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Garcia-Sayre J, Lin YG, Matuso K, Tsao-Wei DD, Mhawech-Fauceglia P, Louie S, Dong T, Ciccone MA, Brunette-Masi LL, Pham HQ, Yessaian AA, Groshen SG, Facio G, Aldana M, Muderspach LI, Garcia AA, Roman LD. Two staged phase II clinical trial of Eribulin monotherapy in advanced or recurrent cervical cancer. Gynecol Oncol 2023; 173:49-57. [PMID: 37079977 DOI: 10.1016/j.ygyno.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Eribulin a microtubule targeting agent and analog of Halichondrin B, a natural product isolated from marine sponge H. okadai, has proven clinical efficacy in metastatic pretreated breast cancer and liposarcoma. We conducted a 2-stage Phase II study of eribulin in patients with advanced/recurrent cervical cancer to examine its clinical activity and evaluate biomarkers for predictors of response. METHODS Women with advanced/recurrent cervical cancer after ≤1 prior chemotherapy regimen, measurable disease and ECOG performance status ≤2 were treated with eribulin (1.4 mg/m2 IV day 1 and 8, every 21 days) with tumor assessments every 2 cycles. Primary endpoint was 6-month progression-free survival (PFS6); secondary were best overall response (RECISTv1.1), toxicity (CTCAEv4.03) and overall survival (OS). Exploratory endpoints were associations of biomarkers with clinical activity. Immunohistochemistry was performed on archival tumor samples. Overexpression was defined when both intensity and distribution scores were ≥ 2. RESULTS 32 patients enrolled from 11/2012-5/2017. 29/32 patients had prior chemotherapy with cisplatin/paclitaxel/bevacizumab (n = 12) or cisplatin/gemcitabine (n = 12) as the most common regimens. 14 patients received prior paclitaxel. 1 (3%) had a complete response, 5 (16%) had a partial response and 13 (41%) had stable disease for ORR of 19% (95% CI 8, 37). Those who are paclitaxel naïve experienced the greatest benefit with a 29% ORR (95% CI 12, 54). Patients who received prior paclitaxel responded less favorably than those who did not (p = .002) and had a shorter PFS and OS. Grade 3/4 adverse events occurring in >10% of patients were anemia (n = 12, 38%), neutropenia (n = 7, 22%) and leukopenia (n = 6, 19%). Analysis of correlative predictors of response revealed that patients who did not overexpress βII and BAX were significantly more likely to respond to e`ribulin. PFS was significantly shorter in patients with βII and BAX overexpression, OS was significantly shorter in those with βIII and BAX overexpression. These associations remained after multivariate analysis. CONCLUSIONS Eribulin shows modest activity in patients with recurrent/advanced cervical cancer with a favorable toxicity profile. Prior paclitaxel exposure is associated with decreased eribulin response. βII, βIII tubulin subtypes and BAX are predictors of response and survival. Eribulin may be an option for women with paclitaxel-naïve recurrent/advanced cervical cancer.
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Affiliation(s)
- Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America.
| | - Yvonne G Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Koji Matuso
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Denice D Tsao-Wei
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States of America
| | | | - Stan Louie
- University of Southern California School of Pharmacy, Los Angeles, CA, United States of America
| | - Tiange Dong
- University of Southern California School of Pharmacy, Los Angeles, CA, United States of America
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Laurie L Brunette-Masi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Susan G Groshen
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States of America
| | - Grace Facio
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Marissa Aldana
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Agustin A Garcia
- Division of Hematology Oncology, Department of Internal Medicine, Louisiana State University, New Orleans, LA, United States of America
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
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Wu AH, Vigen C, Tseng C, Garcia AA, Spicer D. Effect of Chemotherapy on the Gut Microbiome of Breast Cancer Patients During the First Year of Treatment. Breast Cancer (Dove Med Press) 2022; 14:433-451. [PMID: 36532254 PMCID: PMC9747861 DOI: 10.2147/bctt.s305486] [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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/26/2022] [Indexed: 10/24/2023]
Abstract
INTRODUCTION There is accumulating information of the effects of chemotherapy and weight changes on the gut microbiome of breast cancer patients. METHODS In this 1-year follow-up study, we investigated gut microbiome of 33 breast cancer patients who donated fecal samples at baseline and after completion of treatment. We compared alpha diversity and mean taxa abundance at baseline and absolute taxa abundance changes (final-baseline) by treatment (16 neoadjuvant [neoADJ], 13 adjuvant [ADJ], 4 no chemotherapy [noC]) and specific chemotherapy agent using Wilcoxon rank sum and negative binomial mixed model (NBMM) analysis. RESULTS All four gut alpha diversity measures changed in association with chemotherapy treatment; they increased in the neoADJ (+16.4% OTU p = 0.03; +51.6% Chao1 p = 0.03; +7.0% Shannon index p = 0.02; +11.0% PD whole tree p = 0.09) but not in the ADJ and noC group (ADJ+noC). The difference in Chao1 index change between groups was statistically significant (pneoADJ vs. ADJ+noC=0.04). Wilcoxon p values of 0.03-0.003 were observed for five taxa. In NBMM analysis, changes in taxa abundance differed (Bonferroni-adjusted p ≤ 0.0007) for two Bacteroidetes taxa (g_Alistipes, f_S24-7) and two Firmicutes taxa (g_Catenibacterium, g_Eubacterium). NBMM analysis results remained unchanged with adjustment for weight changes. Alpha diversity changes were also found by receipt of chemotherapy agents. Consistent increases in alpha diversity were observed among those treated with TCHP (OTU p = 0.009; Chao1 p = 0.02; Shannon p = 0.02; PD whole tree p = 0.05) but not AC, Taxol or Herceptin. Those treated with TCHP or Herceptin showed increases in Verrucomicrobia (g_Akkermansia) but decreases of Bacteroidetes(g_Alistipes); the differences in changes in taxa abundance were statistically significant. CONCLUSION Results from this pilot longitudinal study support an effect of chemotherapy, particularly neoADJ on the gut microbiome of breast cancer patients even after adjustment for weight changes. Further investigations are needed to confirm these findings in larger studies and with longer follow-up and to assess the impact of these microbiome changes on patient outcome.
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Affiliation(s)
- Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cheryl Vigen
- Mrs. TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Chiuchen Tseng
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Agustin A Garcia
- Department of Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Teixeira ST, Muniz JG, Garcia AA, Ricci-Jr O. AUMENTO DO NÚMERO DE TESTES REAGENTES CONFIRMADOS PARA HIV NO HEMOCENTRO DE SÃO JOSÉ DO RIO PRETO EM 2021. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Manzo J, Puhalla S, Pahuja S, Ding F, Lin Y, Appleman L, Tawbi H, Stoller R, Lee JJ, Diergaarde B, Kiesel BF, Yu J, Tan AR, Belani CP, Chew H, Garcia AA, Morgan RJ, Hendrickson AEW, Visscher DW, Hurley RM, Kaufmann SH, Swisher EM, Oesterreich S, Katz T, Ji J, Zhang Y, Parchment RE, Chen A, Duan W, Giranda V, Shepherd SP, Ivy SP, Chu E, Beumer JH. A phase 1 and pharmacodynamic study of chronically-dosed, single-agent veliparib (ABT-888) in patients with BRCA1- or BRCA2-mutated cancer or platinum-refractory ovarian or triple-negative breast cancer. Cancer Chemother Pharmacol 2022; 89:721-735. [PMID: 35435472 PMCID: PMC9116722 DOI: 10.1007/s00280-022-04430-6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/27/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE BRCA1 or BRCA2 mutated cancers (BRCAmut) have intrinsic sensitivity to PARP inhibitors due to deficiency in homologous recombination-mediated DNA repair. There are similarities between BRCAmut and BRCAwt ovarian and basal-like breast cancers. This phase I study determined the recommended phase II dose (RP2D) and preliminary efficacy of the PARP inhibitor, veliparib (ABT-888), in these patients. PATIENTS AND METHODS Patients (n = 98) were dosed with veliparib 50-500 mg twice daily (BID). The BRCAmut cohort (n = 70) contained predominantly ovarian (53%) and breast (23%) cancers; the BRCAwt cohort (n = 28) consisted primarily of breast cancer (86%). The MTD, DLT, adverse events, PK, PD, and clinical response were assessed. RESULTS DLTs were grade 3 nausea/vomiting at 400 mg BID in a BRCAmut carrier, grade 2 seizure at 400 mg BID in a patient with BRCAwt cancer, and grade 2 seizure at 500 mg BID in a BRCAmut carrier. Common toxicities included nausea (65%), fatigue (45%), and lymphopenia (38%). Grade 3/4 toxicities were rare (highest lymphopenia at 15%). Overall response rate (ORR) was 23% (95% CI 13-35%) in BRCAmut overall, and 37% (95% CI 21-55%) at 400 mg BID and above. In BRCAwt, ORR was 8% (95% CI 1-26%), and clinical benefit rate was 16% (95% CI 4-36%), reflecting prolonged stable disease in some patients. PK was linear with dose and was correlated with response and nausea. CONCLUSIONS Continuous veliparib is safe and tolerable. The RP2D was 400 mg BID. There is evidence of clinical activity of veliparib in patients with BRCAmut and BRCAwt cancers.
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Affiliation(s)
- Julia Manzo
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Shannon Puhalla
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shalu Pahuja
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fei Ding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Yan Lin
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, and UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Leonard Appleman
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hussein Tawbi
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronald Stoller
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James J Lee
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brenda Diergaarde
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, and UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Brian F. Kiesel
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Department of Pharmaceutical Sciences, School of Pharmacy, Pittsburgh, PA, USA
| | - Jing Yu
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center
| | - Antoinette R. Tan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA (Present Address: Levine Cancer Institute, Charlotte, NC, USA)
| | - Chandra P. Belani
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Helen Chew
- Division of Hematology/Oncology, Department of Medicine, University of California Davis, Sacramento, CA USA
| | | | - Robert J. Morgan
- Department of Molecular Pharmacology, City of Hope Beckman Research Institute, Duarte, CA, USA
| | | | - Daniel W. Visscher
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN
| | - Rachel M. Hurley
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Scott H. Kaufmann
- Department of Oncology, Mayo Clinic, Rochester, MN,Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Elizabeth M. Swisher
- Department of Obstetrics and Gynecologic, University of Washington, Seattle, WA, USA
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tiffany Katz
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jiuping Ji
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Yiping Zhang
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Ralph E. Parchment
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Alice Chen
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Wenrui Duan
- Department of Human and Molecular Genetics, the Florida International University, Miami, FL, USA
| | | | | | - S. Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Edward Chu
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jan H. Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Pharmaceutical Sciences, School of Pharmacy, Pittsburgh, PA, USA,Address all correspondence to: Jan H. Beumer, Pharm.D., Ph.D., D.A.B.T., University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Room G27E, 5117 Centre Avenue, Pittsburgh, PA 15213-1863, Tel.: 412-623-3216, Fax: 412-623-1212,
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Krop IE, Jegede OA, Grilley-Olson JE, Lauring JD, Mitchell EP, Zwiebel JA, Gray RJ, Wang V, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Kono SA, Ford JM, Garcia AA, Sui XD, Siegel RD, Slomovitz BM, Conley BA, Arteaga CL, Harris LN, O'Dwyer PJ, Chen AP, Flaherty KT. Phase II Study of Taselisib in PIK3CA-Mutated Solid Tumors Other Than Breast and Squamous Lung Cancer: Results From the NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocol I. JCO Precis Oncol 2022; 6:e2100424. [PMID: 35138919 PMCID: PMC8865530 DOI: 10.1200/po.21.00424] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE PIK3CA mutations frequently contribute to oncogenesis in solid tumors. Taselisib, a potent and selective inhibitor of phosphoinositide 3-kinase, has demonstrated clinical activity in PIK3CA-mutant breast cancer. Whether PIK3CA mutations predict sensitivity to taselisib in other cancer types is unknown. National Cancer Institute-Molecular Analysis for Therapy Choice Arm EAY131-I is a single-arm, phase II study of the safety and efficacy of taselisib in patients with advanced cancers. METHODS Eligible patients had tumors with an activating PIK3CA mutation. Patients with breast or squamous cell lung carcinoma, or whose cancer had KRAS or PTEN mutations, were excluded. Patients received taselisib 4 mg, orally once daily continuously, until disease progression or unacceptable toxicity. The primary end point was objective response rate. Secondary end points included progression-free survival (PFS), 6-month PFS, overall survival (OS), and identification of predictive biomarkers. RESULTS Seventy patients were enrolled, and 61 were eligible and initiated protocol therapy. Types of PIK3CA mutations included helical 41 of 61 (67%), kinase 11 of 61 (18%), and other 9 of 61 (15%). With a median follow-up of 35.7 months, there were no complete or partial responses. Six-month PFS was 19.9% (90% CI, 12.0 to 29.3) and median PFS was 3.1 months (90% CI, 1.8 to 3.7). Six-month OS was 60.7% (90% CI, 49.6 to 70.0) and median OS was 7.2 months (90% CI, 5.9 to 10.0). Individual comutations were too heterogeneous to correlate with clinical outcome. Fatigue, diarrhea, nausea, and hyperglycemia were the most common toxicities, and most were grade 1 and 2. CONCLUSION In this study, taselisib monotherapy had very limited activity in a heterogeneous cohort of heavily pretreated cancer patients with PIK3CA-mutated tumors; the presence of a PIK3CA mutation alone does not appear to be a sufficient predictor of taselisib activity.
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Affiliation(s)
- Ian E. Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Opeyemi A. Jegede
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | | | | | - Robert J. Gray
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Victoria Wang
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
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Lee E, Kawaguchi ES, Zhang J, Kim SE, Deapen D, Liu L, Sheidaee N, Hwang AE, Kang I, Sandhu K, Ursin G, Wu AH, Garcia AA. Bariatric surgery in patients with breast and endometrial cancer in California: population-based prevalence and survival. Surg Obes Relat Dis 2022; 18:42-52. [PMID: 34740554 PMCID: PMC9078098 DOI: 10.1016/j.soard.2021.09.017] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of bariatric surgeries performed in the United States has increased substantially since the 1990's. However, the prevalence and prognostic impact of bariatric surgery, or weight loss surgery (WLS), among patients with cancer are not known. OBJECTIVES We investigated the population-based prevalence of WLS in women with breast or endometrial cancer and conducted exploratory analysis to examine whether postdiagnosis WLS is associated with survival. SETTING Administrative statewide database. METHODS WLS records for women with nonmetastasized breast (n = 395,146) or endometrial (n = 69,859) cancer were identified from the 1991-2014 California Cancer Registry data linked with the California Office of Statewide Health Planning and Development database. Characteristics of the patients were examined according to history of WLS. Using body mass index data available since 2011, a retrospective cohort of patients with breast or endometrial cancer and obesity (n = 12,540) was established and followed until 2017 (5% lost to follow-up). Multivariable cause-specific Cox proportional hazards models were used to examine the associations between postdiagnostic WLS and time to death. RESULTS WLS records were identified for 2844 (.7%) patients with breast cancer and 1140 (1.6%) patients with endometrial cancer; about half of the surgeries were performed after cancer diagnosis. Postdiagnosis WLS was performed in ∼1% of patients with obesity and was associated with a decreased hazard for death (cause-specific hazard ratio = .37; 95% confidence interval = .014-.99; P = .049), adjusting for age, stage, co-morbidity, race/ethnicity, and socioeconomic status. CONCLUSION About 2000 patients with breast or endometrial cancer in California underwent post-diagnosis WLS between 1991 and 2014. Our data support survival benefits of WLS after breast and endometrial cancer diagnosis.
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Affiliation(s)
- Eunjung Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California.
| | - Eric S Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Juanjuan Zhang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sue E Kim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Dennis Deapen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Nasim Sheidaee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Amie E Hwang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Irene Kang
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kulmeet Sandhu
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Agustin A Garcia
- Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana
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Wu AH, Tseng C, Vigen C, Yu Y, Cozen W, Garcia AA, Spicer D. Gut microbiome associations with breast cancer risk factors and tumor characteristics: a pilot study. Breast Cancer Res Treat 2020; 182:451-463. [PMID: 32468338 PMCID: PMC7297869 DOI: 10.1007/s10549-020-05702-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between gut microbiome with breast tumor characteristics (receptor status, stage and grade) and known breast cancer risk factors. METHODS In a pilot cross-sectional study of 37 incident breast cancer patients, fecal samples collected prior to chemotherapy were analyzed by 16S ribosomal RNA (rRNA) gene-based sequencing protocol. Alpha diversity and specific taxa by tumor characteristics and breast cancer risk factors were tested by Wilcoxon rank sum test, and by differential abundance analysis, using a zero-inflated negative binomial regression model with adjustment for total counts, age and race/ethnicity. RESULTS There were no significant alpha diversity or phyla differences by estrogen/progesterone receptor status, tumor grade, stage, parity and body mass index. However, women with human epidermal growth factor receptor 2 positive (HER2+) (n = 12) compared to HER2- (n = 25) breast cancer showed 12-23% lower alpha diversity [number of species (OTU) p = 0.033, Shannon index p = 0.034], lower abundance of Firmicutes (p = 0.005) and higher abundance of Bacteroidetes (p = 0.089). Early menarche (ages ≤ 11) (n = 11) compared with later menarche (ages ≥ 12) (n = 26) was associated with lower OTU (p = 0.036), Chao1 index (p = 0.020) and lower abundance of Firmicutes (p = 0.048). High total body fat (TBF) (> 46%) (n = 12) compared to lower (≤ 46%) TBF was also associated with lower Chao 1 index (p = 0.011). There were other significant taxa abundance differences by HER2 status, menarche age, as well as other tumor and breast cancer risk factors. CONCLUSIONS AND RELEVANCE Further studies are needed to identify characteristics of the human microbiome and the interrelationships between breast cancer hormone receptor status and established breast cancer risk factors.
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Affiliation(s)
- Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Rm 4443, Los Angeles, CA, 90089, USA.
| | - Chiuchen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Rm 4443, Los Angeles, CA, 90089, USA
| | - Cheryl Vigen
- Mrs. TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Yang Yu
- Global Data Science and Analytics- Medical Device Division, Abbott Laboratories, Santa Clara, CA, USA
| | - Wendy Cozen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Rm 4443, Los Angeles, CA, 90089, USA
| | - Agustin A Garcia
- Hematology Oncology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders C, Carrillo J, Chalasani P, Kabos P, Puhalla S, Tkaczuk K, Garcia AA, Ahluwalia MS, Wefel JS, Lakhani N, Ibrahim N. ANG1005, a Brain-Penetrating Peptide-Drug Conjugate, Shows Activity in Patients with Breast Cancer with Leptomeningeal Carcinomatosis and Recurrent Brain Metastases. Clin Cancer Res 2020; 26:2789-2799. [PMID: 31969331 DOI: 10.1158/1078-0432.ccr-19-3258] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE ANG1005, a novel taxane derivative, consists of three paclitaxel molecules covalently linked to Angiopep-2, designed to cross the blood-brain and blood-cerebrospinal barriers and to penetrate malignant cells via LRP1 transport system. Preclinical and clinical evidence of efficacy with ANG1005 has been previously shown. PATIENTS AND METHODS A multicenter, open-label phase II study in adult patients with measurable recurrent brain metastases from breast cancer (BCBM), with or without leptomeningeal carcinomatosis was conducted (n = 72 BCBM; n = 28 leptomeningeal carcinomatosis subset). ANG1005 was administered intravenously at 600 mg/m2 every 3 weeks. Tumor assessment was based on central nervous system (CNS) RECIST 1.1 for intracranial, and RECIST 1.1 for extracranial response. The primary endpoint was determination of intracranial objective response rate (iORR). RESULTS Median age was 47.5 years. Safety profile was similar to that of paclitaxel with myelosuppression as the predominating toxicity. Average number of prior CNS-directed therapies was 2.8 and 94% of the patients had prior taxane treatment. Patient benefit (stable disease or better) was seen in 77% (intracranial) and 86% (extracranial) of the evaluable patients, with iORR of 15% (investigator) or 8% (independent radiology facility [IRF] review). In the leptomeningeal carcinomatosis subset, 79% of the patients had intracranial disease control and estimated median overall survival of 8.0 months (95% CI, 5.4-9.4). CONCLUSIONS Even though the study preset rule for iORR per IRF was not met in this heavily pretreated population, a notable CNS and systemic treatment effect was seen in all patients including symptom improvement and prolonged overall survival compared to historical control for the subset of patients with leptomeningeal carcinomatosis (n = 28).
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Affiliation(s)
- Priya Kumthekar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Shou-Ching Tang
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Santosh Kesari
- John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, California
| | - David E Piccioni
- Department of Neurosciences, UC San Diego Moores Cancer Center, La Jolla, California
| | | | - Jose Carrillo
- John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
| | | | - Peter Kabos
- University of Colorado, Anschutz Medical Campus, Greenwood Village, Colorado
| | - Shannon Puhalla
- University of Pittsburgh Magee Women's Cancer Program, Pittsburgh, Pennsylvania
| | - Katherine Tkaczuk
- University Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Manmeet S Ahluwalia
- Miller Family Endowed Chair in NeuroOncology; Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nehal Lakhani
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, Michigan
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center; Houston, Texas
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9
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Coyne GO'S, Wang L, Zlott J, Juwara L, Covey JM, Beumer JH, Cristea MC, Newman EM, Koehler S, Nieva JJ, Garcia AA, Gandara DR, Miller B, Khin S, Miller SB, Steinberg SM, Rubinstein L, Parchment RE, Kinders RJ, Piekarz RL, Kummar S, Chen AP, Doroshow JH. Intravenous 5-fluoro-2'-deoxycytidine administered with tetrahydrouridine increases the proportion of p16-expressing circulating tumor cells in patients with advanced solid tumors. Cancer Chemother Pharmacol 2020; 85:979-993. [PMID: 32314030 PMCID: PMC7188725 DOI: 10.1007/s00280-020-04073-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Following promising responses to the DNA methyltransferase (DNMT) inhibitor 5-fluoro-2'-deoxycytidine (FdCyd) combined with tetrahydrouridine (THU) in phase 1 testing, we initiated a non-randomized phase 2 study to assess response to this combination in patients with advanced solid tumor types for which tumor suppressor gene methylation is potentially prognostic. To obtain pharmacodynamic evidence for DNMT inhibition by FdCyd, we developed a novel method for detecting expression of tumor suppressor protein p16/INK4A in circulating tumor cells (CTCs). METHODS Patients in histology-specific strata (breast, head and neck [H&N], or non-small cell lung cancers [NSCLC] or urothelial transitional cell carcinoma) were administered FdCyd (100 mg/m2) and THU (350 mg/m2) intravenously 5 days/week for 2 weeks, in 28-day cycles, and progression-free survival (PFS) rate and objective response rate (ORR) were evaluated. Blood specimens were collected for CTC analysis. RESULTS Ninety-three eligible patients were enrolled (29 breast, 21 H&N, 25 NSCLC, and 18 urothelial). There were three partial responses. All strata were terminated early due to insufficient responses (H&N, NSCLC) or slow accrual (breast, urothelial). However, the preliminary 4-month PFS rate (42%) in the urothelial stratum exceeded the predefined goal-though the ORR (5.6%) did not. An increase in the proportion of p16-expressing cytokeratin-positive CTCs was detected in 69% of patients evaluable for clinical and CTC response, but was not significantly associated with clinical response. CONCLUSION Further study of FdCyd + THU is potentially warranted in urothelial carcinoma but not NSCLC or breast or H&N cancer. Increase in the proportion of p16-expressing cytokeratin-positive CTCs is a pharmacodynamic marker of FdCyd target engagement.
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Affiliation(s)
- Geraldine O 'Sullivan Coyne
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Lihua Wang
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Jennifer Zlott
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Lamin Juwara
- Clinical Monitoring Research Program, Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Joseph M Covey
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Jan H Beumer
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Mihaela C Cristea
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Edward M Newman
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Jorge J Nieva
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Agustin A Garcia
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- Louisiana State University, New Orleans, LA, 70112, USA
| | - David R Gandara
- University of California Davis Cancer Center, Sacramento, CA, USA
| | - Brandon Miller
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Sonny Khin
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Sarah B Miller
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Seth M Steinberg
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Larry Rubinstein
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Ralph E Parchment
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Robert J Kinders
- Clinical Pharmacodynamic Biomarkers Program, Applied/Developmental Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Richard L Piekarz
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - Alice P Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, 31 Center Drive, Bldg. 31 Room 3A-44, Bethesda, MD, 20892, USA.
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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10
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Moseley A, Porter DJ, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow JR, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian LM, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Final Analysis of the Prevention of Early Menopause Study (POEMS)/SWOG Intergroup S0230. J Natl Cancer Inst 2020; 111:210-213. [PMID: 30371800 DOI: 10.1093/jnci/djy185] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
Premature menopause is a serious long-term side effect of chemotherapy. We evaluated long-term pregnancy and disease-related outcomes for patients in S0230/POEMS, a study in premenopausal women with stage I-IIIA estrogen receptor-negative, progesterone receptor-negative breast cancer to be treated with cyclophosphamide-containing chemotherapy. Women were randomly assigned to standard chemotherapy with or without goserelin, a gonadotropin-releasing hormone agonist, and were stratified by age and chemotherapy regimen. All statistical tests were two-sided. Of 257 patients, 218 were eligible and evaluable (105 in the chemotherapy + goserelin arm and 113 in the chemotherapy arm). More patients in the chemotherapy + goserelin arm reported at least one pregnancy vs the chemotherapy arm (5-year cumulative incidence = 23.1%, 95% confidence interval [CI] = 15.3% to 31.9%; and 12.2%, 95% CI = 6.8% to 19.2%, respectively; odds ratio = 2.34; 95% CI = 1.07 to 5.11; P = .03). Randomization to goserelin + chemotherapy was associated with a nonstatistically significant improvement in disease-free survival (hazard ratio [HR] = 0.55; 95% CI = 0.27 to 1.10; P = .09) and overall survival (HR = 0.45; 95% CI = 0.19 to 1.04; P = .06). In this long-term analysis of POEMS/S0230, we found continued evidence that patients randomly assigned to receive goserelin + chemotherapy were not only more likely to avoid premature menopause, but were also more likely to become pregnant without adverse effect on disease-related outcomes.
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Affiliation(s)
| | - Joseph M Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kelly-Anne Phillips
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Erika Hitre
- National Institute of Oncology, Budapest, Hungary
| | - Anna Moseley
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David J Porter
- Auckland Regional Cancer and Blood Service, Auckland, New Zealand
| | - Prudence A Francis
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | - Shaker R Dakhil
- Wichita NCORP, Wichita, KS.,Louisiana State University Health Sciences Center, New Orleans, LA
| | - Agustin A Garcia
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Julie R Gralow
- Seattle Cancer Care Alliance, and University of Washington, Seattle, WA
| | | | - John F Forbes
- Breast Cancer Trials Australia and New Zealand (BCT-ANZ), Newcastle, Australia.,Calvary Mater Hospital, Newcastle, Australia
| | | | - William E Barlow
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Frank L Meyskens
- University of California at Irvine Chao Family Comprehensive Cancer Center, Orange, CA
| | - Richard D Gelber
- IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, MA
| | | | - Kathy S Albain
- Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL
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11
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Vergote I, Powell MA, Teneriello MG, Miller DS, Garcia AA, Mikheeva ON, Bidzinski M, Cebotaru CL, Dutcus CE, Ren M, Kadowaki T, Funahashi Y, Penson RT. Second-line lenvatinib in patients with recurrent endometrial cancer. Gynecol Oncol 2020; 156:575-582. [PMID: 31955859 DOI: 10.1016/j.ygyno.2019.12.039] [Citation(s) in RCA: 45] [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] [Received: 12/03/2019] [Accepted: 12/25/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study assessed the efficacy of lenvatinib, a multitargeted tyrosine kinase inhibitor, as second-line therapy in patients with unresectable endometrial cancer. The primary end point was the objective response rate (ORR) as assessed by independent radiologic review (IRR). Secondary end points included median progression-free survival (PFS), overall survival (OS), and clinical benefit rate. Exploratory end points examined the association of baseline levels of plasma biomarkers (50 circulating cytokine and/or angiogenic factors measured by immunoassays) with efficacy outcomes. METHODS An international, open-label, single-arm, multicenter, phase 2 trial was conducted. Eligible patients had histologically confirmed unresectable endometrial cancer that relapsed after 1 prior systemic platinum-based chemotherapy. Patients received once-daily oral lenvatinib 24 mg in a 28-day dosing cycle. RESULTS There were 133 patients in the study. By IRR, 19 patients had a confirmed objective response for an ORR of 14.3% (95% CI: 8.8-21.4). Durable stable disease (≥23 weeks) was observed in 31 patients (23.3%) and the clinical benefit rate was 37.6% (95% CI: 29.3-46.4). Median PFS was 5.6 months (95% CI: 3.7-6.3), and median OS was 10.6 months (95% CI: 8.9-14.9). The most common (any grade) treatment-related adverse events were fatigue/asthenia (48%), hypertension (49%), nausea/vomiting (32%), decreased appetite (32%), and diarrhea (31%). Lower baseline levels of angiopoietin-2 were associated with longer PFS, OS, and a higher ORR. CONCLUSIONS Patients with recurrent endometrial cancer treated with second-line lenvatinib experienced modest antitumor activity and treatment was generally well tolerated, with a safety profile consistent with previous studies.
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Affiliation(s)
- Ignace Vergote
- Division of Gynaecological Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium.
| | - Matthew A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - David S Miller
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Olga N Mikheeva
- State Healthcare Institution Leningrad Regional Oncology Center, St Petersburg, Russia
| | - Mariusz Bidzinski
- Maria Sklodowska-Curie Memorial Institute, Oncology Center, Warsaw, Poland
| | - Cristina Ligia Cebotaru
- Department of Radiotherapy I-Medical Oncology, Prof Dr Ion Chircuta Institute of Oncology, Cluj Napoca, Romania
| | | | - Min Ren
- Eisai Inc, Woodcliff Lake, NJ, USA
| | | | | | - Richard T Penson
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
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12
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Kang I, Spicer DV, Lu JM, Groshen SG, Tsao-Wei D, Garcia AA. Phase II trial of metronomic capecitabine and cyclophosphamide with lapatinib and trastuzumab in patients with HER2-positive metastatic breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12508 Background: Metronomic chemotherapy is an emerging paradigm of cancer therapy in which low doses of chemotherapy are delivered at frequent intervals. Activity in patients with metastatic breast cancer (MBC) has been demonstrated in several phase II clinical trials. Methods: We proposed a regimen with metronomic chemotherapy and dual HER2 inhibition in HER2 positive patients with MBC. We hypothesized that this regimen will be highly active in MBC and have a favorable toxicity profile. Patients were treated on a 21-day cycle with capecitabine 1500mg PO daily, cyclophosphamide 50mg daily, lapatinib 1000mg PO daily and trastuzumab 6mg/kg IV once per 21-day cycle. This regimen was continued until disease progression or unacceptable toxicity. Primary endpoint was progression free survival (PFS). Secondary endpoints were overall response rate (ORR), clinical benefit rate (CBR), overall survival (OS), and safety and tolerability of this regimen. Eligibility criteria were patients 18 years of age and older who had histologically confirmed HER2-positive metastatic breast cancer with prior trastuzumab use in the adjuvant or metastatic setting with no more than two prior regimens for MBC. Results: Ten patients were accrued from Jan 2014-Oct 2016. Median age was 52 (range 38 - 79) years. Median number of chemotherapy regimens for metastatic disease was 0.5 (range 0-2). Median PFS was 13.7 (95% CI: 2.6, 16.6) months. Median OS was 29.6 (95% CI: 11.8, 60.5+) months. ORR was 30%, and CBR was 70%. Grade 3 or 4 toxicities were identified in 6 patients. The most common toxicities of any grade were fatigue (100%), diarrhea (80%), anemia, neutropenia, ALT increase, nausea and hand-foot syndrome 50% each. One patient achieved CR for over 3 years and continues on treatment at time of this report. 8 patients progressed and 1 patient withdrew from study without response evaluation. The trial was closed due to lack of accrual. Conclusions: The proposed regimen of metronomic capecitabine and cyclophosphamide with lapatinib and trastuzumab appears to be active in patients with HER2 positive MBC but with significant toxicity. Clinical trial information: NCT01873833.
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Affiliation(s)
- Irene Kang
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
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13
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Garcia J, Lin YG, Louie S, Fauceglia P, Tsao-Wei DD, Yoo E, Ciccone M, Adams C, Brunette LL, MATSUO KOJI, Pham HQ, Yessaian AA, Groshen SG, Facio G, Watkins K, Muderspach LI, Garcia AA, Roman LD. Phase II clinical trial of eribulin (E) in advanced/recurrent cervical cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jocelyn Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Yvonne Gail Lin
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Stan Louie
- University of Southern California School of Pharmacy, Los Angeles, CA
| | - Paulette Fauceglia
- University of Southern California, Department of Clinical Pathology, Los Angeles, CA, US
| | - Denice D Tsao-Wei
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - EunJeong Yoo
- University of Southern California School of Pharmacy, Los Angeles, CA
| | - Marcia Ciccone
- University of Southern California, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles, CA
| | - Crystal Adams
- University of Southern California, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles, CA
| | | | - KOJI MATSUO
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Huyen Q. Pham
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Annie A. Yessaian
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | - Grace Facio
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Kristy Watkins
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Laila I. Muderspach
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Lynda D. Roman
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
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14
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Dorff TB, Shelechi M, Kang I, Morgan TE, Groshen SG, Yennu S, Garcia AA, Quinn DI, Longo V. A randomized phase II clinical trial of a fasting-mimic diet prior to chemotherapy to evaluate the impact on toxicity and efficacy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps10132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Irene Kang
- LAC and University of Southern California, Los Angeles, CA
| | | | | | - Sriram Yennu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - David I. Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Valter Longo
- USC Davis School of Gerontology, Los Angeles, CA
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15
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Abstract P1-15-01: Final analysis of SWOG S0230/Prevention of early menopause study (POEMS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-15-01] [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: The SWOG S0230/POEMS study demonstrated a 70% reduction in ovarian failure (OF) with goserelin coadministration during chemotherapy (CT) for ER-negative early breast cancer (BC; Moore H et al, NEJM 2015). Goserelin use was also associated with more pregnancies as well as favorable disease free survival (DFS) and overall survival (OS). Here we report the final analysis after 5 years of follow-up.
METHODS: Premenopausal women age <50 with stage I-IIIA ER/PR-negative BC to be treated with cyclophosphamide-containing CT were randomized to receive standard CT with or without monthly goserelin 3.6 mg SQ starting at least 1 week prior to the first CT dose. The primary endpoint was OF at 2-years, defined as amenorrhea for the prior 6 months and post-menopausal FSH. Secondary endpoints included pregnancies, disease free survival (DFS) and overall survival (OS). An unplanned analysis of rate of menses recovery at 2 years (presence of menses within 6 months of the 2 year time-point or pregnancy within the first 2 years) was also conducted. OF and pregnancy endpoints were analyzed using multivariable logistic regression adjusting for stratification factors (age and CT regimen); DFS and OS were examined using multivariable Cox regression, adjusting for stratification factors and stage. Two-sided p-values are reported unless otherwise specified in accordance with protocol design.
RESULTS: Among 257 randomized participants, 218 were eligible and evaluable. One hundred thirty-six eligible and evaluable patients had OF data and 186 had menstrual data. Median age was 37.7 years. Among the 136 patients with OF data, the odds ratio (OR) for OF at 2 years was 0.30 (95% CI 0.1-0.98; one-sided p=0.023) comparing CT with goserelin to standard CT alone. Among 186 patients with menstrual data, 80% recovered menses by 2 years in the goserelin arm compared with 70% in the standard arm (OR=1.74, 95% CI: 0.83-3.66, p=0.15). Pregnancies, DFS and OS are reported for all 218 eligible and evaluable patients. With a median follow-up of 5.1 years, 22% of patients in the goserelin group had at least one pregnancy compared with 12% in the standard group (OR 2.38, 95% CI 1.08-5.26, p=0.03). Cumulative incidence of pregnancy at 5 years is 23% in the goserelin arm compared with 12% in the standard group. Five-year Kaplan-Meier DFS estimates are 88% in the goserelin arm compared with 79% in the standard arm (HR=0.50, p=0.05). Five-year OS is 92% with goserelin versus 83% in the standard arm (HR=0.47, p=0.06). Including all 257 randomized patients, HR for DFS and OS are 0.67 and 0.48 (p=0.18 and p=0.05).
CONCLUSION: Ovarian suppression with goserelin during chemotherapy for hormone receptor-negative breast cancer reduces OF risk and, after 5 years of follow-up, continues to be associated with more pregnancies and improved survival compared with chemotherapy without goserelin.
SUPPORT: NIH/NCI grant awards CA189974, CA180888, CA180819, CA074362; AstraZeneca
Citation Format: Moore HCF, Unger JM, Phillips K-A, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Final analysis of SWOG S0230/Prevention of early menopause study (POEMS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-01.
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Affiliation(s)
- HCF Moore
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Unger
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - K-A Phillips
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - F Boyle
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - E Hitre
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - A Moseley
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - D Porter
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - PA Francis
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - LJ Goldstein
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - HL Gomez
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CS Vallejos
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AH Partridge
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - SR Dakhil
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AA Garcia
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - J Gralow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Lombard
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JF Forbes
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - S Martino
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - WE Barlow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CJ Fabian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - L Minasian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - FL Meyskens
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - RD Gelber
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - GN Hortobagyi
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - KS Albain
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
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Rustin G, Vergote I, Micha JP, Duska LR, Reed N, Bendell J, Spitz D, Dark G, Hoch U, Tagliaferri M, Hannah AL, Garcia AA. A multicenter, open-label, expanded phase 2 study to evaluate the safety and efficacy of etirinotecan pegol, a polymer conjugate of irinotecan, in women with recurrent platinum-resistant or refractory ovarian cancer. Gynecol Oncol 2017; 147:276-282. [PMID: 28935273 DOI: 10.1016/j.ygyno.2017.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/22/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Etirinotecan pegol (EP) is a novel polyethylene glycol conjugated form of irinotecan with documented activity in platinum-resistant ovarian cancer (PROC). We report the results of the expanded portion of a phase II study of EP in patients with PROC who received prior pegylated liposomal doxorubicin (PLD) or who were unable to receive it. METHODS This multicenter, open-label, phase II study evaluated EP q21d for PROC. The primary endpoint was objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors version 1.0. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Patient populations evaluated included a modified intent-to-treat (mITT) group consisting of all patients who received at least one dose and with measurable disease and a primary efficacy (pEFF) group (subset of the mITT population who received prior PLD). RESULTS One hundred thirty-nine patients were enrolled. Of the 132 patients in the mITT group, 20 achieved an ORR (15.2%; 95% CI 9.5-22.4); median PFS and OS were 4.4 months and 10.2 months, respectively. In the pEFF group (n=104), 15 patients (14.4%; 95% CI 8.3-22.7) achieved an ORR; median PFS and OS were 4.4 months and 10.9 months, respectively. The most common grade 3/4 toxicities were diarrhea (20%), abdominal pain (17%), vomiting (14%), dehydration (13%), and nausea (13%). Severe diarrhea was reduced to 15% with strict adherence to screening and management guidelines. CONCLUSIONS This study confirms the activity and safety of single-agent EP in patients with PROC, including patients who received prior PLD. Further evaluation earlier in the disease course and in combination is warranted.
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Affiliation(s)
- G Rustin
- Mount Vernon Hospital, Middlesex, United Kingdom
| | - I Vergote
- Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - J P Micha
- Gynecologic Oncology Associates, Newport Beach, CA, USA
| | - L R Duska
- University of Virginia Health System, Division of Gynecologic Oncology, Charlottesville, VA, USA
| | - N Reed
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Bendell
- Tennessee Oncology, PLLC, Sarah Cannon Research Institute, Nashville, TN, USA
| | - D Spitz
- Palm Beach Cancer Institute, West Palm Beach, FL, USA
| | - G Dark
- Freemen Hospital, High Heaton, Newcastle-upon-Tyne, United Kingdom
| | - U Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | - A L Hannah
- Nektar Therapeutics, San Francisco, CA, USA
| | - A A Garcia
- USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA, USA; LSU Stanley S. Scott Cancer Center, New Orleans, LA, USA.
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Becerra C, Garcia AA, Hays JL, Method MW, Richey SL, Langleben A, Richards DA, Cote GM, Kossler K, Li W, Li Y, Hitron M, Li C. A phase 1b/2 study of napabucasin with weekly paclitaxel in advanced, previously treated platinum resistant ovarian cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5548 Background: Napabucasin is a first-in-class cancer stemness inhibitor, identified by its ability to inhibit STAT3-driven gene transcription and spherogenesis of cancer stem cells (Li et al PNAS 112 (6):1839, 2015). Napabucasin has shown potent synergistic preclinical anti-tumor activity with paclitaxel (PTX). In a phase Ib dose escalation study in patients (pts) with advanced solid tumors, napabucasin plus weekly PTX was well tolerated. A phase II expansion cohort was opened for patients with platinum resistant ovarian cancer. Methods: Pts with advanced ovarian cancer who had disease progression either during or in the 6 months following platinum-based systemic therapy were enrolled. napabucasin was administered orally at a starting dose of 240, 480, or 500 mg twice daily with PTX 80 mg/m2 IV weekly on 3 of every 4 weeks. AEs were evaluated using CTCAE v4.03 and objective assessments were performed per RECIST 1.1 every 8 weeks. Results: A total of 98 pts were enrolled. The average number of prior lines of systemic treatment was 3.5, including prior taxane-based therapy in 100% of patients. Treatment was well tolerated. Related grade 3 adverse events occurring ≥ 5% of pts included diarrhea (12.2%) and vomiting (5.1%). Among pts who received RECIST evaluation (n = 76), the disease control rate (DCR, proportion with SD at 8 weeks + PR + CR) was 65%, and the objective response rate (ORR, PR+CR) was 20%, with complete response in 3 pts (4%). In all patients (ITT, n = 98), the median progression-free survival (mPFS) was 3.0 months and median overall survival (mOS) was 9.3 months. Conclusions: Clinical safety and encouraging signs of anti-cancer activity, including three complete responses, were observed in pts with pre-treated platinum resistant ovarian cancer who received treatment with napabucasin plus weekly PTX. Further clinical evaluation in controlled trials is warranted. Clinical trial information: NCT01325441.
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Affiliation(s)
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - John L. Hays
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Stephen Lane Richey
- Texas Oncology, The US Oncology Network, McKesson Specialty Health, Fort Worth, TX
| | | | | | | | | | - Wei Li
- Boston Biomedical Inc., Cambridge, MA
| | - Youzhi Li
- Boston Biomedical Inc., Cambridge, MA
| | | | - Chiang Li
- Boston Biomedical Inc., Cambridge, MA
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Lee SC, Grant E, Sheth P, Garcia AA, Desai B, Ji L, Groshen S, Hwang D, Yamashita M, Hovanessian-Larsen L. Accuracy of Contrast-Enhanced Ultrasound Compared With Magnetic Resonance Imaging in Assessing the Tumor Response After Neoadjuvant Chemotherapy for Breast Cancer. J Ultrasound Med 2017; 36:901-911. [PMID: 28150325 PMCID: PMC7710668 DOI: 10.7863/ultra.16.05060] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/25/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVES This pilot study compared contrast enhanced ultrasound (US) with contrast-enhanced magnetic resonance imaging (MRI) in assessing the treatment response in patients with breast cancer receiving preoperative neoadjuvant chemotherapy (NAC). METHODS This prospective Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study included 30 patients, from January 2014 to October 2015, with invasive breast cancer detected by mammography, conventional US imaging, or both and scheduled for NAC. Informed consent was obtained. Contrast-enhanced US (perflutren lipid microspheres, 10 μL/kg) and MRI (gadopentetate dimeglumine, 0.1 mmol/kg) scans were performed at baseline before starting NAC and after completing NAC before surgery. Results of the imaging techniques were compared with each other and with histopathologic findings obtained at surgery using the Spearman correlation. Tumor size and enhancement parameters were compared for 15 patients with contrast-enhanced US, MRI, and surgical pathologic findings. RESULTS The median tumor size at baseline was 3.1 cm on both contrast-enhanced US and MRI scans. The Spearman correlation showed strong agreement in tumor size at baseline between contrast-enhanced US and MRI (r = 0.88; P < .001) but less agreement in tumor size after NAC (r = 0.66; P = .004). Trends suggested that contrast-enhanced US (r = 0.75; P < .001) had a better correlation than MRI (r = 0.42; P = .095) with tumor size at surgery. Contrast-enhanced US was as effective as MRI in predicting a complete pathologic response (4 patients; 75.0% accuracy for both) and a non-complete pathologic response (11 patients; 72.7% accuracy for both). CONCLUSIONS Contrast enhanced US is a valuable imaging modality for assessing the treatment response in patients receiving NAC and had a comparable correlation as MRI with breast cancer size at surgery.
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Affiliation(s)
- Sandy C Lee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Edward Grant
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pulin Sheth
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Agustin A Garcia
- Department of Internal Medicine, Section of Hematology/Oncology, Louisiana State University, New Orleans, Louisiana, USA
| | - Bhushan Desai
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lingyun Ji
- Department of Preventive Medicine , Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Susan Groshen
- Department of Preventive Medicine , Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Darryl Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mary Yamashita
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda Hovanessian-Larsen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Somlo G, Frankel PH, Arun BK, Ma CX, Garcia AA, Cigler T, Cream LV, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Beumer JH, Hurria A, Mortimer J, Piekarz R, Sand S, Herzog J, Van Tongeren LR, Ferry-Galow KV, Chen AP, Ruel C, Newman EM, Gandara DR, Weitzel JN. Efficacy of the PARP Inhibitor Veliparib with Carboplatin or as a Single Agent in Patients with Germline BRCA1- or BRCA2-Associated Metastatic Breast Cancer: California Cancer Consortium Trial NCT01149083. Clin Cancer Res 2017; 23:4066-4076. [PMID: 28356425 DOI: 10.1158/1078-0432.ccr-16-2714] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We aimed to establish the MTD of the poly (ADP-ribose) (PAR) polymerase inhibitor, veliparib, in combination with carboplatin in germline BRCA1- and BRCA2- (BRCA)-associated metastatic breast cancer (MBC), to assess the efficacy of single-agent veliparib, and of the combination treatment after progression, and to correlate PAR levels with clinical outcome.Experimental Design: Phase I patients received carboplatin (AUC of 5-6, every 21 days), with escalating doses (50-20 mg) of oral twice-daily (BID) veliparib. In a companion phase II trial, patients received single-agent veliparib (400 mg BID), and upon progression, received the combination at MTD. Peripheral blood mononuclear cell PAR and serum veliparib levels were assessed and correlated with outcome.Results: Twenty-seven phase I trial patients were evaluable. Dose-limiting toxicities were nausea, dehydration, and thrombocytopenia [MTD: veliparib 150 mg po BID and carboplatin (AUC of 5)]. Response rate (RR) was 56%; 3 patients remain in complete response (CR) beyond 3 years. Progression-free survival (PFS) and overall survival (OS) were 8.7 and 18.8 months. The PFS and OS were 5.2 and 14.5 months in the 44 patients in the phase II trial, with a 14% RR in BRCA1 (n = 22) and 36% in BRCA2 (n = 22). One of 30 patients responded to the combination therapy after progression on veliparib. Higher baseline PAR was associated with clinical benefit.Conclusions: Safety and efficacy are encouraging with veliparib alone and in combination with carboplatin in BRCA-associated MBC. Lasting CRs were observed when the combination was administered first in the phase I trial. Further investigation of PAR level association with clinical outcomes is warranted. Clin Cancer Res; 23(15); 4066-76. ©2017 AACR.
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Affiliation(s)
- George Somlo
- City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Paul H Frankel
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia X Ma
- Washington University School of Medicine, St. Louis, Missouri
| | - Agustin A Garcia
- University of Southern California/Norris Cancer Center, Los Angeles, California
| | | | - Leah V Cream
- Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Joseph A Sparano
- Montefiore Medical Center, Moses & Weuker Divisions, Department of Oncology, Bronx, New York
| | - Rita Nanda
- The University of Chicago, Chicago, Illinois
| | - Helen K Chew
- University of California, Davis Cancer Center, Sacramento, California
| | | | | | | | - Jan H Beumer
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | - Sharon Sand
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Josef Herzog
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Katherine V Ferry-Galow
- Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratories, Frederick, Maryland
| | - Alice P Chen
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | | | - Edward M Newman
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - David R Gandara
- University of California, Davis Cancer Center, Sacramento, California
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21
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Vahdat LT, Layman R, Yardley DA, Gradishar W, Salkeni MA, Joy A, Garcia AA, Ward P, Khatcheressian J, Sparano J, Rodriguez G, Tang S, Gao L, Dalal RP, Kauh J, Miller K. Randomized Phase II Study of Ramucirumab or Icrucumab in Combination with Capecitabine in Patients with Previously Treated Locally Advanced or Metastatic Breast Cancer. Oncologist 2017; 22:245-254. [PMID: 28220020 PMCID: PMC5344637 DOI: 10.1634/theoncologist.2016-0265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Icrucumab (ICR) and ramucirumab (RAM) bind vascular endothelial growth factor (VEGF) receptors 1 and 2 (VEGFR-1 and -2), respectively. This open-label, randomized phase II study evaluated their efficacy and safety in combination with capecitabine (CAP) in patients with previously treated unresectable, locally advanced or metastatic breast cancer. METHODS Patients were randomly assigned (1:1:1) to receive CAP (1,000 mg/m2 orally twice daily, days 1-14) alone or in combination with RAM (10 mg/kg intravenously [IV], days 1 and 8) (RAM + CAP) or ICR (12 mg/kg IV, days 1 and 8) (ICR + CAP) every 21 days. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), tumor response, safety, and pharmacokinetics. RESULTS Of 153 patients randomized, 150 received treatment. Median PFS (95% confidence interval) was 22.1 (12.1-36.1) weeks on RAM + CAP, 7.3 (6.3-13.0) weeks on ICR + CAP, and 19.0 (12.1-24.3) weeks on CAP (hazard ratios [HRs]: 0.691, p = .1315, RAM + CAP versus CAP; 1.480, p = .0851, ICR + CAP versus CAP). Median OS was 67.4 weeks on RAM + CAP, 62.1 weeks on ICR + CAP, and 71.6 weeks on CAP (HRs: 1.833, p = .0283, RAM + CAP versus CAP; 1.468, p = .1550, ICR + CAP versus CAP). There was no statistically significant difference in PFS or OS between either combination arm and CAP. Treatment-related adverse events more frequent (by ≥10%) on RAM + CAP than on CAP were constipation, decreased appetite, headache, epistaxis, and hypertension. Those more frequent (by ≥10%) on ICR + CAP than CAP were anemia, increased lacrimation, periorbital edema, nausea, vomiting, peripheral edema, facial edema, dehydration, and dyspnea. CONCLUSION Combining RAM or ICR with CAP did not improve PFS in the targeted study population. The Oncologist 2017;22:245-254 IMPLICATIONS FOR PRACTICE: Icrucumab and ramucirumab are recombinant human IgG1 monoclonal antibodies that bind vascular endothelial growth factor (VEGF) receptors 1 and 2 (VEGFR-1 and -2), respectively. VEGFR-1 activation on endothelial and tumor cell surfaces increases tumor vascularization and growth and supports tumor growth via multiple mechanisms, including contributions to angiogenesis and direct promotion of cancer cell proliferation. Strong preclinical and clinical evidence suggests key roles for VEGF and angiogenesis in breast cancer growth, invasion, and metastasis. This randomized phase II study evaluated the efficacy and safety of each antibody in combination with capecitabine in patients with previously treated unresectable, locally advanced or metastatic breast cancer.
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Affiliation(s)
- Linda T Vahdat
- Weill Cornell Breast Center, Weill Cornell Medicine, New York, New York, USA
| | | | | | - William Gradishar
- Northwestern University Feinburg School of Medicine, Chicago, Illinois, USA
| | - Mohamad A Salkeni
- Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Anil Joy
- University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Agustin A Garcia
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Patrick Ward
- Oncology Hematology Care Incorporated, Cincinnati, Ohio, USA
| | | | - Joseph Sparano
- Weiler Division, Montefiore Medical Center, Bronx, New York, USA
| | | | - Shande Tang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ling Gao
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Rita P Dalal
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - John Kauh
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Kathy Miller
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana, USA
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22
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Connolly RM, Li H, Jankowitz RC, Zhang Z, Rudek MA, Jeter SC, Slater SA, Powers P, Wolff AC, Fetting JH, Brufsky A, Piekarz R, Ahuja N, Laird PW, Shen H, Weisenberger DJ, Cope L, Herman JG, Somlo G, Garcia AA, Jones PA, Baylin SB, Davidson NE, Zahnow CA, Stearns V. Combination Epigenetic Therapy in Advanced Breast Cancer with 5-Azacitidine and Entinostat: A Phase II National Cancer Institute/Stand Up to Cancer Study. Clin Cancer Res 2016; 23:2691-2701. [PMID: 27979916 DOI: 10.1158/1078-0432.ccr-16-1729] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/27/2016] [Accepted: 11/19/2016] [Indexed: 01/20/2023]
Abstract
Purpose: In breast cancer models, combination epigenetic therapy with a DNA methyltransferase inhibitor and a histone deacetylase inhibitor led to reexpression of genes encoding important therapeutic targets, including the estrogen receptor (ER). We conducted a multicenter phase II study of 5-azacitidine and entinostat in women with advanced hormone-resistant or triple-negative breast cancer (TNBC).Experimental Design: Patients received 5-azacitidine 40 mg/m2 (days 1-5, 8-10) and entinostat 7 mg (days 3, 10) on a 28-day cycle. Continuation of epigenetic therapy was offered with the addition of endocrine therapy at the time of progression [optional continuation (OC) phase]. Primary endpoint was objective response rate (ORR) in each cohort. We hypothesized that ORR would be ≥20% against null of 5% using Simon two-stage design. At least one response was required in 1 of 13 patients per cohort to continue accrual to 27 per cohort (type I error, 4%; power, 90%).Results: There was one partial response among 27 women with hormone-resistant disease (ORR = 4%; 95% CI, 0-19), and none in 13 women with TNBC. One additional partial response was observed in the OC phase in the hormone-resistant cohort (n = 12). Mandatory tumor samples were obtained pre- and posttreatment (58% paired) with either up- or downregulation of ER observed in approximately 50% of posttreatment biopsies in the hormone-resistant, but not TNBC cohort.Conclusions: Combination epigenetic therapy was well tolerated, but our primary endpoint was not met. OC phase results suggest that some women benefit from epigenetic therapy and/or reintroduction of endocrine therapy beyond progression, but further study is needed. Clin Cancer Res; 23(11); 2691-701. ©2016 AACR.
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Affiliation(s)
- Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Huili Li
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Zhe Zhang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stacie C Jeter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shannon A Slater
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Penny Powers
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John H Fetting
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adam Brufsky
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Richard Piekarz
- Cancer Therapy Evaluation Program (CTEP), NCI, Bethesda, Maryland
| | - Nita Ahuja
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Peter W Laird
- Van Andel Research Institute, Grand Rapids, Michigan
| | - Hui Shen
- Van Andel Research Institute, Grand Rapids, Michigan
| | | | - Leslie Cope
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James G Herman
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | | | - Peter A Jones
- Van Andel Research Institute, Grand Rapids, Michigan
| | - Stephen B Baylin
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nancy E Davidson
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Cynthia A Zahnow
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
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23
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Piatek CI, Ji L, Kaur C, Russell CA, Tripathy D, Church T, Sposto R, Sener SF, Garcia AA. Value of routine staging imaging studies for patients with stage III breast cancer. J Surg Oncol 2016; 114:917-921. [PMID: 27642105 DOI: 10.1002/jso.24436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/23/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Routine staging imaging studies (RSIS) are optional in stage III breast cancer (BC). The impact of RSIS on treatment decisions and patient outcomes has not been extensively studied. The goal of this study was to determine whether RSIS in stage III BC affected treatment or patient outcomes. METHODS Stage III BC patients from 2000 to 2010 were retrospectively identified. RSIS results and treatment plan in response to RSIS results were recorded. Univariate and multivariate Cox proportional hazards regression models with time-dependent covariates were used to assess associations between RSIS use and recurrence-free survival (RFS). RESULTS Of 420 patients, 362 (86.2%) received RSIS. RSIS were negative in 264 (72.9%), indeterminate in 77 (18.3%), and positive in 21 patients (5.0%) for metastatic disease. Treatment was altered in 21 (5.8%) patients based on RSIS results (20 with metastatic disease, 1 with indeterminate disease). There was no difference in RFS with RSIS use on multivariate analysis (hazard ratio 1.3; 95% confidence interval 0.73-2.5, P = 0.32). CONCLUSIONS Most stage III BC patients underwent RSIS, but RSIS results infrequently affected treatment decisions. There was no significant difference in RFS with RSIS use. RSIS to identify metastatic disease for stage III BC has limited value. J. Surg. Oncol. 2016;114:917-921. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Caroline I Piatek
- Jane Anne Nohl Division of Hematology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Lingyun Ji
- Department of Biostatistics, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Chandan Kaur
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Christy A Russell
- Department of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Debu Tripathy
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Terry Church
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Richard Sposto
- Department of Biostatistics, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Stephen F Sener
- Department of Surgery, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Agustin A Garcia
- Department of Hematology/Oncology, Louisiana State University, New Orleans, Louisiana
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24
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Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders CK, Carrillo JA, Chalasani P, Kabos P, Puhalla S, Garcia AA, Tkaczuk KH, Ahluwalia MS, Lakhani NJ, Ibrahim NK. ANG1005, a novel brain-penetrant taxane derivative, for the treatment of recurrent brain metastases and leptomeningeal carcinomatosis from breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - David Eric Piccioni
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, San Diego, CA
| | - Carey K. Anders
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Peter Kabos
- University of Colorado Denver, Greenwood Village, CO
| | | | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
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25
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Garcia AA, Hays JL, Cote GM, Becerra C, Langleben A, Lau SK, Roman LD, McCormick CC, Richards DA, Braiteh FS, Yimer HA, Richey SL, Edenfield WJ, Kossler K, Hume S, Li Y, Hitron M, Li C. A phase Ib/II study of cancer stemness inhibitor napabucasin (BB608) combined with weekly paclitaxel in platinum-resistant ovarian cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Agustin A. Garcia
- Los Angeles County Hospital/University of Southern California, Los Angeles, CA
| | - John L. Hays
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Carlos Becerra
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | | | | | - Lynda D. Roman
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | - Donald A. Richards
- Tyler Cancer Center, US Oncology Research, McKesson Specialty Health, Houston, TX
| | - Fadi S. Braiteh
- The US Oncology Network/McKesson Specialty Health, The Woodlands, TX
| | | | - Stephen Lane Richey
- Texas Oncology, The US Oncology Network, McKesson Specialty Health, Fort Worth, TX
| | - William Jeffery Edenfield
- Institute for Translational Oncology Research, Greenville Hospital System/University Medical Center, Greenville, SC
| | | | | | - Youzhi Li
- Boston Biomedical, Inc., Cambridge, MA
| | | | - Chiang Li
- Boston Biomedical, Inc., Cambridge, MA
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26
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Garcia J, Lin YG, Louie S, Yoo E, Tsao-Wei DD, Tierney KE, Brunette LL, Matsuo K, Pham HQ, Yessaian AA, Groshen SG, Facio G, Watkins K, Roman LD, Muderspach LI, Garcia AA. Phase II clinical trial of eribulin in advanced or recurrent cervical cancer (CC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps5617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jocelyn Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Yvonne Gail Lin
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Stan Louie
- University of Southern California School of Pharmacy, Los Angeles, CA
| | - EunJeong Yoo
- University of Southern California School of Pharmacy, Los Angeles, CA
| | - Denice D Tsao-Wei
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Koji Matsuo
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Huyen Q. Pham
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Annie A. Yessaian
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Susan G. Groshen
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Grace Facio
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Kristy Watkins
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Lynda D. Roman
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Laila I. Muderspach
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
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Somlo G, Frankel PH, Luu TH, Ma CX, Arun B, Garcia AA, Cigler T, Cream L, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Hurria A, Mortimer JE, Gandara DR, Chen AP, Weitzel JN. Efficacy of the PARP inhibitor (PI) ABT-888 (veliparib [vel]) either with carboplatin (carb) or as a single agent followed by post-progression therapy in combination with carb in patients (pts) with BRCA1- or BRCA2- (BRCA)-associated metastatic breast cancer (MBC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | - Leah Cream
- Penn State College of Medicine, Hershey, PA
| | | | | | | | | | | | | | | | | | | | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Konecny GE, Finkler N, Garcia AA, Lorusso D, Lee PS, Rocconi RP, Fong PC, Squires M, Mishra K, Upalawanna A, Wang Y, Kristeleit R. Second-line dovitinib (TKI258) in patients with FGFR2-mutated or FGFR2-non-mutated advanced or metastatic endometrial cancer: a non-randomised, open-label, two-group, two-stage, phase 2 study. Lancet Oncol 2015; 16:686-94. [PMID: 25981814 DOI: 10.1016/s1470-2045(15)70159-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Activating FGFR2 mutations are found in 10-16% of primary endometrial cancers and provide an opportunity for targeted therapy. We assessed the safety and activity of dovitinib, a potent tyrosine-kinase inhibitor of fibroblast growth factor receptors, VEGF receptors, PDGFR-β, and c-KIT, as second-line therapy both in patients with FGFR2-mutated (FGFR2(mut)) endometrial cancer and in those with FGFR2-non-mutated (FGFR2(non-mut)) endometrial cancer. METHODS In this phase 2, non-randomised, two-group, two-stage study, we enrolled adult women who had progressive disease after first-line chemotherapy for advanced or metastatic endometrial cancer from 46 clinical sites in seven countries. We grouped women according to FGFR2 mutation status and gave all women dovitinib (500 mg per day, orally, on a 5-days-on and 2-days-off schedule) until disease progression, unacceptable toxicity, death, or study discontinuation for any other reason. The primary endpoint was proportion of patients in each group who were progression-free at 18 weeks. For each group, the second stage of the trial (enrolment of 20 additional patients) could proceed if at least eight of the first 20 treated patients were progression free at 18 weeks. Activity was assessed in all enrolled patients and safety was assessed in all patients who received at least one dose of dovitinib. The completed study is registered with ClinicalTrials.gov, number NCT01379534. FINDINGS Of 248 patients with FGFR2 prescreening results, 27 (11%) had FGFR2(mut) endometrial cancer. Between Feb 17, 2012, and Dec 13, 2013, we enrolled 22 patients in the FGFR2(mut) group and 31 patients in the FGFR2(non-mut) group. Seven (31·8%, 95% CI 13·9-54·9) patients in the FGFR2(mut) group and nine (29·0%, 14·2-48·0) in the FGFR2(non-mut) group were progression-free at 18 weeks. On the basis of predefined criteria, neither group continued to stage two: seven (35%) of the first 20 patients in the FGFR2(mut) group were progression free at 18 weeks, as were five (25%) of the first 20 in the FGFR2(mut) population. Rates of treatment-emergent adverse events were similar between groups and events were most frequently gastrointestinal. Overall, the most common grade 3 or 4 adverse events suspected to be related to the study drug were hypertension (nine patients; 17%) and diarrhoea (five; 9%). The most frequently reported serious adverse events suspected to be related to study drug were pulmonary embolism (four patients; 8%), vomiting (four; 8%), dehydration (three; 6%), and diarrhoea (three; 6%). Only one death was deemed to be treatment-related: one patient in the FGFR2(non-mut) group died from cardiac arrest with contributing reason of pulmonary embolism (grade 4, suspected to be study drug related) 4 days previously. INTERPRETATION Second-line dovitinib in FGFR2(mut) and FGFR2(non-mut) advanced or metastatic endometrial cancer had single-agent activity, although it did not reach the prespecified study criteria. Observed treatment effects seemed independent of FGFR2 mutation status. These data should be considered exploratory and additional studies are needed. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- Gottfried E Konecny
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
| | - Neil Finkler
- Florida Hospital Cancer Institute, Orlando, FL, USA
| | | | - Domenica Lorusso
- Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Paula S Lee
- Duke University Medical Center, Durham, NC, USA
| | - Rodney P Rocconi
- University of South Alabama-Mitchell Cancer Institute, Mobile, AL, USA
| | - Peter C Fong
- Auckland Hospital and University of Auckland, Auckland, New Zealand
| | | | - Kaushal Mishra
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Yongyu Wang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Yardley DA, Weaver R, Melisko ME, Saleh MN, Arena FP, Forero A, Cigler T, Stopeck A, Citrin D, Oliff I, Bechhold R, Loutfi R, Garcia AA, Cruickshank S, Crowley E, Green J, Hawthorne T, Yellin MJ, Davis TA, Vahdat LT. EMERGE: A Randomized Phase II Study of the Antibody-Drug Conjugate Glembatumumab Vedotin in Advanced Glycoprotein NMB-Expressing Breast Cancer. J Clin Oncol 2015; 33:1609-19. [PMID: 25847941 DOI: 10.1200/jco.2014.56.2959] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Glycoprotein NMB (gpNMB), a negative prognostic marker, is overexpressed in multiple tumor types. Glembatumumab vedotin is a gpNMB-specific monoclonal antibody conjugated to the potent cytotoxin monomethyl auristatin E. This phase II study investigated the activity of glembatumumab vedotin in advanced breast cancer by gpNMB expression. PATIENTS AND METHODS Patients (n = 124) with refractory breast cancer that expressed gpNMB in ≥ 5% of epithelial or stromal cells by central immunohistochemistry were stratified by gpNMB expression (tumor, low stromal intensity, high stromal intensity) and were randomly assigned 2:1 to glembatumumab vedotin (n = 83) or investigator's choice (IC) chemotherapy (n = 41). The study was powered to detect overall objective response rate (ORR) in the glembatumumab vedotin arm between 10% (null) and 22.5% (alternative hypothesis) with preplanned investigation of activity by gpNMB distribution and/or intensity (Stratum 1 to Stratum 3). RESULTS Glembatumumab vedotin was well tolerated as compared with IC chemotherapy (less hematologic toxicity; more rash, pruritus, neuropathy, and alopecia). ORR was 6% (five of 83) for glembatumumab vedotin versus 7% (three of 41) for IC, without significant intertreatment differences for predefined strata. Secondary end point revealed ORR of 12% (10 of 83) versus 12% (five of 41) overall, and 30% (seven of 23) versus 9% (one of 11) for gpNMB overexpression (≥ 25% of tumor cells). Unplanned analysis showed ORR of 18% (five of 28) versus 0% (0 of 11) in patients with triple-negative breast cancer (TNBC), and 40% (four of 10) versus 0% (zero of six) in gpNMB-overexpressing TNBC. CONCLUSION Glembatumumab vedotin is well tolerated in heavily pretreated patients with breast cancer. Although the primary end point in advanced gpNMB-expressing breast cancer was not met for all enrolled patients (median tumor gpNMB expression, 5%), activity may be enhanced in patients with gpNMB-overexpressing tumors and/or TNBC. A pivotal phase II trial (METRIC [Metastatic Triple-Negative Breast Cancer]) is underway.
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Affiliation(s)
- Denise A Yardley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Robert Weaver
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michelle E Melisko
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Mansoor N Saleh
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Francis P Arena
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Andres Forero
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Tessa Cigler
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Alison Stopeck
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Dennis Citrin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Ira Oliff
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Rebecca Bechhold
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Randa Loutfi
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Agustin A Garcia
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Scott Cruickshank
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Elizabeth Crowley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Jennifer Green
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas Hawthorne
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michael J Yellin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas A Davis
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Linda T Vahdat
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ.
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015; 372:923-32. [PMID: 25738668 PMCID: PMC4405231 DOI: 10.1056/nejmoa1413204] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ovarian failure is a common toxic effect of chemotherapy. Studies of the use of gonadotropin-releasing hormone (GnRH) agonists to protect ovarian function have shown mixed results and lack data on pregnancy outcomes. METHODS We randomly assigned 257 premenopausal women with operable hormone-receptor-negative breast cancer to receive standard chemotherapy with the GnRH agonist goserelin (goserelin group) or standard chemotherapy without goserelin (chemotherapy-alone group). The primary study end point was the rate of ovarian failure at 2 years, with ovarian failure defined as the absence of menses in the preceding 6 months and levels of follicle-stimulating hormone (FSH) in the postmenopausal range. Rates were compared with the use of conditional logistic regression. Secondary end points included pregnancy outcomes and disease-free and overall survival. RESULTS At baseline, 218 patients were eligible and could be evaluated. Among 135 with complete primary end-point data, the ovarian failure rate was 8% in the goserelin group and 22% in the chemotherapy-alone group (odds ratio, 0.30; 95% confidence interval [CI], 0.09 to 0.97; two-sided P=0.04). Owing to missing primary end-point data, sensitivity analyses were performed, and the results were consistent with the main findings. Missing data did not differ according to treatment group or according to the stratification factors of age and planned chemotherapy regimen. Among the 218 patients who could be evaluated, pregnancy occurred in more women in the goserelin group than in the chemotherapy-alone group (21% vs. 11%, P=0.03); women in the goserelin group also had improved disease-free survival (P=0.04) and overall survival (P=0.05). CONCLUSIONS Although missing data weaken interpretation of the findings, administration of goserelin with chemotherapy appeared to protect against ovarian failure, reducing the risk of early menopause and improving prospects for fertility. (Funded by the National Cancer Institute and others; POEMS/S0230 ClinicalTrials.gov number, NCT00068601.).
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Affiliation(s)
- Halle C F Moore
- From the Cleveland Clinic Foundation, Cleveland (H.C.F.M.); SWOG Cancer Research Group Statistical Center, Fred Hutchinson Cancer Research Center (J.M.U., W.E.B.), and Seattle Cancer Care Alliance and University of Washington (J.G.) - all in Seattle; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC (K.-A.P., P.A.F.), Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) (K.-A.P., P.A.F., J.F.F.), Calvary Mater Hospital, Newcastle, NSW (F.B., J.M.L., J.F.F.), and University of Sydney, Sydney (F.B.) - all in Australia; International Breast Cancer Study Group (IBCSG), Bern, Switzerland (K.-A.P., P.A.F.); National Institute of Oncology, Budapest, Hungary (E.H.); Auckland Regional Cancer and Blood Service, Auckland, New Zealand (D.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.); Instituto de Enfermedades Neoplasicas (H.L.G.) and Oncosalud SAC (C.S.V.), Lima, Peru; Dana-Farber Cancer Institute (A.H.P., R.D.G.) and IBCSG Statistical Center (R.D.G.) - both in Boston; Wichita Community Clinical Oncology Program, Wichita (S.R.D.), and University of Kansas, Westwood (C.J.F.) - both in Kansas; University of Southern California Norris Cancer Center, Los Angeles (A.A.G.), the Angeles Clinic and Research Institute, Santa Monica (S.M.), and University of California at Irvine Chao Family Comprehensive Cancer Center, Orange (F.L.M) - all in California; National Cancer Institute, Division of Cancer Prevention, Bethesda, MD (L.M.); M.D. Anderson Cancer Center, Houston (G.N.H.); and Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL (K.S.A.)
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Piatek CI, Raja GL, Ji L, Gitlitz BJ, Dorff TB, Quinn DI, Hu J, El-Khoueiry AB, Pham HQ, Roman L, Garcia AA. Phase I clinical trial of temsirolimus and vinorelbine in advanced solid tumors. Cancer Chemother Pharmacol 2014; 74:1227-34. [DOI: 10.1007/s00280-014-2600-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
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Pahuja S, Beumer JH, Appleman LJ, Tawbi HAH, Stoller RG, Lee JJ, Lin Y, Kiesel B, Yu J, Tan AR, Belani CP, Chew HK, Garcia AA, Morgan R, Chen AP, Giranda VL, Shepherd SP, Chu E, Puhalla S. Outcome of BRCA 1/2-mutated (BRCA+) and triple-negative, BRCA wild type (BRCA-wt) breast cancer patients in a phase I study of single-agent veliparib (V). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
135 Background: Veliparib (V) (ABT-888) is an oral, potent inhibitor of PARP 1/2. PARP inhibitors have preclinical and clinical efficacy in BRCA+ malignancies. There are genotypic and phenotypic similarities between BRCA+ cancers, serous ovarian cancer and basal-like breast cancer and we postulated that these tumors types may be similarly sensitive to single-agent PARP inhibition. This study sought to establish the maximum tolerated dose (MTD), dose -limiting toxicities (DLT), pharmacokinetic and pharmocodynamic properties, and preliminary efficacy of chronically-dosed V in 2 cohorts of patients, BRCA+ and BRCA-wt (consisting of serous ovarian cancer and triple-negative breast cancer (TNBC). Methods: A 3+3 dose escalation phase I trial was performed. Nine dose levels (DL) were planned, and dose escalation started at 50 mg BID to a maximum of 500 mg BID to determine a maximum tolerated dose (MTD) and recommended phase II dose (RP2D). V was administered orally continuously on a 28 day cycle. BRCA+ and BRCA-wt patients were enrolled in 2 separate cohorts with 2 separate escalations. Results: 98 (70 BRCA+ and 28 BRCA-wt) pts have been enrolled. The maximum administered dose (MAD) was 500mg BID and the MTD/RP2D is 400mg BID for both cohorts. 59 BRCA+ pts and 24 BRCA-wt pts (21 TNBC and 3 ovary) were evaluable for response. ORR was defined as CR+PR and clinical benefit rate (CBR) as CR+PR+SD > 6 months. Results are summarized in the table. Conclusions: There is evidence of anti-tumor activity with V comparable to that of other PARP inhibitors in the BRCA+ population. There was indication of dose responsiveness with greater activity in this population at higher doses. There is less activity in the mostly TNBC, BRCA-wt population, although there was evidence of benefit in a small number of patients. Ongoing tissue correlative studies will help to identify potential mechanisms of sensitivity and resistance. Clinical trial information: NCT00892736. [Table: see text]
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Affiliation(s)
- Shalu Pahuja
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | | | | | - James J. Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yan Lin
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Brian Kiesel
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Jing Yu
- University of Pittsburgh, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Antoinette R. Tan
- National Surgical Adjuvant Breast and Bowel Project and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | | | - Alice P. Chen
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | | | - Edward Chu
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Shannon Puhalla
- University of Pittsburgh Medical Center, Women's Cancer Program at Magee-Womens Hospital of UPMC, Pittsburgh, PA
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Piatek CI, Ji L, Kaur C, Church T, Spicer DV, Tripathy D, Russell CA, Lang JE, Macdonald HR, Sener SF, Silberman H, Sposto R, Garcia AA. Value of routine staging imaging studies (RSIS) for patients with stage III breast cancer (BC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
122 Background: RSIS (CT, bone and PET scan) in pts with stage I or II BC is not recommended by NCCN and is considered optional in stage III BC. 10-15% of pts with stage III BC have occult metastases by RSIS, but it is unclear if this finding affects pt management or outcome. The addition of PET scans to conventional imaging (CT and bone scans) is of little added value (Niikura, et al. Oncologist 2011; 16: 772-82). We hypothesized that the use of RSIS in pts with stage III BC does not lead to changes in treatment or pt outcomes. Methods: After IRB approval, we retrospectively identified 875 women with stage III or stage IV BC from 2000-2010 through the Los Angeles County-University of Southern California and Norris Comprehensive Cancer Center cancer registries. Pts with clinically apparent stage IV disease, pregnancy at time of diagnosis, a history of prior malignancy, or incomplete medical records were excluded. Pts who underwent RSIS prior to planned treatment (before surgery, neoadjuvant or adjuvant therapy) were identified. RSIS results and the treatment plan in response to the results were recorded. Results: 424 pts were identified with clinical or pathologic stage III BC: 197 pts (46%) were < 50 years old, 224 (53%) had ER+ or PR+/HER2- tumors, 111 (26%) had ER-/PR-/HER2+ tumors, 74 (17%) had triple negative tumors, 15 (4%) had missing biomarker data, and 61 (14%) had inflammatory BC. 365 pts (86%) underwent RSIS. RSIS were negative for metastatic disease in 266 (73%), indeterminate in 75 (21%), and positive in 24 (7%). Treatment was altered in 21 pts (6%) based on RSIS (20 with metastatic disease, 1 with indeterminate disease). Median follow-up was 3.8 years (range: 0.1 to 13.3). When controlled for age, stage, or biomarker status, no differences in progression-free survival (PFS) were observed between the pts who underwent RSIS compared to those that did not. Conclusions: Most pts with stage III BC undergo RSIS. However, the results of RSIS infrequently affect treatment decisions. We did not observe a difference in PFS between pts who underwent RSIS and those who did not. Our findings suggest RSIS in stage III BC has limited value. A prospective study of this research question is warranted.
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Affiliation(s)
- Caroline Irene Piatek
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Lingyun Ji
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Terry Church
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | - Richard Sposto
- Children’s Center for Cancer and Blood Diseases, Children's Hospital Los Angeles & Keck School of Medicine, University of Southern California, Los Angeles, CA
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Connolly RM, Jankowitz RC, Zahnow CA, Zhang Z, Rudek MA, Slater S, Powers P, Jeter S, Brufsky A, Piekarz R, Herman JG, Ahuja N, Somlo G, Garcia AA, Baylin S, Davidson NE, Stearns V. Phase 2 study investigating the safety, efficacy, and surrogate biomarkers of response to 5-azacitidine (5-AZA) and entinostat in advanced breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Roisin M. Connolly
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Rachel Catherine Jankowitz
- University of Pittsburgh Medical Center, Women's Cancer Program at Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | - Zhe Zhang
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Michelle A. Rudek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Shannon Slater
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Penny Powers
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Stacie Jeter
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Adam Brufsky
- University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - James Gordon Herman
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Nita Ahuja
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Stephen Baylin
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Vered Stearns
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Puhalla S, Beumer JH, Pahuja S, Appleman LJ, Tawbi HAH, Stoller RG, Lee JJ, Lin Y, Kiesel B, Yu J, Tan AR, Belani CP, Chew HK, Garcia AA, Morgan R, Giranda VL, Shepherd SP, Chen AP, Chu E. Final results of a phase 1 study of single-agent veliparib (V) in patients (pts) with either BRCA1/2-mutated cancer (BRCA+), platinum-refractory ovarian, or basal-like breast cancer (BRCA-wt). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2570] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shannon Puhalla
- University of Pittsburgh Medical Center, Women's Cancer Program at Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | - Shalu Pahuja
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | | | - James J. Lee
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Yan Lin
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Brian Kiesel
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Jing Yu
- University of Pittsburgh, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | | | | | | | | | | | | | | | - Edward Chu
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Kimball BC, James KM, Yost KJ, Fernandez CA, Kumbamu A, Leppin AL, Robinson ME, Geller G, Roter DL, Larson SM, Lenz HJ, Garcia AA, Braddock CH, Jatoi A, de Nuncio MLZ, Montori VM, Koenig BA, Tilburt JC. Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology. BMC Cancer 2013; 13:455. [PMID: 24093624 PMCID: PMC3850997 DOI: 10.1186/1471-2407-13-455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient's position on the cancer care continuum. Yet, many of the routine needs of cancer patients after initial cancer treatment are often not addressed adequately. Our goal is to identify areas of strength and areas for improvement in cancer communication by investigating real-time cancer consultations in a cross section of patient-clinician interactions at diverse study sites. METHODS/DESIGN In this paper we describe the rationale and approach for an ongoing observational study involving three institutions that will utilize quantitative and qualitative methods and employ a short-term longitudinal, prospective follow-up component to investigate decision-making, key topics, and clinician-patient-companion communication dynamics in clinical oncology. DISCUSSION Through a comprehensive, real-time approach, we hope to provide the fundamental groundwork from which to promote improved patient-centered communication in cancer care.
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Quinn DI, Groshen SG, Shah M, Tsao-Wei DD, Garcia AA, Pham H, Lin YG, Ketchens C, Massopust K, Wei M, Longo V, Dorff TB. Final results of a phase I trial of fasting prior to platinum-based chemotherapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9632 Background: Fasting confers dramatic protection against chemotherapy toxicity in mice (PNAS 2008). We studied safety and feasibility of escalated fasting duration prior to platinum doublet chemotherapy in cancer patients (pts). Insulin, glucose, ketones and insulin-like growth factor (IGF) were measured as potential biomarkers of the fasting state. Methods: 3 fasting cohorts were evaluated: 24, 48 and 72 hours (hr) (48 pre/24 post chemotherapy). Subjects recorded all calories consumed during the fast period. Feasibility was defined as 4/6 subjects in each cohort consuming < 200 kCal/24 hr without excess fasting toxicity (using CTCAE v4.0). Results: Primary cancer: Urothelial 5, breast 5, ovarian 7, uterine 1, NSCLC 1. Regimens: gemcitabine+ cisplatin 6, docetaxel + carboplatin (C) + trastuzumab 5, C + paclitaxel 8. Median age: 61y (31-73). 4/6 pts, 5/7 pts and 4/6 pts in the 24, 48 and 72 hr groups were fasting compliant <200 kCal/24 hr with no significant toxicities. Median weight change was 0 after 1 cycle of fasting (-3.8% to +3.1%); 1 pt failed to regain 25% of lost weight prior to second cycle and per protocol did not fast again. Reasons for failure included forgetting and inability to maintain fast. Worst symptoms during the 48 and 72 hr fast: grade 1 hypoglycemia and hyponatremia; grade 2 headache, fatigue and dizziness; there were no grade 3 or 4 fasting-related toxicities. After fasting, insulin levels fell by medians of 69% in 24hr pts and 60% in 48hr pts (p=0.014). Median IGF1 levels Δ by -18.3% (p=0.012), interestingly 3 pts who fasted 72 hr had further Δ -19% to -59% from 48 to 72 hr. Conclusions: Fasting for up to 72 hr around chemotherapy is safe and feasible for cancer pts and resulted in significant decline in insulin and IGF1 levels. The randomized phase II portion of the trial commenced with 72 hr fast, seeking to delineate insulin and IGF1 as potential biomarkers of chemotherapy toxicity reduction. Clinical trial information: NCT00936364.
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Affiliation(s)
- David I. Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Susan G. Groshen
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Manali Shah
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Denice D Tsao-Wei
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Huyen Pham
- University of Southern California, Los Angeles, CA
| | | | | | | | - Min Wei
- USC Davis School of Gerontology, Los Angeles, CA
| | - Valter Longo
- University of Southern California School of Gerontology, Los Angeles, CA
| | - Tanya B. Dorff
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Vergote I, Teneriello M, Powell MA, Miller DS, Garcia AA, Mikheeva ON, Pinter T, Bidzinski M, Cebotaru CL, Fan J, Ren M, Meneses N, Funahashi Y, Kadowaki T, O'Brien JP, Penson RT. A phase II trial of lenvatinib in patients with advanced or recurrent endometrial cancer: Angiopoietin-2 as a predictive marker for clinical outcomes. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.5520] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5520 Background: Lenvatinib is an oral receptor tyrosine kinase inhibitor targeting VEGFR1-3, FGFR1-4, RET, KIT, and PDGFRβ. The importance of angiogenesis in endometrial cancer (EC) highlights the need to understand clinical mechanisms of escape (eg, angiopoietin-2 [Ang-2]) from antiangiogenic therapy. Methods: Patients (pts) had metastatic/unresectable EC after 1 or 2 prior platinum-based treatments (Tx), ≤2 prior chemotherapies, and ECOG PS ≤2. Pts received lenvatinib 24 mg once daily until disease progression or development of unmanageable toxicities. Primary endpoint was objective response rate (ORR: complete + partial response [CR+PR]) by RECIST 1.1. Archival tumor tissue and baseline (BL) and post-Tx plasma samples were collected for molecular analyses (reported elsewhere). Results: 133 pts were treated (median age: 62 y) and evaluated for safety, efficacy, and molecular correlative analysis. Dose reduction (31%) or Tx discontinuation (31%) occurred for toxicity. Median Tx duration was 112 days. The most common adverse events were hypertension 55% (Gr 3/4: 33%), fatigue 42% (Gr 3: 12.8%), diarrhea 35% (Gr 3: 5.3%), decreased appetite 35% (Gr 3: 2.3%), and nausea 32% (Gr 3: 3%); 1 pt had Gr 5 asthenia. Bowel obstruction, fistula formation, and perforation occurred in 3.8%, 2.3%, and 1.5%, respectively. Confirmed CR+PRs were observed in 19 pts (14.3%) by independent review (IRR) and 29 pts (21.8%) by investigator assessment (Inv). mPFS was 5.4 mos and mOS was 10.6 mos. Among 50 serum factors tested, only BL plasma Ang-2 correlated with maximal tumor shrinkage, R = 0.36 (Spearman), p < 0.001; ORR; PFS; and OS. The 24 pts with low BL Ang-2 plasma levels (cut-off value <2082 pg/mL) were compared with the 98 pts with high BL Ang-2 (>2082 pg/mL) and improved ORR (61% vs 18%), mPFS (9.5 vs 3.7 mos), and mOS (23 vs 8.9 mos) were observed. Conclusions: Lenvatinib in this population was tolerable and resulted in a 14.3% (IRR) and 21.8% (Inv) ORR and mOS of 10.6 mos.Low BL Ang-2 level appears to predict clinical benefit in a subset of pts with advanced EC who may achieve high response rates and prolonged overall survival. Further assessment is warranted. Clinical trial information: NCT01111461.
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Affiliation(s)
| | | | - Matthew A. Powell
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Olga N. Mikheeva
- State Healthcare Institution Leningrad Regional Oncology Center, St Petersburg, Russia
| | - Tamas Pinter
- Aladar Petz Teaching County Hospital, Gyõr, Hungary
| | | | | | | | - Min Ren
- Eisai Inc., Woodcliff Lake, NJ
| | | | | | | | | | - Richard T. Penson
- Massachusetts General Hospital/Dana-Farber Harvard Cancer Center, Boston, MA
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Nguyen B, Cusumano PG, Deck K, Kerlin D, Garcia AA, Barone JL, Rivera E, Yao K, de Snoo FA, van den Akker J, Stork-Sloots L, Generali D. Comparison of Molecular Subtyping with BluePrint, MammaPrint, and TargetPrint to Local Clinical Subtyping in Breast Cancer Patients. Ann Surg Oncol 2012; 19:3257-63. [DOI: 10.1245/s10434-012-2561-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Indexed: 11/18/2022]
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Garcia AA, Yessaian A, Pham H, Facio G, Muderspach L, Roman L. Phase II study of gemcitabine and docetaxel in recurrent platinum resistant ovarian cancer. Cancer Invest 2012; 30:295-9. [PMID: 22468744 DOI: 10.3109/07357907.2012.657812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED To evaluate the activity of gemcitabine and docetaxel in patients with recurrent ovarian cancer. METHODS Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks. RESULTS Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression. CONCLUSIONS In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF.
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Affiliation(s)
- Agustin A Garcia
- Kenneth Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Lin NU, Winer EP, Wheatley D, Carey LA, Houston S, Mendelson D, Munster P, Frakes L, Kelly S, Garcia AA, Cleator S, Uttenreuther-Fischer M, Jones H, Wind S, Vinisko R, Hickish T. A phase II study of afatinib (BIBW 2992), an irreversible ErbB family blocker, in patients with HER2-positive metastatic breast cancer progressing after trastuzumab. Breast Cancer Res Treat 2012; 133:1057-65. [PMID: 22418700 PMCID: PMC3387495 DOI: 10.1007/s10549-012-2003-y] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 12/12/2022]
Abstract
Afatinib is an oral, ErbB family blocker, which covalently binds and irreversibly blocks all kinase-competent ErbB family members. This phase II, open-label, single-arm study explored afatinib activity in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients progressing after trastuzumab treatment. Patients had stage IIIB/IV HER2-positive metastatic breast cancer, with progression following trastuzumab or trastuzumab intolerance and an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2. Patients received 50 mg afatinib once-daily until disease progression. Primary endpoint was objective response rate (Response Evaluation Criteria in Solid Tumors 1.0), with tumor assessments every 8 weeks. Forty-one patients were treated. Patients had received a median of three prior chemotherapy lines (range, 0–15) and 68.3% had received trastuzumab for >1 year. Four patients (10% of 41 treated; 11% of evaluable patients) had partial response. Fifteen patients (37% of 41) had stable disease as best response and 19 (46% of 41) achieved clinical benefit. Median progression-free survival was 15.1 weeks (95% confidence interval [CI]: 8.1–16.7); median overall survival was 61.0 weeks (95% CI: 56.7–not evaluable). Most frequent common terminology criteria for adverse events grade 3 treatment-related adverse events were diarrhea (24.4%) and rash (9.8%). Afatinib monotherapy was associated with promising clinical activity in extensively pretreated HER2-positive breast cancer patients who had progressed following trastuzumab treatment.
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Affiliation(s)
- Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Garcia AA, Sill MW, Lankes HA, Godwin AK, Mannel RS, Armstrong DK, Carolla RL, Liepman MK, Spirtos NM, Fischer EG, Leslie KK. A phase II evaluation of lapatinib in the treatment of persistent or recurrent epithelial ovarian or primary peritoneal carcinoma: a gynecologic oncology group study. Gynecol Oncol 2012; 124:569-74. [PMID: 22037316 PMCID: PMC3971755 DOI: 10.1016/j.ygyno.2011.10.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Activation and dimerization of the ERBB family play a role in the pathogenesis and progression of ovarian cancer. We conducted a phase II trial to evaluate the activity and tolerability of lapatinib in patients with recurrent or persistent epithelial ovarian cancer (EOC) and to explore the clinical value of expression levels of epidermal growth factor receptors (EGFR), phosphorylated EGFR, HER-2/neu, and Ki-67, and the presence of EGFR mutations. METHODS Eligible patients had recurrent or persistent EOC or primary peritoneal carcinoma, measurable disease, and up to 2 prior chemotherapy regimens for recurrent disease. Patients were treated with lapatinib 1500 mg/day. The primary endpoint of efficacy was 6-month progression free survival (PFS). RESULTS Twenty-five of 28 patients were eligible and evaluable for analysis of efficacy and toxicity. Two (8.0%) were alive and progression-free at 6 months. No objective responses were observed. There were 1 grade 4 toxicity (fatigue) and few grade 3 toxicities. Associations between Ki-67 with prior platinum-free interval, PFS, and a polymorphism in EGFR were suggested. CONCLUSIONS Lapatinib has minimal activity in recurrent ovarian cancer. Ki-67 expression may be associated with prior PFS and a polymorphism in EGFR exon 20 (2361G>A, Q787Q).
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Garcia AA, Fels RJ, Mosher LJ, Kenney MJ. Bacillus anthracis lethal toxin alters regulation of visceral sympathetic nerve discharge. J Appl Physiol (1985) 2011; 112:1033-40. [PMID: 22114180 DOI: 10.1152/japplphysiol.01105.2011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bacillus anthracis infection is a pathophysiological condition that is complicated by progressive decreases in mean arterial pressure (MAP). Lethal toxin (LeTx) is central to the pathogenesis of B. anthracis infection, and the sympathetic nervous system plays a critical role in physiological regulation of acute stressors. However, the effect of LeTx on sympathetic nerve discharge (SND), a critical link between central sympathetic neural circuits and MAP regulation, remains unknown. We determined visceral (renal, splenic, and adrenal) SND responses to continuous infusion of LeTx [lethal factor (100 μg/kg) + protective antigen (200 μg/kg) infused at 0.5 ml/h for ≤6 h] and vehicle (infused at 0.5 ml/h) in anesthetized, baroreceptor-intact and baroreceptor (sinoaortic)-denervated (SAD) Sprague-Dawley rats. LeTx infusions produced an initial state of cardiovascular and sympathetic nervous system activation in intact and SAD rats. Subsequent to peak LeTx-induced increases in arterial blood pressure, intact rats demonstrated a marked hypotension that was accompanied by significant reductions in SND (renal and splenic) and heart rate (HR) from peak levels. After peak LeTx-induced pressor and sympathoexcitatory responses in SAD rats, MAP, SND (renal, splenic, and adrenal), and HR were progressively and significantly reduced, supporting the hypothesis that LeTx alters the central regulation of sympathetic nerve outflow. These findings demonstrate that the regulation of visceral SND is altered in a complex manner during continuous anthrax LeTx infusions and suggest that sympathetic nervous system dysregulation may contribute to the marked hypotension accompanying B. anthracis infection.
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Affiliation(s)
- A A Garcia
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas 66506, USA
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Margiocco ML, Borgarelli M, Musch TI, Hirai DM, Hageman KS, Fels RJ, Garcia AA, Kenney MJ. Effects of combined aging and heart failure on visceral sympathetic nerve and cardiovascular responses to progressive hyperthermia in F344 rats. Am J Physiol Regul Integr Comp Physiol 2010; 299:R1555-63. [PMID: 20844265 DOI: 10.1152/ajpregu.00434.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sympathetic nerve discharge (SND) responses to hyperthermia are attenuated in aged rats without heart failure (HF) and in young HF (Y(HF)) rats, demonstrating that individually aging and HF alter SND regulation. However, the combined effects of aging and HF on SND regulation to heat stress are unknown, despite the high prevalence of HF in aged individuals. We hypothesized that SND responses to heating would be additive when aging and HF are combined, demonstrated by marked reductions in SND and mean arterial pressure (MAP) responses to heating in aged HF (A(HF)) compared with aged sham HF (A(SHAM)) rats, and in A(HF) compared with Y(HF) rats. Renal and splenic SND responses to hyperthermia (colonic temperature increased to 41.5°C) were determined in anesthetized Y(HF), young sham (Y(SHAM)), A(HF), and A(SHAM) Fischer rats. HF was induced by myocardial infarction and documented using echocardiographic, invasive, and postmortem measures. The severity of HF was similar in Y(HF) and A(HF) rats. SND responses to heating were attenuated in Y(HF) compared with Y(SHAM) rats, demonstrating an effect of HF on SND regulation in young rats. In contrast, A(HF) and A(SHAM) rats demonstrated similar SND responses to heating, suggesting a prominent influence of age on SND regulation in A(HF) rats. Splenic SND and MAP responses to heating were similar in Y(HF), A(HF), and A(SHAM) rats, indicating that the imposition of HF in young rats changes the regulatory status of these variables to one consistent with aged rats. These data suggest that the effect of HF on SND regulation to hyperthermia is age dependent.
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Affiliation(s)
- M L Margiocco
- Dept. of Anatomy and Physiology, Kansas State Univ., Manhattan, KS 66506, USA
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Pintao M, Garcia AA, Borgel D, Alhenc-Gelas M, Spek CA, de Visser MCH, Gandrille S, Reitsma PH. Novel human pathological mutations. Gene symbol: PROS1. Disease: Protein S deficiency. Hum Genet 2010; 127:121. [PMID: 20108435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Wichers IM, Garcia AA, Tanck MWT, Middeldorp S, Reitsma PH. No linkage for venous thrombosis at a candidate region on chromosome 18 in Dutch thrombophilic families. J Thromb Haemost 2009; 7:1239-40. [PMID: 19422449 DOI: 10.1111/j.1538-7836.2009.03462.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schultheis AM, Lurje G, Rhodes KE, Zhang W, Yang D, Garcia AA, Morgan R, Gandara D, Scudder S, Oza A, Hirte H, Fleming G, Roman L, Lenz HJ. Polymorphisms and clinical outcome in recurrent ovarian cancer treated with cyclophosphamide and bevacizumab. Clin Cancer Res 2009; 14:7554-63. [PMID: 19010874 DOI: 10.1158/1078-0432.ccr-08-0351] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [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] [Indexed: 12/30/2022]
Abstract
PURPOSE This study was designed to evaluate the associations between angiogenesis gene polymorphisms and clinical outcome in ovarian cancer patients treated with low-dose cyclophosphamide and bevacizumab. EXPERIMENTAL DESIGN Seventy recurrent/metastatic epithelial ovarian cancer patients were enrolled in a phase II clinical trial. Genomic DNA was available from 53 blood samples. Polymorphisms were analyzed using the PCR-RFLP protocol. A 5' end 33P gammaATP-labeled PCR protocol was used to analyze dinucleotide repeats. RESULTS Patients genotyped A/A or A/T for the IL-8 T-251A gene polymorphism had a statistically significant lower response rate (19%; 0%) than those homozygous T/T (50%; P = 0.006, Fisher's exact test). Patients carrying a minimum one C allele (C/C; C/T) of the CXCR2 C+785T polymorphism showed a median progression-free survival (PFS) of 7.4 months compared with the PFS of 3.7 months for those homozygous T/T (P = 0.026, log-rank test). Patients with the VEGF C+936T polymorphism C/T genotype had a longer median PFS of 11.8 months, compared with those with the C/C and T/T genotype, which had median PFS of 5.5 months and 3.2 months, respectively (P = 0.061, log-rank test). Patients carrying both AM 3'end alleles < 14 CA repeats had the shortest median PFS of 3.4 months; patients with at least one allele > 14 repeats or both alleles > 14 repeats showed a median PFS of 6.4 months and 7.2 months, respectively (P = 0.008, log-rank test). CONCLUSION Our data suggest that the IL-8 A-251T polymorphism may be a molecular predictor of response to bevacizumab-based chemotherapy. The CXCR2 C+785T, VEGF C+936T single nucleotide polymorphisms and the AM 3' dinucleotide repeat polymorphisms may be molecular markers for PFS in ovarian cancer patients.
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Affiliation(s)
- Anne M Schultheis
- University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California 90033, USA
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Garcia AA, Blessing JA, Nolte S, Mannel RS. A phase II evaluation of weekly docetaxel in the treatment of recurrent or persistent endometrial carcinoma: a study by the Gynecologic Oncology Group. Gynecol Oncol 2008; 111:22-6. [PMID: 18675446 DOI: 10.1016/j.ygyno.2008.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [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: 05/08/2008] [Revised: 06/13/2008] [Accepted: 06/18/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A phase II study was conducted to evaluate the anti-tumor activity and adverse effects of weekly docetaxel in patients with previously treated endometrial cancer. METHODS Eligible patients were to have measurable disease with no more than one prior chemotherapy regimen. Docetaxel 36 mg/m(2) was administered intravenously over 1 h on days 1, 8 and 15. Cycles were repeated every 28 days until progression of disease or adverse effects prohibited further therapy. RESULTS Twenty-seven patients were entered onto this study, of whom 26 were eligible and evaluable. All patients had received prior platinum with twenty (76.9%) having received prior treatment with paclitaxel. There were two (7.7%) partial responses, eight patients (30.8%) with stable disease, and fourteen patients (53.8%) with increasing disease. The most frequently reported adverse events were leucopenia, neutropenia, gastrointestinal, constitutional and peripheral neuropathy. Grade 3 and 4 adverse events were uncommon. CONCLUSIONS Docetaxel, at the dose and schedule tested, has modest activity in this patient population.
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Affiliation(s)
- Agustin A Garcia
- Division of Medical Oncology, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
PURPOSE OF REVIEW Hormonal treatment is one of the cornerstones of management for breast cancer. For many years, tamoxifen represented the gold standard. The development of aromatase inhibitors has, however, challenged the primary role of tamoxifen. Randomized studies evaluating the role of aromatase inhibitors in both the metastatic and adjuvant settings, in postmenopausal women, have been conducted. This article describes the most recent available data for these trials. RECENT FINDINGS The efficacy of aromatase inhibitors for metastatic disease is well established and has not changed recently. Multiple adjuvant aromatase inhibitor trials have been completed and published or presented. These trials vary in the timing of aromatase inhibitor administration, but all show statistically significant reductions in breast-cancer recurrence. An improvement in overall survival has not been observed to date. Tolerability is improved with aromatase inhibitors, the major concern with the use of aromatase inhibitors being the development of osteoporosis and bone fractures. SUMMARY Aromatase inhibitors are consistently showing improved efficacy and tolerability to tamoxifen for both early and advanced breast cancer. Optimal therapy for postmenopausal women should include an aromatase inhibitor. The optimal sequence of aromatase inhibitors and tamoxifen for adjuvant therapy is still, however, under investigation.
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Affiliation(s)
- Richard E Gould
- Division of Hematology and Oncology, Cedars Sinai Medical Center, Los Angeles, USA
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