in the subgroup with low risk of HC failure.
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Affiliation(s)
- H J Ryu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J H Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - C K Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - T M Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - S H Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S T Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
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Chung H, Seo H, Choi SH, Park CK, Kim TM, Park SH, Won JK, Lee JH, Lee ST, Lee JY, Hwang I, Kang KM, Yun TJ. Cluster Analysis of DSC MRI, Dynamic Contrast-Enhanced MRI, and DWI Parameters Associated with Prognosis in Patients with Glioblastoma after Removal of the Contrast-Enhancing Component: A Preliminary Study. AJNR Am J Neuroradiol 2022; 43:1559-1566. [PMID: 36175084 PMCID: PMC9731243 DOI: 10.3174/ajnr.a7655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE No report has been published on the use of DSC MR imaging, DCE MR imaging, and DWI parameters in combination to create a prognostic prediction model in glioblastoma patients. The aim of this study was to develop a machine learning-based model to find preoperative multiparametric MR imaging parameters associated with prognosis in patients with glioblastoma. Normalized CBV, volume transfer constant, and ADC of the nonenhancing T2 high-signal-intensity lesions were evaluated using K-means clustering. MATERIALS AND METHODS A total of 142 patients with glioblastoma who underwent preoperative MR imaging and total resection were included in this retrospective study. From the normalized CBV, volume transfer constant, and ADC maps, the parametric data were sorted using the K-means clustering method. Patients were divided into training and test sets (ratio, 1:1), and the optimal number of clusters was determined using receiver operating characteristic analysis. Kaplan-Meier survival analysis and log-rank tests were performed to identify potential parametric predictors. A multivariate Cox proportional hazard model was conducted to adjust for clinical predictors. RESULTS The nonenhancing T2 high-signal-intensity lesions were divided into 6 clusters. The cluster (class 4) with the relatively low normalized CBV and volume transfer constant value and the lowest ADC values was most associated with predicting glioblastoma prognosis. The optimal cutoff of the class 4 volume fraction of nonenhancing T2 high-signal-intensity lesions predicting 1-year progression-free survival was 9.70%, below which the cutoff was associated with longer progression-free survival. Two Kaplan-Meier curves based on the cutoff value showed a statistically significant difference (P = .037). When we adjusted for all clinical predictors, the cluster with the relatively low normalized CBV and volume transfer constant values and the lowest ADC value was an independent prognostic marker (hazard ratio, 3.04; P = .048). The multivariate Cox proportional hazard model showed a concordance index of 0.699 for progression-free survival. CONCLUSIONS Our model showed that nonenhancing T2 high-signal-intensity lesions with the relatively low normalized CBV, low volume transfer constant values, and the lowest ADC values could serve as useful prognostic imaging markers for predicting survival outcomes in patients with glioblastoma.
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Affiliation(s)
- H Chung
- From the Seoul National University College of Medicine (H.C., H.S.), Seoul, Korea
| | - H Seo
- From the Seoul National University College of Medicine (H.C., H.S.), Seoul, Korea
| | - S H Choi
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Center for Nanoparticle Research (S.H.C.), Institute for Basic Science, Seoul, Korea
- School of Chemical and Biological Engineering (S.H.C.), Seoul National University, Seoul, Korea
| | - C-K Park
- Department of Neurosurgery (C.-K.P.), Internal Medicine
| | - T M Kim
- Cancer Research Institute (T.M.K.)
| | - S-H Park
- Departments of Pathology (S.-H.P., J.K.W.), Radiation Oncology
| | - J K Won
- Departments of Pathology (S.-H.P., J.K.W.), Radiation Oncology
| | - J H Lee
- Cancer Research Institute (J.H.L.)
| | - S-T Lee
- Neurology (S.-T.L.), Seoul National University Hospital, Seoul, Korea
| | - J Y Lee
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - I Hwang
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - K M Kang
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - T J Yun
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Planchard D, Feng PH, Karaseva N, Kim SW, Kim TM, Lee CK, Poltoratskiy A, Yanagitani N, Marshall R, Huang X, Howarth P, Jänne PA, Kobayashi K. Osimertinib plus platinum-pemetrexed in newly diagnosed epidermal growth factor receptor mutation-positive advanced/metastatic non-small-cell lung cancer: safety run-in results from the FLAURA2 study. ESMO Open 2021; 6:100271. [PMID: 34543864 PMCID: PMC8453202 DOI: 10.1016/j.esmoop.2021.100271] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background The phase III FLAURA2 (NCT04035486) study will evaluate efficacy and safety of first-line osimertinib with platinum–pemetrexed chemotherapy versus osimertinib monotherapy in epidermal growth factor receptor mutation-positive (EGFRm) advanced/metastatic non-small-cell lung cancer (NSCLC). The safety run-in, reported here, assessed the safety and tolerability of osimertinib with chemotherapy prior to the randomized phase III evaluation. Patients and methods Patients (≥18 years; Japan: ≥20 years) with EGFRm locally advanced/metastatic NSCLC received oral osimertinib 80 mg once daily (QD), with either intravenous (IV) cisplatin 75 mg/m2 or IV carboplatin target area under the curve 5, plus pemetrexed 500 mg/m2 every 3 weeks (Q3W) for four cycles. Maintenance was osimertinib 80 mg QD with pemetrexed 500 mg/m2 Q3W until progression/discontinuation. The primary objective was to evaluate safety and tolerability of the osimertinib–chemotherapy combination. Results Thirty patients (15 per group) received treatment [Asian, 73%; female, 63%; median age (range) 61 (45-84) years]. Adverse events (AEs) were reported by 27 patients (90%): osimertinib–carboplatin–pemetrexed, 100%; osimertinib–cisplatin–pemetrexed, 80%. Most common AEs were constipation (60%) with osimertinib–carboplatin–pemetrexed and nausea (60%) with osimertinib–cisplatin–pemetrexed. In both groups, 20% of patients reported serious AEs. No specific pattern of AEs leading to dose modifications/discontinuations was observed; one patient discontinued all study treatments including osimertinib due to pneumonitis (study-specific discontinuation criterion). Hematologic toxicities were as expected and manageable. Conclusions Osimertinib–chemotherapy combination had a manageable safety and tolerability profile in EGFRm advanced/metastatic NSCLC, supporting further assessment in the FLAURA2 randomized phase. FLAURA2 aims to assess efficacy and safety of first-line osimertinib with platinum–pemetrexed in EGFRm advanced NSCLC. In the FLAURA2 safety run-in period, 30 patients received osimertinib and pemetrexed with carboplatin or cisplatin. Most common AEs were constipation and nausea; no AE patterns leading to dose modifications/discontinuations were observed. The FLAURA2 safety run-in study showed that the safety profile of this combination was as expected and manageable.
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Affiliation(s)
- D Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Oncology Unit, Villejuif, France.
| | - P-H Feng
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - N Karaseva
- City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - S-W Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - T M Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Lee
- Clinical Research Unit, Division of Cancer Services, St. George Hospital, Kogarah, Australia
| | - A Poltoratskiy
- Department of Clinical Trials, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - N Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | | | | | | | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama Medical School International Medical Center, Saitama, Japan
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Kim TM, Cho JY, Kim SY, Kim SH. Diagnostic accuracy of the jetting sign and a dilatation ratio of left renal vein in CT urography for detecting anterior nutcracker syndrome. Clin Radiol 2021; 76:510-518. [PMID: 33736881 DOI: 10.1016/j.crad.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic value of computed tomography (CT) urography findings of anterior nutcracker syndrome (NCS). MATERIALS AND METHODS The study included patients with left renal vein (LRV) compression at the aortomesenteric portion at CT urography who underwent renal venography or cystoscopy. Patients with a renocaval pressure gradient of ≥3 mmHg on renal venography or bloody urine jetting from the left ureteral orifice on cystoscopy were defined as the NCS group; the remaining patients comprised the non-NCS group. CT findings were analysed using the jetting of contrast medium flow from the LRV to the inferior vena cava (jetting sign), aortomesenteric distance, presence of collateral veins, and a dilatation ratio of LRV diameter at the aortomesenteric portion (arterial phase/delayed phases). Clinical findings, including age, gender, and body-mass-index, were also analysed. CT features and clinical findings were compared between the NCS and non-NCS groups. Diagnostic performance of CT parameters was assessed using receiver operating characteristic curve analysis. RESULTS A total of 70 patients (21 men, mean age 44.4 ± 17.2 years) with NCS (n=13) and non-NCS (n=57) were included. Younger age (<40 years), presence of the jetting sign, and a lower dilatation ratio of LRV diameter between the arterial and delayed phases (<1.7) were found to be significant independent factors for predicting the NCS group (OR 24.5, 18.9, 19.4, respectively, p<0.05 for all). The combination of the presence of the jetting sign and a dilatation ratio of LRV diameter of <1.7 obtained the highest AUC of 0.88. CONCLUSION The jetting sign and the dilatation ratio of LRV diameter between the arterial and delayed phases can both be very useful in the diagnosis of anterior nutcracker syndrome during CT urography.
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Affiliation(s)
- T M Kim
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - J Y Cho
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.
| | - S Y Kim
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - S H Kim
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea
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Schuler M, Berardi R, Lim WT, de Jonge M, Bauer TM, Azaro A, Gottfried M, Han JY, Lee DH, Wollner M, Hong DS, Vogel A, Delmonte A, Akimov M, Ghebremariam S, Cui X, Nwana N, Giovannini M, Kim TM. Molecular correlates of response to capmatinib in advanced non-small-cell lung cancer: clinical and biomarker results from a phase I trial. Ann Oncol 2020; 31:789-797. [PMID: 32240796 DOI: 10.1016/j.annonc.2020.03.293] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 10/13/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dysregulation of receptor tyrosine kinase MET by various mechanisms occurs in 3%-4% of non-small-cell lung cancer (NSCLC) and is associated with unfavorable prognosis. While MET is a validated drug target in lung cancer, the best biomarker strategy for the enrichment of a susceptible patient population still remains to be defined. Towards this end we analyze here primary data from a phase I dose expansion study of the MET inhibitor capmatinib in patients with advanced MET-dysregulated NSCLC. PATIENTS AND METHODS Eligible patients [≥18 years; Eastern Cooperative Oncology Group (ECOG) performance status ≤2] with MET-dysregulated advanced NSCLC, defined as either (i) MET status by immunohistochemistry (MET IHC) 2+ or 3+ or H-score ≥150, or MET/centromere ratio ≥2.0 or gene copy number (GCN) ≥5, or (ii) epidermal growth factor receptor wild-type (EGFRwt) and centrally assessed MET IHC 3+, received capmatinib at the recommended dose of 400 mg (tablets) or 600 mg (capsules) b.i.d. The primary objective was to determine safety and tolerability; the key secondary objective was to explore antitumor activity. The exploratory end point was the correlation of clinical activity with different biomarker formats. RESULTS Of 55 patients with advanced MET-dysregulated NSCLC, 40/55 (73%) had received two or more prior systemic therapies. All patients discontinued treatment, primarily due to disease progression (69.1%). The median treatment duration was 10.4 weeks. The overall response rate per RECIST was 20% (95% confidence interval, 10.4-33.0). In patients with MET GCN ≥6 (n = 15), the overall response rate by both the investigator and central assessments was 47%. The median progression-free survival per investigator for patients with MET GCN ≥6 was 9.3 months (95% confidence interval, 3.8-11.9). Tumor responses were observed in all four patients with METex14. The most common toxicities were nausea (42%), peripheral edema (33%), and vomiting (31%). CONCLUSIONS MET GCN ≥6 and/or METex14 are suited to predict clinical activity of capmatinib in patients with NSCLC (NCT01324479).
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Affiliation(s)
- M Schuler
- Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - R Berardi
- Clinica Oncologica, Università Politecnica delle Marche-Ospedali Riuniti, Ancona, Italy
| | - W-T Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M de Jonge
- Medical Oncology, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - T M Bauer
- Drug Development Unit, Sarah Cannon Research Institute, and Tennessee Oncology, PLCC, Nashville, USA
| | - A Azaro
- Medical Oncology, Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Pharmacology Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M Gottfried
- Department of Oncology, Oncology Institute of Meir Medical Center, Tel-Aviv, Israel
| | - J-Y Han
- Center for Lung Cancer, National Cancer Center, Seoul
| | - D H Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M Wollner
- Thoracic Service Oncology Department, Rambam Health Care Campus, Haifa, Israel
| | - D S Hong
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, USA
| | - A Vogel
- Gastroenterology, Hepatology, Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Delmonte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - M Akimov
- Oncology Global Development, Novartis Pharma AG, Basel, Switzerland
| | | | - X Cui
- Novartis Institutes for Biomedical Research
| | | | - M Giovannini
- Oncology Global Development, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - T M Kim
- Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hwang I, Choi SH, Park CK, Kim TM, Park SH, Won JK, Kim IH, Lee ST, Yoo RE, Kang KM, Yun TJ, Kim JH, Sohn CH. Dynamic Contrast-Enhanced MR Imaging of Nonenhancing T2 High-Signal-Intensity Lesions in Baseline and Posttreatment Glioblastoma: Temporal Change and Prognostic Value. AJNR Am J Neuroradiol 2019; 41:49-56. [PMID: 31806595 DOI: 10.3174/ajnr.a6323] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of dynamic contrast-enhanced MR imaging on nonenhancing T2 high-signal-intensity lesions in patients with glioblastoma has not been thoroughly elucidated to date. We evaluated the temporal change and prognostic value for progression-free survival of dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters on nonenhancing T2 high-signal-intensity lesions in patients with glioblastoma before and after standard treatment, including gross total surgical resection. MATERIALS AND METHODS This retrospective study included 33 patients who were newly diagnosed with glioblastoma and treated with gross total surgical resection followed by concurrent chemoradiation therapy and adjuvant chemotherapy with temozolomide in a single institution. All patients underwent dynamic contrast-enhanced MR imaging before surgery as a baseline and after completion of maximal surgical resection and concurrent chemoradiation therapy. On the whole nonenhancing T2 high-signal-intensity lesion, dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters (volume transfer constant [K trans], volume of extravascular extracellular space [v e], and blood plasma volume [vp ]) were calculated. The Cox proportional hazards regression model analysis was performed to determine the histogram features or percentage changes of pharmacokinetic parameters related to progression-free survival. RESULTS Baseline median K trans, baseline first quartile K trans, and posttreatment median K trans were significant independent variables, as determined by univariate analysis (P < .05). By multivariate Cox regression analysis including methylation status of O6-methylguanine-DNA methyltransferase, baseline median K trans was determined to be the significant independent variable and was negatively related to progression-free survival (hazard ratio = 1.48, P = .003). CONCLUSIONS Baseline median K trans from nonenhancing T2 high-signal-intensity lesions could be a potential prognostic imaging biomarker in patients undergoing gross total surgical resection followed by standard therapy for glioblastoma.
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Affiliation(s)
- I Hwang
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
| | - S H Choi
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research .,Institute for Basic Science, and School of Chemical and Biological Engineering (S.H.C.)
| | - C-K Park
- Department of Neurosurgery and Biomedical Research Institute (P.C.-K.)
| | - T M Kim
- Department of Internal Medicine and Cancer Research Institute (T.M.K.)
| | - S-H Park
- Department of Pathology (S.-H.P., J.K.W.)
| | - J K Won
- Department of Pathology (S.-H.P., J.K.W.)
| | - I H Kim
- Department of Radiation Oncology and Cancer Research Institute (I.H.K.)
| | - S-T Lee
- Department of Neurology (S.-T.L.), Seoul National University Hospital, Seoul, Korea
| | - R-E Yoo
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
| | - K M Kang
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
| | - T J Yun
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
| | - J-H Kim
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
| | - C-H Sohn
- From the Department of Radiology (I.H., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-H.K., C.-H.S.), Center for Nanoparticle Research
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Kim SH, Cho KH, Choi SH, Kim TM, Park CK, Park SH, Won JK, Kim IH, Lee ST. Prognostic Predictions for Patients with Glioblastoma after Standard Treatment: Application of Contrast Leakage Information from DSC-MRI within Nonenhancing FLAIR High-Signal-Intensity Lesions. AJNR Am J Neuroradiol 2019; 40:2052-2058. [PMID: 31727756 DOI: 10.3174/ajnr.a6297] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Attempts have been made to quantify the microvascular leakiness of glioblastomas and use it as an imaging biomarker to predict the prognosis of the tumor. The purpose of our study was to evaluate whether the extraction fraction value from DSC-MR imaging within nonenhancing FLAIR hyperintense lesions was a better prognostic imaging biomarker than dynamic contrast-enhanced MR imaging parameters for patients with glioblastoma. MATERIALS AND METHODS A total of 102 patients with glioblastoma who received a preoperative dynamic contrast-enhanced MR imaging and DSC-MR imaging were included in this retrospective study. Patients were classified into the progression (n = 87) or nonprogression (n = 15) groups at 24 months after surgery. We extracted the means and 95th percentile values for the contrast leakage information parameters from both modalities within the nonenhancing FLAIR high-signal-intensity lesions. RESULTS The extraction fraction 95th percentile value was higher in the progression-free survival group of >24 months than at ≤24 months. The median progression-free survival of the group with an extraction fraction 95th percentile value of >13.32 was 17 months, whereas that of the group of ≤13.32 was 12 months. In addition, it was an independent predictor variable for progression-free survival in the patients regardless of their ages and genetic information. CONCLUSIONS The extraction fraction 95th percentile value was the only independent parameter for prognostic prediction in patients with glioblastoma among the contrast leakage information, which has no statistically significant correlations with the DCE-MR imaging parameters.
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Affiliation(s)
- S H Kim
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
| | - K H Cho
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
| | - S H Choi
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
- Center for Nanoparticle Research (S.H.C.), Institute for Basic Science, Seoul, Korea
- School of Chemical and Biological Engineering (S.H.C.), Seoul National University, Seoul, Korea
| | - T M Kim
- Departments of Internal Medicine (T.M.K.)
| | - C K Park
- Department of Neurosurgery (C.K.P.), Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - I H Kim
- Radiation Oncology (I.H.K.), Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - S T Lee
- Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Korea
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Knox JJ, Barrios CH, Kim TM, Cosgriff T, Srimuninnimit V, Pittman K, Sabbatini R, Rha SY, Flaig TW, Page RD, Beck JT, Cheung F, Yadav S, Patel P, Geoffrois L, Niolat J, Berkowitz N, Marker M, Chen D, Motzer RJ. Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC. Ann Oncol 2018; 29:2269. [PMID: 29390043 PMCID: PMC6290878 DOI: 10.1093/annonc/mdx807] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Kim HR, Kang HN, Shim HS, Kim EY, Kim J, Kim DJ, Lee JG, Lee CY, Hong MH, Kim SM, Kim H, Pyo KH, Yun MR, Park HJ, Han JY, Youn HA, Ahn MJ, Paik S, Kim TM, Cho BC. Co-clinical trials demonstrate predictive biomarkers for dovitinib, an FGFR inhibitor, in lung squamous cell carcinoma. Ann Oncol 2018; 28:1250-1259. [PMID: 28460066 DOI: 10.1093/annonc/mdx098] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background We conducted co-clinical trials in patient-derived xenograft (PDX) models to identify predictive biomarkers for the multikinase inhibitor dovitinib in lung squamous cell carcinoma (LSCC). Methods The PDX01-02 were established from LSCC patients enrolled in the phase II trial of dovitinib (NCT01861197) and PDX03-05 were established from LSCC patients receiving surgery. These five PDX tumors were subjected to in vivo test of dovitinib efficacy, whole exome sequencing and gene expression profiling. Results The PDX tumors recapitulate histopathological properties and maintain genomic characteristics of originating tumors. Concordant with clinical outcomes of the trial enrolled-LSCC patients, dovitinib produced substantial tumor regression in PDX-01 and PDX-05, whereas it resulted in tumor progression in PDX-02. PDX-03 and -04 also displayed poor antitumor efficacy to dovitinib. Mutational and genome-wide copy number profiles revealed no correlation between genomic alterations of FGFR1-3 and sensitivity to dovitinib. Of note, gene expression profiles revealed differentially expressed genes including FGF3 and FGF19 between PDX-01 and 05 and PDX-02-04. Pathway analysis identified two FGFR signaling-related gene sets, FGFR ligand binding/activation and SHC-mediated cascade pathway were substantially up-regulated in PDX-01 and 05, compared with PDX-02-04. The comparison of gene expression profiles between dovitinib-sensitive versus -resistant lung cancer cell lines in the Cancer Cell Line Encyclopedia database also found that transcriptional activation of 18 key signaling components in FGFR pathways can predict the sensitivity to dovitinib both in cell lines and PDX tumors. These results highlight FGFR pathway activation as a key molecular determinant for sensitivity to dovitinib. Conclusions FGFR gene expression signatures are predictors for the response to dovitinib in LSCC.
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Affiliation(s)
- H R Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - H N Kang
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | | | - E Y Kim
- Pulmonology, Yonsei University College of Medicine, Seoul
| | - J Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - D J Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - J G Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - C Y Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - M H Hong
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - S-M Kim
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H Kim
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - K-H Pyo
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - M R Yun
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H J Park
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - J Y Han
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H A Youn
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - M-J Ahn
- Division of Hematology & Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S Paik
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul
| | - T-M Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - B C Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul.,JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
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10
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Knox JJ, Barrios CH, Kim TM, Cosgriff T, Srimuninnimit V, Pittman K, Sabbatini R, Rha SY, Flaig TW, Page RD, Beck JT, Cheung F, Yadav S, Patel P, Geoffrois L, Niolat J, Berkowitz N, Marker M, Chen D, Motzer RJ. Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC. Ann Oncol 2018; 28:1339-1345. [PMID: 28327953 PMCID: PMC5452072 DOI: 10.1093/annonc/mdx075] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background RECORD-3 compared everolimus and sunitinib as first-line therapy, and the sequence of everolimus followed by sunitinib at progression compared with the opposite (standard) sequence in patients with metastatic renal cell carcinoma (mRCC). This final overall survival (OS) analysis evaluated mature data for secondary end points. Patients and methods Patients received either first-line everolimus followed by second-line sunitinib at progression (n = 238) or first-line sunitinib followed by second-line everolimus (n = 233). Secondary end points were combined first- and second-line progression-free survival (PFS), OS, and safety. The impacts of neutrophil lymphocyte ratio (NLR) and baseline levels of soluble biomarkers on OS were explored. Results At final analysis, median duration of exposure was 5.6 months for everolimus and 8.3 months for sunitinib. Median combined PFS was 21.7 months [95% confidence interval (CI) 15.1–26.7] with everolimus-sunitinib and 22.2 months (95% CI 16.0–29.8) with sunitinib-everolimus [hazard ratio (HR)EVE-SUN/SUN-EVE, 1.2; 95% CI 0.9–1.6]. Median OS was 22.4 months (95% CI 18.6–33.3) for everolimus-sunitinib and 29.5 months (95% CI 22.8–33.1) for sunitinib-everolimus (HREVE-SUN/SUN-EVE, 1.1; 95% CI 0.9–1.4). The rates of grade 3 and 4 adverse events suspected to be related to second-line therapy were 47% with everolimus and 57% with sunitinib. Higher NLR and 12 soluble biomarker levels were identified as prognostic markers for poor OS with the association being largely independent of treatment sequences. Conclusions Results of this final OS analysis support the sequence of sunitinib followed by everolimus at progression in patients with mRCC. The safety profiles of everolimus and sunitinib were consistent with those previously reported, and there were no unexpected safety signals. Clinical Trials number ClinicalTrials.gov identifier, NCT00903175
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Affiliation(s)
- J J Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - C H Barrios
- PUCRS School of Medicine, Porto Alegre, Brazil
| | - T M Kim
- Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - T Cosgriff
- Crescent City Research Consortium, Marrero, USA
| | - V Srimuninnimit
- Internal Medicine, Siriraj Hospital, Mahidol University, Mahidol, Thailand
| | - K Pittman
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, Australia
| | | | - S Y Rha
- Yonsei Cancer Center, Seoul, South Korea
| | - T W Flaig
- University of Colorado School of Medicine, Aurora
| | - R D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | - J T Beck
- Highlands Oncology Group, Fayetteville, USA
| | - F Cheung
- Department of Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - S Yadav
- Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, Canada
| | - P Patel
- Academic Division of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - L Geoffrois
- Department of Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre Lès Nancy
| | - J Niolat
- Novartis Pharma SAS, Rueil-Malmaison, France
| | | | | | - D Chen
- Novartis Oncology, East Hanover
| | - R J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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11
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Lee SH, Lee JK, Ahn MJ, Kim DW, Sun JM, Keam B, Kim TM, Heo DS, Ahn JS, Choi YL, Min HS, Jeon YK, Park K. Vandetanib in pretreated patients with advanced non-small cell lung cancer-harboring RET rearrangement: a phase II clinical trial. Ann Oncol 2017; 28:292-297. [PMID: 27803005 DOI: 10.1093/annonc/mdw559] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Chromosomal rearrangements involving RET, which are found in about 1% of non-small cell lung cancer (NSCLC), define a unique molecular subset. We performed this study to examine the efficacy and safety of vandetanib 300 mg daily in this patient population. Patients and methods This study was a multi-center, open-label, phase II clinical trial. Patients were enrolled if they had metastatic or recurrent NSCLC with a RET rearrangement, which was confirmed by fluorescence in situ hybridization, had progressive disease against platinum-based doublet chemotherapy, and had a performance status of 0-2. The primary endpoint was the objective response rate. Results A total of 18 patients were enrolled in this study between July 2013 and October 2015. Patients were aged 35-71 years; three had a performance status of 2, and the majority were a heavily pretreated population (≥ two different previous chemotherapy regimens in 72% of the patients). Among the 17 evaluable patients, three had a partial response (objective response rate = 18%) and eight had a stable disease (disease control rate = 65%). Among these patients, the partial response or disease stabilization was durable for more than 6 months in eight patients. Vandetanib also showed a progression-free survival of 4.5 months, and an overall survival of 11.6 months during a median follow-up duration of 14 months. The safety profile was comparable with previous studies of vandetanib. Most vandetanib-related adverse events were mild with prevalent hypertension and rash (in >70% of patients). Grade 3 toxicity included hypertension (n = 3), QT prolongation (2), and elevation of aminotransferases (1), and as a consequence the dose was reduced in four patients. There were no adverse events associated with grade 4 or 5 toxicity. Conclusion Vandetanib is moderately active in pretreated patients with advanced NSCLC-harboring RET rearrangements.
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Affiliation(s)
- S-H Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - J-K Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - M-J Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - D-W Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - J-M Sun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - B Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - T M Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - D S Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - J S Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Y-L Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - H-S Min
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Y K Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - K Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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12
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Lee JK, Louzada S, An Y, Kim SY, Kim S, Youk J, Park S, Koo SH, Keam B, Jeon YK, Ku JL, Yang F, Kim TM, Ju YS. Complex chromosomal rearrangements by single catastrophic pathogenesis in NUT midline carcinoma. Ann Oncol 2017; 28:890-897. [PMID: 28203693 PMCID: PMC5378225 DOI: 10.1093/annonc/mdw686] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/15/2016] [Indexed: 01/12/2023] Open
Abstract
Background Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare aggressive malignancy often occurring in the tissues of midline anatomical structures. Except for the pathognomonic BRD3/4–NUT rearrangement, the comprehensive landscape of genomic alterations in NMCs has been unexplored. Patients and methods We investigated three NMC cases, including two newly diagnosed NMC patients in Seoul National University Hospital, and a previously reported cell line (Ty-82). Whole-genome and transcriptome sequencing were carried out for these cases, and findings were validated by multiplex fluorescence in situ hybridization and using individual fluorescence probes. Results Here, we present the first integrative analysis of whole-genome sequencing, transcriptome sequencing and cytogenetic characterization of NUT midline carcinomas. By whole-genome sequencing, we identified a remarkably similar pattern of highly complex genomic rearrangements (previously denominated as chromoplexy) involving the BRD3/4–NUT oncogenic rearrangements in two newly diagnosed NMC cases. Transcriptome sequencing revealed that these complex rearrangements were transcribed as very simple BRD3/4–NUT fusion transcripts. In Ty-82 cells, we also identified a complex genomic rearrangement involving the BRD4–NUT rearrangement underlying the simple t(15;19) karyotype. Careful inspections of rearrangement breakpoints indicated that these rearrangements were likely attributable to single catastrophic events. Although the NMC genomes had >3000 somatic point mutations, canonical oncogenes or tumor suppressor genes were rarely affected, indicating that they were largely passenger events. Mutational signature analysis showed predominant molecular clock-like signatures in all three cases (accounting for 54%−75% of all base substitutions), suggesting that NMCs may arise from actively proliferating normal cells. Conclusion Taken together, our findings suggest that a single catastrophic event in proliferating normal cells could be sufficient for neoplastic transformation into NMCs.
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Affiliation(s)
- J-K Lee
- Korea Advanced Institute of Science and Technology, Graduate School of Medical Science and Engineering, Daejeon, South Korea
| | - S Louzada
- Molecular Cytogenetics Core Facility, Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Y An
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - S Y Kim
- Department of Laboratory Medicine, Chungnam National University School of Medicine, Daejeon, South Korea
| | - S Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea
| | - J Youk
- Korea Advanced Institute of Science and Technology, Graduate School of Medical Science and Engineering, Daejeon, South Korea
| | - S Park
- Korea Advanced Institute of Science and Technology, Graduate School of Medical Science and Engineering, Daejeon, South Korea
| | - S H Koo
- Department of Laboratory Medicine, Chungnam National University School of Medicine, Daejeon, South Korea
| | - B Keam
- Department of Internal Medicine Seoul National University Hospital, Seoul, South Korea
| | - Y K Jeon
- Pathology, Seoul National University Hospital, Seoul, South Korea
| | - J-L Ku
- Seoul National University Cancer Research Institute, Seoul, South Korea
| | - F Yang
- Molecular Cytogenetics Core Facility, Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - T M Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea.,Department of Internal Medicine Seoul National University Hospital, Seoul, South Korea
| | - Y S Ju
- Korea Advanced Institute of Science and Technology, Graduate School of Medical Science and Engineering, Daejeon, South Korea.,Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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13
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Jeong YJ, Kim H, Baik SJ, Kim TM, Yang SJ, Lee SH, Cho JH, Lee H, Yim HW, Choi IY, Yoon KH, Kim HS. Analysis and comparison of the cost-effectiveness of statins according to the baseline low-density lipoprotein cholesterol level in Korea. J Clin Pharm Ther 2017; 42:292-300. [PMID: 28251662 DOI: 10.1111/jcpt.12512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/03/2016] [Accepted: 02/02/2017] [Indexed: 01/01/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE There are a few Korean studies on the economics of statins based on reduction in low-density lipoprotein cholesterol (LDL-C) data from other countries. This study aimed to analyse and compare the cost-effectiveness of statins according to the baseline LDL-C level in Korea. METHODS Between January 2009 and December 2015, the data of patients who were prescribed statins for the first time were extracted from electronic medical records. We performed a cost-effectiveness analysis (CEA) based on the LDL-C reduction rate (CEA-RR) and target achievement rate. RESULTS AND DISCUSSION Among high-intensity statins, the CEA-RR value of rosuvastatin (20 mg) was significantly lower than that of atorvastatin (40 mg) at all baseline LDL-C levels, except levels of 160-189 mg/dL. Additionally, at baseline LDL-C levels of 130-159 mg/dL, the CEA-RR value of rosuvastatin (20 mg) was three times lower than that of atorvastatin (40 mg) (9·1 ± 2·5 $/% vs. 31·7 ± 15·0 $/%, P < 0·001). Among moderate-to-low-intensity statins, rosuvastatin (5 mg) showed the lowest CEA-RR value (4·0 ± 0·6 $/%), and the value significantly increased for pitavastatin (2 mg) (8·0 ± 0·6 $/%), atorvastatin (10 mg) (9·5 ± 0·5 $/%), simvastatin (10·8 ± 1·1 $/%) and pravastatin (40 mg) (11·5 ± 0·9 $/%) in order (P < 0·0001). On changing from atorvastatin (10 mg) to atorvastatin (20 mg), the additional yearly cost was 16·0 and additional CEA-RR value was 2·74 $/%. On the other hand, on changing from atorvastatin (10 mg) to rosuvastatin (10 mg), the additional yearly cost was -16·3 and additional CEA-RR value was -1·8 $/%. WHAT IS NEW AND CONCLUSION We successfully compared the cost-effectiveness of statins according to the baseline LDL-C level in Korea. It is expected that our findings will help clinical decision-making with regard to statin prescription, and this will help reduce national medical expenditure.
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Affiliation(s)
- Y J Jeong
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - S J Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - T M Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S J Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S-H Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J-H Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - H W Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I Y Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K-H Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H-S Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Yoo RE, Choi SH, Kim TM, Lee SH, Park CK, Park SH, Kim IH, Yun TJ, Kim JH, Sohn CH. Independent Poor Prognostic Factors for True Progression after Radiation Therapy and Concomitant Temozolomide in Patients with Glioblastoma: Subependymal Enhancement and Low ADC Value. AJNR Am J Neuroradiol 2015; 36:1846-52. [PMID: 26294653 DOI: 10.3174/ajnr.a4401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Subependymal enhancement and DWI have been reported to be useful MR imaging markers for identifying true progression. Our aim was to determine whether the subependymal enhancement pattern and ADC can differentiate true progression from pseudoprogression in patients with glioblastoma multiforme treated with concurrent chemoradiotherapy by using temozolomide. MATERIALS AND METHODS Forty-two patients with glioblastoma multiforme with newly developed or enlarged enhancing lesions on the first follow-up MR images obtained within 2 months of concurrent chemoradiotherapy completion were included. Subependymal enhancement was analyzed for the presence, location, and pattern (local or distant relative to enhancing lesions). The mean ADC value and the fifth percentile of the cumulative ADC histogram were determined. A multiple logistic regression analysis was performed to identify independent factors associated with true progression. RESULTS Distant subependymal enhancement (ie, extending >1 cm or isolated from the enhancing lesion) was significantly more common in true progression (n = 24) than in pseudoprogression (n = 18) (P = .042). The fifth percentile of the cumulative ADC histogram was significantly lower in true progression than in pseudoprogression (P = .014). Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were independent factors associated with true progression (P = .041 and P = .033, respectively). Sensitivity and specificity for the diagnosis of true progression were 83% and 67%, respectively, by using both factors. CONCLUSIONS Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were significant independent factors predictive of true progression.
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Affiliation(s)
- R-E Yoo
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Center for Nanoparticle Research (R.-E.Y., S.H.C.) Institute for Basic Science and School of Chemical and Biological Engineering (R.-E.Y., S.H.C.), Seoul National University, Seoul, Korea
| | - S H Choi
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Center for Nanoparticle Research (R.-E.Y., S.H.C.) Institute for Basic Science and School of Chemical and Biological Engineering (R.-E.Y., S.H.C.), Seoul National University, Seoul, Korea.
| | - T M Kim
- Departments of Internal Medicine (S.-H.L., T.M.K.)
| | - S-H Lee
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - C-K Park
- Department of Neurosurgery (C.-K.P.), Biomedical Research Institute; Seoul National University College of Medicine, Seoul, Korea
| | - S-H Park
- Pathology (S.-H.P.) Departments of Internal Medicine (S.-H.L., T.M.K.)
| | - I H Kim
- Radiation Oncology (C.H.S., I.H.K.), Cancer Research Institute
| | - T J Yun
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - J-H Kim
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - C H Sohn
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Radiation Oncology (C.H.S., I.H.K.), Cancer Research Institute
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15
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Gore ME, Szczylik C, Porta C, Bracarda S, Bjarnason GA, Oudard S, Lee SH, Haanen J, Castellano D, Vrdoljak E, Schöffski P, Mainwaring P, Hawkins RE, Crinò L, Kim TM, Carteni G, Eberhardt WEE, Zhang K, Fly K, Matczak E, Lechuga MJ, Hariharan S, Bukowski R. Final results from the large sunitinib global expanded-access trial in metastatic renal cell carcinoma. Br J Cancer 2015; 113:12-9. [PMID: 26086878 PMCID: PMC4647545 DOI: 10.1038/bjc.2015.196] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We report final results with extended follow-up from a global, expanded-access trial that pre-regulatory approval provided sunitinib to metastatic renal cell carcinoma (mRCC) patients, ineligible for registration-directed trials. METHODS Patients ⩾18 years received oral sunitinib 50 mg per day on a 4-weeks-on-2-weeks-off schedule. Safety was assessed regularly. Tumour measurements were scheduled per local practice. RESULTS A total of 4543 patients received sunitinib. Median treatment duration and follow-up were 7.5 and 13.6 months. Objective response rate was 16% (95% confidence interval (CI): 15-17). Median progression-free survival (PFS) and overall survival (OS) were 9.4 months (95% CI: 8.8-10.0) and 18.7 months (95% CI: 17.5-19.5). Median PFS in subgroups of interest: aged ⩾65 years (33%), 10.1 months; Eastern Cooperative Oncology Group performance status ⩾2 (14%), 3.5 months; non-clear cell histology (12%), 6.0 months; and brain metastases (7%), 5.3 months. OS was strongly associated with the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model (n=4065). The most common grade 3/4 treatment-related adverse events were thrombocytopenia (10%), fatigue (9%), and asthenia, neutropenia, and hand-foot syndrome (each 7%). CONCLUSION Final analysis of the sunitinib expanded-access trial provided a good opportunity to evaluate the long-term side effects of a tyrosine kinase inhibitor used worldwide in mRCC. Efficacy and safety findings were consistent with previous results.
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Affiliation(s)
- M E Gore
- Royal Marsden Hospital NHS Trust, Fulham Road, London SW3 6JJ, UK
| | - C Szczylik
- Military Medical Institute, Department of Oncology, 128 Szaserów Street 04-141 Warsaw, Poland
| | - C Porta
- IRCCS San Matteo University Hospital Foundation, Piazzale C. Golgi, 19, I-27100 Pavia, Italy
| | - S Bracarda
- San Donato Hospital, Istituto Toscano Tumori (ITT), Via Pietro Nenni, 20 52100 Arezzo, Italy
| | - G A Bjarnason
- Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5
| | - S Oudard
- Hôpital Européen Georges Pompidou, René Descartes University Paris 5, 20 Rue Leblanc, 75015 Paris, France
| | - S-H Lee
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - J Haanen
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - D Castellano
- Hospital Universitario 12 de Octubre, Avenida de Córdoba, 28041 Madrid, Spain
| | - E Vrdoljak
- Department of Oncology, Clinical Hospital Center Split, School of Medicine, University of Split, Spinčićeva 1 21000 Split, Croatia
| | - P Schöffski
- University Hospitals Leuven, Leuven Cancer Institute, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - P Mainwaring
- Mater Adult Hospital, Raymond Terrace, South Brisbane, QLD 4101, Australia
| | - R E Hawkins
- Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - L Crinò
- Azienda Ospedaliera di Perugia, via Dottori, 106156 Perugia, Italy
| | - T M Kim
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - G Carteni
- A.O.R.N. 'A Cardarelli', Divisione di Oncologia, via A. Cardarelli, 9-80131 Naples, Italy
| | - W E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - K Zhang
- Pfizer Oncology, 10555 Science Center Drive, La Jolla, CA 92121, USA
| | - K Fly
- Pfizer Oncology, 558 Eastern Point Road, Groton, CT 06340, USA
| | - E Matczak
- Pfizer Oncology, 235 East 42nd Street, New York, NY 10017, USA
| | - M J Lechuga
- Pfizer Oncology, Pfizer Italia Srl, Via Lorenteggio 257, 20152 Milan, Italy
| | - S Hariharan
- Pfizer Oncology, 235 East 42nd Street, New York, NY 10017, USA
| | - R Bukowski
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue/R35, Cleveland, OH 44195, USA
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Won JK, Keam B, Koh J, Cho HJ, Jeon YK, Kim TM, Lee SH, Lee DS, Kim DW, Chung DH. Concomitant ALK translocation and EGFR mutation in lung cancer: a comparison of direct sequencing and sensitive assays and the impact on responsiveness to tyrosine kinase inhibitor. Ann Oncol 2014; 26:348-54. [PMID: 25403583 DOI: 10.1093/annonc/mdu530] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation are considered mutually exclusive in nonsmall-cell lung cancer (NSCLC). However, sporadic cases having concomitant EGFR and ALK alterations have been reported. The present study aimed to assess the prevalence of NSCLCs with concomitant EGFR and ALK alterations using mutation detection methods with different sensitivity and to propose an effective diagnostic and therapeutic strategy. PATIENTS AND METHODS A total of 1458 cases of lung cancer were screened for EGFR and ALK alterations by direct sequencing and flourescence in situ hybridization (FISH), respectively. For the 91 patients identified as having an ALK translocation, peptide nucleic acid (PNA)-clamping real-time PCR, targeted next-generation sequencing (NGS), and mutant-enriched NGS assays were carried out to detect EGFR mutation. RESULTS EGFR mutations and ALK translocations were observed in 42.4% (612/1445) and 6.3% (91/1445) of NSCLCs by direct sequencing and FISH, respectively. Concomitant EGFR and ALK alterations were detected in four cases, which accounted for 4.4% (4/91) of ALK-translocated NSCLCs. Additional analyses for EGFR using PNA real-time PCR and ultra-deep sequencing by NGS, mutant-enriched NGS increased the detection rate of concomitant EGFR and ALK alterations to 8.8% (8/91), 12.1% (11/91), and 15.4% (14/91) of ALK-translocated NSCLCs, respectively. Of the 14 patients, 3 who were treated with gefitinib showed poor response to gefitinib with stable disease in one and progressive disease in two patients. However, eight patients who received ALK inhibitor (crizotinib or ceritinib) showed good response, with response rate of 87.5% (7/8 with partial response) and durable progression-free survival. CONCLUSIONS A portion of NSCLC patients have concomitant EGFR and ALK alterations and the frequency of co-alteration detection increases when sensitive detection methods for EGFR mutation are applied. ALK inhibitors appear to be effective for patients with co-alterations.
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Affiliation(s)
| | - B Keam
- Department of Internal Medicine
| | | | | | | | - T M Kim
- Department of Internal Medicine
| | - S H Lee
- Department of Internal Medicine
| | - D S Lee
- Department of Nuclear Medicine
| | - D W Kim
- Department of Internal Medicine
| | - D H Chung
- Department of Pathology Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Lee JK, Shin JY, Kim S, Lee S, Park C, Kim JY, Koh Y, Keam B, Min HS, Kim TM, Jeon YK, Kim DW, Chung DH, Heo DS, Lee SH, Kim JI. Primary resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in patients with non-small-cell lung cancer harboring TKI-sensitive EGFR mutations: an exploratory study. Ann Oncol 2013; 24:2080-7. [PMID: 23559152 DOI: 10.1093/annonc/mdt127] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- J K Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Lee JL, Ahn JH, Lim HY, Park SH, Lee SH, Kim TM, Lee DH, Cho YM, Song C, Hong JH, Kim CS, Ahn H. Multicenter phase II study of sunitinib in patients with non-clear cell renal cell carcinoma. Ann Oncol 2012; 23:2108-2114. [PMID: 22228449 DOI: 10.1093/annonc/mdr586] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Retrospective and molecular biologic data suggest that sunitinib may be effective in patients with non-clear cell renal cell carcinoma (nccRCC). PATIENTS AND METHODS Eligibility criteria included advanced nccRCC except for collecting duct carcinoma and sarcomatoid carcinoma without identifiable renal cell carcinoma subtypes. Patients were treated with 50 mg/day oral sunitinib for 4 weeks, followed by 2 weeks of rest. The primary end point was overall response rate (RR). RESULTS Thirty-one eligible patients were enrolled. Twenty-four patients (77%) had prior nephrectomy. By Memorial Sloan-Kettering Cancer Center criteria, 8 patients (26%) had poor risk and 14 (45%) had intermediate risk. Twenty-two patients had papillary renal cell carcinoma (RCC), and three had chromophobe RCC. Eleven patients had partial response with a RR of 36% (95% confidence interval (CI) 19% to 52%) and an additional 17 patients (55%) had stable disease. Median duration of response was 12.7 months (95% CI 6.3-19.1 months), and median progression-free survival was 6.4 months (95% CI 4.2-8.6 months). At a median follow-up duration of 18.7 months (95% CI 13.7-23.7 months), 13 patients (42%) had died, resulting in an estimated median survival of 25.6 months (95% CI 8.4-42.9 months). Toxicity profiles were commensurate with prior reports. CONCLUSIONS Sunitinib has promising activity in patients with nccRCC (NCT01219751).
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Affiliation(s)
- J-L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
| | - J-H Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - H Y Lim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - S H Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - S H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - T M Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - D-H Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Y M Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - C Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C-S Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim TM, Ha SA, Kim HK, Yoo J, Kim S, Yim SH, Jung SH, Kim DW, Chung YJ, Kim JW. Gene expression signatures associated with the in vitro resistance to two tyrosine kinase inhibitors, nilotinib and imatinib. Blood Cancer J 2011; 1:e32. [PMID: 22829191 PMCID: PMC3255246 DOI: 10.1038/bcj.2011.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/07/2011] [Indexed: 01/12/2023] Open
Abstract
The use of selective inhibitors targeting Bcr-Abl kinase is now established as a standard protocol in the treatment of chronic myelogenous leukemia; however, the acquisition of drug resistance is a major obstacle limiting the treatment efficacy. To elucidate the molecular mechanism of drug resistance, we established K562 cell line models resistant to nilotinib and imatinib. Microarray-based transcriptome profiling of resistant cells revealed that nilotinib- and imatinib-resistant cells showed the upregulation of kinase-encoding genes (AURKC, FYN, SYK, BTK and YES1). Among them, the upregulation of AURKC and FYN was observed both in nilotinib- and imatinib-resistant cells irrespective of exposure doses, while SYK, BTK and YES1 showed dose-dependent upregulation of expression. Upregulation of EGF and JAG1 oncogenes as well as genes encoding ATP-dependent drug efflux pump proteins such as ABCB1 was also observed in the resistant cells, which may confer alternative survival benefits. Functional gene set analysis revealed that molecular categories of ‘ATPase activity', ‘cell adhesion' or ‘tyrosine kinase activity' were commonly activated in the resistant clones. Taken together, the transcriptome analysis of tyrosine kinase inhibitors (TKI)-resistant clones provides the insights into the mechanism of drug resistance, which can facilitate the development of an effective screening method as well as therapeutic intervention to deal with TKI resistance.
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Kim JW, Im SA, Kim JH, Ham HS, Han HS, Kim JS, Kim TM, Han SW, Oh DY, Lee SH, Kim DW, Cho N, Moon WK, Kim TY, Park IA, Heo DS, Bang YJ. Abstract P2-09-36: Role of ABCB1 Polymorphisms as Predictive Markers in Patients with HER-2 FISH Positive Metastatic Breast Cancer Who Were Treated with Taxane Plus Trastuzumab First Line Chemotherapy. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-09-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ABCB1 polymorphisms could predict treatment results of taxane therapy in several malignancies. FCGR2A and FCGR3A polymorphisms were associated with clinical outcomes in several diseases after treatment with monoclonal antibody drugs which had antibody-dependent cell-mediated cytotoxicity activity. These polymorphisms could be possible predictive markers after taxane plus trastuzumab (TH) chemotherapy in patients with HER-2-positive metastatic breast cancer (MBC).
Methods: Fifty-seven patients with HER-2 FISH positive MBC who received TH chemotherapy as the 1st-line treatment were enrolled. We analyzed 5 polymorphisms using DNA from peripheral blood mononuclear cells: ABCB1 1236C>T (rs1128503), ABCB1 2677G>T/A (rs2032582), ABCB1 3435C>T (rs1045642), FCGR2A 131H/R (rs1801274), and FCGR3A 158V/F (rs396991), then correlated them to treatment results of patients.
Results: Among 57 patients, 22 patients (38.6%) received weekly paclitaxel plus trastuzumab, 26 patients (45.6%) tri-weekly paclitaxel plus trastuzumab, and 9 patients (15.8%) tri-weekly docetaxel plus trastuzumab. After a median follow-up of 30.6 (range, 0.6-75.9) months, median progression-free survival (PFS) was 15.1 (95% confidence interval (CI), 10.3-19.8) months. ABCB1 2677T allele carriers had longer PFS than the others (42.1 (95% CI, 12.7-71.4) months vs. 13.0 (95% CI, 10.6-15.4) months; p=0.037) along with a tendency toward higher response rate (RR) (86.4% vs. 76.0%; p=0.470) and longer overall survival (OS) (54.7 (95% CI, 43.0-66.4) months vs. 38.9 (95% CI, 18.1-59.7) months; p=0.057). In addition, ABCB1 3435CC genotype carriers had shorter PFS than the others (13.0 (95% CI, 10.8-15.2) months vs. 19.1 (95% CI, 0.0-38.5) months; p=0.039) along with a tendency toward lower RR (78.6% vs. 100%; p=0.567) and shorter OS (38.9 (95% CI, 19.7-58.1) months vs. 54.7 (95% CI, 43.0-66.4) months; p=0.093). ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F were not significantly associated with RR, PFS, and OS. None of these polymorphisms were associated with any grades of hematologic or cardiac toxicities.
Conclusions: Our results support that ABCB1 2677G>T/A and 3435C>T may have predictive roles after the 1st-line TH chemotherapy in patients with HER-2-positive MBC. In contrast, ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F could not predict response after TH treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-36.
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Affiliation(s)
- J-W Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-A Im
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - JH Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - HS Ham
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - H-S Han
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - J-S Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - T-M Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-W Han
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - D-Y Oh
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-H Lee
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - D-W Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - N Cho
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - WK Moon
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - T-Y Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - IA Park
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - DS Heo
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - Y-J. Bang
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
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Chung YJ, Kim TM, Kim DW, Namkoong H, Kim HK, Ha SA, Kim S, Shin SM, Kim JH, Lee YJ, Kang HM, Kim JW. Gene expression signatures associated with the resistance to imatinib. Leukemia 2006; 20:1542-50. [PMID: 16855633 DOI: 10.1038/sj.leu.2404310] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/09/2022]
Abstract
Imatinib (imatinib mesylate, STI-571, Gleevec) is a selective BCR-ABL tyrosine kinase inhibitor that has been used as a highly effective chemoagent for treating chronic myelogenous leukemia. However, the initial response to imatinib is often followed by the recurrence of a resistant form of the disease, which is major obstacle to many therapeutic modalities. The aim of this study was to identify the gene expression signatures that confer resistance to imatinib. A series of four resistant K562 sublines was established with different imatinib dosage (200, 400, 600 and 800 nM) and analyzed using microarray technology. The transcripts of the genes showing universal or dose-dependent expression changes across the resistant sublines were identified. The gene sets associated with the imatinib-resistance were also identified using gene set enrichment analysis. In the resistant K562 sublines, the transcription- and apoptosis-related expression signatures were upregulated, whereas those related to the protein and energy metabolism were downregulated. Several genes identified in this study such as IGF1 and RAB11A have the potential to become surrogate markers useful in a clinical evaluation of imatinib-resistant patients without BCR-ABL mutation. The expression signatures identified in this study provide insights into the mechanism of imatinib-resistance and are expected to facilitate the development of an effective diagnostic and therapeutic strategy.
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Affiliation(s)
- Y-J Chung
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Park DH, Kim TM, Han DG, Ahn KY. A comparative study of the surgical treatment of axillary osmidrosis by instrument, manual, and combined subcutaneous shaving procedures. Ann Plast Surg 1998; 41:488-97. [PMID: 9827951 DOI: 10.1097/00000637-199811000-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Between 1986 and 1996, 128 patients underwent surgery for axillary osmidrosis via en bloc removal of subcutaneous cellular tissue. The patients were followed for 6 months to 7 years (average follow-up, 25 months). The authors propose three categories in which they classified shaving procedures: instrumental shavings (N = 84), manual shavings (N = 96), and combined shaving procedures (N = 76). A modified Inaba's shaver was used in instrument shavings. Combined shaving is mixture of instrument and conventional manual shaving. All patients were asked to complete a questionnaire postoperatively. This follow-up demonstrated that 92.9% of patients who underwent instrument shaving, 95.8% of patients who underwent manual shaving, and 97.4% of patients who underwent combined shaving experienced no odor or occasional, very mild axillary odor postoperatively. Postoperative scar formation was either invisible or excellent in 92.9% of instrument shavings, and 92.1% of patients who underwent the combined procedure reported either a hairless axilla or a marked decrease of axillary hair. The total satisfaction rate in the combined procedure was 94.7%, which is a better result than the instrument (92.9%) and the manual (91.7%) shaving procedures. The wound complication rate per patient with the combined procedure was 13.2%. There was no scar contracture or limitation in arm abduction. The combined subcutaneous shaving procedure using the modified Inaba's shaver has the advantages of rapid and accurate shaving, low incidence of hematoma formation, enhanced wound healing, and easy postoperative care. Therefore, en bloc resection of subcutaneous cellular tissue by combined shaving is a viable option for treatment of axillary osmidrosis.
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Affiliation(s)
- D H Park
- Department of Plastic and Reconstructive Surgery, Catholic University of Taegu Hyosung, College of Medicine, Korea
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Abstract
The approach to nasal bone classic corrective rhinoplasty is an almost-blind technique, where the results depends on feeling by the surgeon's hand. To overcome these drawbacks, endoscopic-assisted corrective rhinoplasty and septoplasty were performed for 16 cases of deviated noses between January 1995 and May 1997. The average follow-up period was 18 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection, and septal deviation. The postoperative courses were satisfactory in most cases, with few complications. Compared with 28 cases of classic rhinoplasty, the patient satisfaction rate was high (87.5% in endoscopic-assisted rhinoplasty, 71.4% in classic rhinoplasty), and the complication and revision rate was low (0% in endoscopic-assisted rhinoplasty, 14.3 and 7.1% in classic rhinoplasty). But extra time (about 40 min) and greater expense were required for endoscopic-assisted rhinoplasty. It appeared to us that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum, the cause of the deformity, and the immediate effect of the corrective measures used. The use of an endoscope in corrective rhinoplasty for deviated noses provides an expanded field of vision, direct manipulation of lesions, and better aesthetic and functional results.
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Affiliation(s)
- D H Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Taegu Hyosung, Korea
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Cheng PC, Gosewehr JA, Kim TM, Velicescu M, Wan M, Zheng J, Felix JC, Cofer KF, Luo P, Biela BH, Godorov G, Dubeau L. Potential role of the inactivated X chromosome in ovarian epithelial tumor development. J Natl Cancer Inst 1996; 88:510-8. [PMID: 8606379 DOI: 10.1093/jnci/88.8.510] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [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: 01/31/2023] Open
Abstract
BACKGROUND Ovarian epithelial tumors can be divided into subcategories often regarded as different stages of neoplastic transformation. Cystadenomas belong to the least aggressive subgroup and are noninvasive and nonmetastatic. Ovarian tumors of low malignant potential (LMP) are intermediate between cystadenomas and carcinomas and show markedly reduced invasive and metastatic abilities. Invasion and metastasis are the hallmarks of carcinomas, which constitute the most aggressive subgroup and can be further subdivided into different grades. PURPOSE We performed comparative allelotype analyses of ovarian cystadenomas, LMP tumors, and carcinomas, reasoning that such analyses could provide clues about the molecular determinants of their phenotypic differences. Because we realized that allelic losses involving the X chromosome might be associated with LMP tumor development, we determined whether such losses were interstitial and whether they involved the active or the inactive X chromosome. METHODS Frequencies of loss of heterozygosity (LOH) at specific loci in every chromosomal arm were determined in 16 ovarian cystadenomas, 23 ovarian LMP tumors, 15 low-grade ovarian carcinomas, and 35 high-grade ovarian carcinomas by use of either the polymerase chain reaction (PCR) or Southern blot analyses. We took advantage of the fact that DNA methylation is an important mechanism of X-chromosome inactivation to determine whether losses involving the X chromosome were in the active or the inactive copy. We analyzed the methylation status of retained alleles on the X chromosome by determining whether they could be amplified by PCR after digestion with the methylation-sensitive restriction endonuclease Hpa II. RESULTS High-grade carcinomas contained frequent(>50%) LOH in four autosomal chromosome arms, i.e., 6q, 13q, 17p, and 17q. Except for 13q, these same chromosomal arms showed frequent LOH in low-grade carcinomas. LOH in autosomal chromosomes was comparatively rare in LMP tumors and was absent in cystadenomas. In contrast, half (eight of 16) of LMP tumors informative for a locus in the proximal portion of chromosome Xq showed LOH at that locus. These losses were the result of interstitial deletions in six of the eight cases and involved the inactive copy of the X chromosome exclusively. Similar losses in the X chromosome were not seen in either cystadenomas or low-grade carcinomas. CONCLUSIONS AND IMPLICATIONS LOH at multiple loci is associated with the development of ovarian carcinomas but not with the development of cystadenomas and LMP tumors. However, the integrity of a locus in chromosome Xq that possibly escapes X-chromosome inactivation is important for the control of LMP tumor development. The fact that this locus does not appear to be involved in the genesis of low-grade carcinomas suggests that LMP tumors are not precursors of such carcinomas.
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Affiliation(s)
- P C Cheng
- Department of Gynecologic Oncology, Comprehensive Cancer Center, University of Southern California, Los Angeles, 90033, USA
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Zheng J, Benedict WF, Xu HJ, Hu SX, Kim TM, Velicescu M, Wan M, Cofer KF, Dubeau L. Genetic disparity between morphologically benign cysts contiguous to ovarian carcinomas and solitary cystadenomas. J Natl Cancer Inst 1995; 87:1146-53. [PMID: 7674319 DOI: 10.1093/jnci/87.15.1146] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Ovarian carcinomas occasionally contain large, histologically benign cysts contiguous to the clearly malignant areas (cystadenocarcinomas). The question of whether such cysts are remnants of pre-existing benign tumors (cystadenomas) or constitute integral components of the carcinomas is important in clarifying the role of cystadenomas in ovarian carcinogenesis. It is also important for our general understanding of tumor heterogeneity, a phenomenon thought to result from the gradual accumulation of genetic abnormalities in initially homogeneous tumors. This question is also pertinent to the clinical management of ovarian cystadenomas, which are frequent in women of childbearing age and are usually treated surgically based on the possibility that they may give rise to carcinomas. PURPOSE Reasoning that molecular markers of ovarian malignancy would be confined to the histologically malignant portions of cystadenocarcinomas if the morphologically benign portions are in fact pre-existing typical cystadenomas, we sought to verify that mutations in the p53 tumor suppressor gene are markers of malignancy in ovarian tumors and to determine the distribution of such mutations in cystadenocarcinomas. METHODS We used immunohistochemical and DNA-sequencing techniques to analyze 46 ovarian carcinomas, 21 ovarian tumors of low malignant potential, and 16 solitary cystadenomas for the presence of p53 mutations. We then used similar techniques to examine the distribution of such mutations in different portions of cystadenocarcinomas. The observed differences in mutation frequencies were analyzed by the two-tailed Fisher's exact test. RESULTS Mutations in the p53 gene were present in 24 (52%) of the 46 carcinomas, but they were absent in the 21 tumors of low malignant potential (P < .0001) and the 16 solitary cystadenomas (P = .0002). Six of six cystadenocarcinomas with p53 mutations showed the presence of the same mutations in the adjacent, histologically benign cysts. The mutations were seen not only in cells immediately adjacent to the carcinomas, but also throughout the morphologically benign cysts. Twenty (83%) of the 24 cases showing mutation of one p53 allele also showed loss of genetic heterozygosity, suggesting that the other p53 allele was deleted. Such allelic loss, if present in morphologically malignant portions of cystadenocarcinomas, was also observed in the contiguous cysts. CONCLUSIONS Ovarian carcinomas can be distinguished from ovarian cystadenomas and tumors of low malignant potential by p53 mutations. The fact that the mutations were present in histologically benign cysts contiguous to ovarian carcinomas suggests that such cysts are not typical cystadenomas and may carry a genetic predisposition to carcinogenesis that is not present in ordinary cystadenomas.
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Affiliation(s)
- J Zheng
- Department of Pathology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California School of Medicine, Los Angeles 90033, USA
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Abstract
The cloning and characterization of cDNAs encoding the cell-surface-specific integrin receptors of baboon platelets has been undertaken to provide species-specific probes. These will be used to investigate the expression and distribution of these receptors among primate species. Clones GPIIb-16 and GPIIb-3, encoding portions of the baboon glycoprotein GPIIb, were isolated from a cDNA library derived from baboon platelet mRNA. GPIIb-3 includes an insert of 43 bp, when compared to GPIIb-16 or human GPIIb. This insert is the result of alternative processing of mRNA. The probable origin of the inserted bases is the 3' end of the intron preceeding exon 28 of the gene. A different product of alternative splicing has been reported in this same region of the human GPIIb sequence, suggesting that this location is susceptible to wobble in the intron-exon junctions. The projected shift in the reading frame of the baboon GPIIb-3 cDNA would give a radically altered C terminus of the deduced amino-acid sequence, and the possibility of a novel functional peptide on the platelet surface.
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Affiliation(s)
- D J Hayzer
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322
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27
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Kim TM, Benedict WF, Xu HJ, Hu SX, Gosewehr J, Velicescu M, Yin E, Zheng J, D'Ablaing G, Dubeau L. Loss of heterozygosity on chromosome 13 is common only in the biologically more aggressive subtypes of ovarian epithelial tumors and is associated with normal retinoblastoma gene expression. Cancer Res 1994; 54:605-9. [PMID: 8306317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We examined the frequencies of loss of heterozygosity on chromosome 13 in 77 primary ovarian epithelial tumors subdivided into cystadenomas, tumors of low malignant potential, low grade carcinomas, and high grade carcinomas. Such losses were found in approximately 50% of high grade carcinomas but were not detected in any of the other tumor subtypes (P < 0.0001), suggesting a strong association between these abnormalities and the high grade carcinoma phenotype. The tumors were also examined for abnormalities in expression of the retinoblastoma susceptibility gene (RB). This was assessed by immunohistochemical staining of archival tumor sections with a polyclonal antibody directed against both the phosphorylated and the underphosphorylated forms of the RB protein. Most of the tumors, including those with allelic deletions on chromosome 13, showed normal RB nuclear protein staining patterns. We conclude that loss of RB expression is not a frequent event in primary ovarian carcinomas and that this gene is probably not the target of the frequent allelic deletions on chromosome 13 found in high grade ovarian carcinomas.
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Affiliation(s)
- T M Kim
- Department of Pathology, Kenneth Norris Jr. Comprehensive Cancer Center, USC School of Medicine, Los Angeles 90033
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28
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Abstract
A cDNA probe, encoding part of the human integrin polypeptide, GPIIIa (beta 3), was used to screen a cDNA library derived from baboon smooth muscle polyadenylated mRNA. One cross-hybridizing clone, lacking the baboon equivalent of 478 bp of the human sequence, was found to be 98% similar to a human cDNA encoding the beta 5-chain of the receptor for vitronectin, a cell adhesion molecule. The baboon mRNA terminates at 3' position 212 nucleotides upstream from the polyadenylation site of the aligned human mRNA.
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Affiliation(s)
- M Shoji
- Division of Hematology-Oncology, Emory University School of Medicine, Atlanta, GA 30322
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29
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Abstract
A cDNA probe, encoding part of the baboon integrin polypeptide, GPIIb, was used to screen a cDNA library derived from baboon platelet polyadenylated mRNA. One cross-hybridizing clone was found to be 94% similar to a human cDNA encoding the beta-chain of the receptor for von Willebrand factor, a major component of the platelet-subendothelium attachment mechanism.
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Affiliation(s)
- D J Hayzer
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322
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30
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Kim TM, Brown HR, Lee SH, Powell CV, Bethune P, Goller NL, Tran HT, Mackay JS. Delayed acute measles inclusion body encephalitis in a 9-year-old girl: ultrastructural, immunohistochemical, and in situ hybridization studies. Mod Pathol 1992; 5:348-52. [PMID: 1353879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
A 9-yr-old girl developed delayed acute measles inclusion body encephalitis, which was different from subacute sclerosing panencephalitis (SSPE) in clinical course. Measles virus was demonstrated by electron microscopy, immunohistochemistry, and in situ hybridization. Contrary to the most previous reports, matrix (M) protein was present in the brain, cerebrospinal fluid, and serum and was demonstrated by Western blot analysis and in situ hybridization. The hybridization was performed by a nonradioactive digoxigenin method.
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Affiliation(s)
- T M Kim
- Department of Pathology, Saint John Regional Hospital, Dalhousie Medical School, N.B. Canada
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31
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Pla M, Podgorsak EB, Kim TM, Freeman CR. Improved radiotherapeutic technique for prophylaxis of the central nervous system in patients with acute lymphoblastic leukaemia. Br J Radiol 1981; 54:412-5. [PMID: 6786406 DOI: 10.1259/0007-1285-54-641-412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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