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Rodrigo JP, López-Álvarez F, Medina JE, Silver CE, Robbins KT, Hamoir M, Mäkitie A, de Bree R, Takes RP, Golusinski P, Kowalski LP, Forastiere AA, Homma A, Hanna EY, Rinaldo A, Ferlito A. Treatment of the neck in residual/recurrent disease after chemoradiotherapy for advanced primary laryngeal cancer. Eur J Surg Oncol 2024; 50:108389. [PMID: 38728962 DOI: 10.1016/j.ejso.2024.108389] [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: 11/26/2023] [Revised: 04/09/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
Concomitant chemoradiotherapy (CRT) is extensively used as primary organ preservation treatment for selected advanced laryngeal squamous cell carcinomas (LSCC). The oncologic outcomes of such regimens are comparable to those of total laryngectomy followed by adjuvant radiotherapy. However, the management of loco-regional recurrences after CRT remains a challenge, with salvage total laryngectomy being the only curative option. Furthermore, the decision whether to perform an elective neck dissection (END) in patients with rN0 necks, and the extent of the neck dissection in patients with rN + necks is still, a matter of debate. For rN0 patients, meta-analyses have reported occult metastasis rates ranging from 0 to 31 %, but no survival advantage for END. In addition, meta-analyses also showed a higher incidence of complications in patients who received an END. Therefore, END is not routinely recommended in addition to salvage laryngectomy. Although some evidence suggests a potential role of END for supraglottic and locally advanced cases, the decision to perform END should weigh benefits against potential complications. In rN + patients, several studies suggested that selective neck dissection (SND) is oncologically safe for patients with specific conditions: when lymph node metastases are not fixed and are absent at level IV or V. Super-selective neck dissection (SSND) may be an option when nodes are confined to one level. In conclusion, current evidence suggests that in rN0 necks routine END is not necessary and that in rN + necks with limited nodal recurrences SND or a SSND could be sufficient.
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Affiliation(s)
- Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain.
| | - Fernando López-Álvarez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Jesús E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Marc Hamoir
- Department of Otorhinolaryngology, Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Institut de Recherche Experimentale, 1200, Brussels, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poznan, Poland
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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2
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Argiris A, Flamand Y, Savvides P, Johnson JM, Vathiotis I, Levine M, Li S, Forastiere AA, Burtness B. A new prognostic model in chemotherapy-treated patients with recurrent or metastatic head and neck cancer: An analysis of ECOG-ACRIN E1305. Eur J Cancer 2024; 199:113509. [PMID: 38215573 DOI: 10.1016/j.ejca.2023.113509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION For patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) periodic reassessment of prognostic factors provides valuable information that can aid in patient stratification. PATIENTS AND METHODS This post hoc analysis included all patients with R/M HNSCC enrolled in the ECOG-ACRIN E1305 phase III clinical trial who received first-line treatment with platinum-containing chemotherapy doublet with or without bevacizumab. Overall survival (OS) was estimated using the Kaplan-Meier method. Prognostic factors for OS were identified using univariate and multivariable analyses. A new prognostic model for OS was built retaining the prognostic factors which were significant in the final multivariable analysis (P < 0.05). RESULTS All 403 study participants were included in the analysis. The median OS in the whole study cohort was 11.8 months (90% confidence intervals [CI], 10.6-13.2). The new prognostic model for OS comprised four risk factors (ECOG performance status [1 versus 0], primary tumor location [other versus oropharynx], presence of bone or liver metastasis, and prior radiation to the head and neck); patients with ≤ 2 (n = 249) and > 2 risk factors (n = 154) had a median OS of 15.2 and 7.6 months, respectively (Hazard ratio, 2.14; 95% CI, 1.73-2.66; P < 0.0001). CONCLUSIONS The new proposed model includes 4 clinical prognostic factors that can be readily assessed at baseline. Similar models have the potential to improve trial design and optimize stratification of patients with R/M HNSCC.
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Affiliation(s)
| | - Yael Flamand
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | | | | | | | - Shuli Li
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 2023; 41:3965-3972. [PMID: 37586209 DOI: 10.1200/jco.22.02764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
PURPOSE The Southwest Oncology Group (SWOG) coordinated an Intergroup study with the participation of Radiation Therapy Oncology Group (RTOG), and Eastern Cooperative Oncology Group (ECOG). This randomized phase III trial compared chemoradiotherapy versus radiotherapy alone in patients with nasopharyngeal cancers. MATERIALS AND METHODS Radiotherapy was administered in both arms: 1.8- to 2.0-Gy/d fractions Monday to Friday for 35 to 39 fractions for a total dose of 70 Gy. The investigational arm received chemotherapy with cisplatin 100 mg/m2 on days 1, 22, and 43 during radiotherapy; postradiotherapy, chemotherapy with cisplatin 80 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d on days 1 to 4 was administered every 4 weeks for three courses. Patients were stratified by tumor stage, nodal stage, performance status, and histology. RESULTS Of 193 patients registered, 147 (69 radiotherapy and 78 chemoradiotherapy) were eligible for primary analysis for survival and toxicity. The median progression-free survival (PFS) time was 15 months for eligible patients on the radiotherapy arm and was not reached for the chemo-radiotherapy group. The 3-year PFS rate was 24% versus 69%, respectively (P < .001). The median survival time was 34 months for the radiotherapy group and not reached for the chemo-radiotherapy group, and the 3-year survival rate was 47% versus 78%, respectively (P = .005). One hundred eighty-five patients were included in a secondary analysis for survival. The 3-year survival rate for patients randomized to radiotherapy was 46%, and for the chemoradiotherapy group was 76% (P < .001). CONCLUSION We conclude that chemoradiotherapy is superior to radiotherapy alone for patients with advanced nasopharyngeal cancers with respect to PFS and overall survival.
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Kemeny MM, Zhao F, Forastiere AA, Catalano P, Hamilton SR, Miedema BW, Dawson NA, Weiner LM, Smith BD, Mason BA, Graziano SL, Gilman PB, Venook AP, Pinto HA, Whitehead RP, O’Dwyer PJ, Benson AB. Phase III Prospectively Randomized Trial of Perioperative 5-FU After Curative Resection for Colon Cancer: An Intergroup Trial of the ECOG-ACRIN Cancer Research Group (E1292). Ann Surg Oncol 2023; 30:1099-1109. [PMID: 36305992 PMCID: PMC9807536 DOI: 10.1245/s10434-022-12705-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 10/04/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Studies suggest that adjuvant chemotherapy should be initiated at the earliest possible time. The Eastern Cooperative Oncology Group (ECOG) and Intergroup evaluated the effect of perioperative fluorouracil (5-FU) on overall survival (OS) for colon cancer. PATIENTS AND METHODS This phase III trial randomized patients to receive continuous infusional 5-FU for 7 days starting within 24 h after curative resection (arm A) or no perioperative 5-FU (arm B). Patients with Dukes' B3 and C disease received adjuvant chemotherapy per standard of care. The primary endpoint of the trial was overall survival in patients with Dukes' B3 and C disease. The secondary objective was to determine whether a week of perioperative infusion would affect survival in patients with Dukes' B2 colon cancer with no additional chemotherapy. RESULTS From August 1993 to May 2000, 859 patients were enrolled and 855 randomized (arm A: 427; arm B: 428). The trial was terminated early due to slow accrual. The median follow-up is 15.4 years (0.03-20.3 years). Among patients with Dukes' B3 and C disease, there was no statistically significant difference in OS [median 10.3 years (95% CI 8.4, 13.2) for perioperative chemotherapy and 9.3 years (95% CI 5.7, 12.3) for no perioperative therapy, one-sided log-rank p = 0.178, HR = 0.88 (95% CI 0.66, 1.16)] or disease-free survival (DFS). For patients with Dukes' B2 disease, there was also no significant difference in OS (median 16.1 versus 12.9 years) or DFS. There was no difference between treatment arms in operative complications. One week of continuous infusion of 5-FU was tolerable; 18% of arm A patients experienced grade 3 or greater toxicity.
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Affiliation(s)
- M. Margaret Kemeny
- Icahn School of Medicine at Mount Sinai, Queens Cancer Center of NYC Health + Hospitals/Queens, Jamaica, NY USA
| | - Fengmin Zhao
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | - Arlene A. Forastiere
- John Hopkins University and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD USA
| | - Paul Catalano
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | | | | | | | | | | | | | | | | | - Alan P. Venook
- Helen Diller Family Comprehensive Cancer Center, USCF, San Francisco, CA USA
| | | | | | - Peter J. O’Dwyer
- University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA USA
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Nathan CA, Khandelwal AR, Wolf GT, Rodrigo JP, Mäkitie AA, Saba NF, Forastiere AA, Bradford CR, Ferlito A. TP53 mutations in head and neck cancer. Mol Carcinog 2022; 61:385-391. [PMID: 35218075 DOI: 10.1002/mc.23385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
Head and neck squamous cell carcinomas (HNSCCs) arising in the mucosal linings of the upper aerodigestive tract are highly heterogeneous, aggressive, and multifactorial tumors affecting more than half a million patients worldwide each year. Classical etiological factors for HNSCC include alcohol, tobacco, and human papillomavirus (HPV) infection. Current treatment options for HNSCCs encompass surgery, radiotherapy, chemotherapy, or combinatorial remedies. Comprehensive integrative genomic analysis of HNSCC has identified mutations in TP53 gene as the most frequent of all somatic genomic alterations. TP53 mutations are associated with either loss of wild-type p53 function or gain of functions that promote invasion, metastasis, genomic instability, and cancer cell proliferation. Interestingly, disruptive TP53 mutations in tumor DNA are associated with aggressiveness and reduced survival after surgical treatment of HNSCC. This review summarizes the current evidence and impact of TP53 mutations in HNSCC.
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Affiliation(s)
- Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA
| | - Alok R Khandelwal
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Juan P Rodrigo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Arlene A Forastiere
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Golusinski P, Corry J, Poorten VV, Simo R, Sjögren E, Mäkitie A, Kowalski LP, Langendijk J, Braakhuis BJM, Takes RP, Coca-Pelaz A, Rodrigo JP, Willems SM, Forastiere AA, De Bree R, Saba NF, Teng Y, Sanabria A, Di Maio P, Szewczyk M, Ferlito A. De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed? Oral Oncol 2021; 123:105620. [PMID: 34798575 DOI: 10.1016/j.oraloncology.2021.105620] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022]
Abstract
Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).
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Affiliation(s)
- Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora; Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poland.
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Vincent Vander Poorten
- Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ricard Simo
- Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose, Finland
| | - Luis Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Johannes Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology Emory University School of Medicine; Winship Cancer Institute of Emory University, Georgia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, San Remo, Italy
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Oswald LB, Lee JW, Argiris A, Webster KA, Forastiere AA, Cella D. Validation of brief symptom indexes among patients with recurrent or metastatic squamous cell carcinoma of the head and neck: A trial of the ECOG-ACRIN Cancer Research Group (E1302). Cancer Med 2020; 9:8884-8894. [PMID: 33040481 PMCID: PMC7724483 DOI: 10.1002/cam4.3506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/14/2020] [Accepted: 09/13/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with advanced head and neck cancer have identified pain, fatigue, and difficulties swallowing, breathing, and communicating as high-priority disease-related symptoms. The Functional Assessment of Cancer Therapy-Head and Neck Symptom Index-10 (FHNSI-10) assesses these symptoms. We sought to validate the FHNSI-10, another brief symptom index (FHNSI-7), and individual symptom endpoints representing these high-rated priority disease symptoms among patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). METHODS Patients (N = 239) were enrolled in a phase III randomized clinical trial (E1302) and completed the FHNSI-10 at multiple time points. We assessed the internal consistencies and test-retest reliabilities of the FHNSI-10 and FHNSI-7 scores, and the known-groups validity, predictive criterion validity, and responsiveness-to-change of the symptom indexes and individual symptom endpoint scores. RESULTS The FHNSI-10 and FHNSI-7 indexes showed satisfactory internal consistencies (Cronbach's alpha coefficient range 0.60-0.75) and acceptable test-retest reliabilities (intraclass correlation coefficients = 0.75 and 0.74, respectively). The FHNSI-10, FHNSI-7, and the pain, fatigue, swallowing, and breathing symptom scores showed evidence of known-groups validity by performance status at baseline. The FHNSI-10, FHNSI-7, and the pain, fatigue, and breathing symptom scores at baseline showed evidence of predictive criterion validity for overall survival, but not time-to-progression (TTP). Changes in the symptom indexes and individual symptom scores were not associated with changes in performance status over 4 weeks, though most patients had stable performance status. CONCLUSIONS There is initial evidence of validity for the FHNSI-10 and FHNSI-7 indexes and selected individual symptom endpoints as brief disease-related symptom assessments for patients with recurrent or metastatic SCCHN.
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Affiliation(s)
- Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ju-Whei Lee
- Department of Data Sciences, Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kimberly A Webster
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zhang W, Williams TA, Bhagwath AS, Hiermann JS, Peacock CD, Watkins DN, Ding P, Park JY, Montgomery EA, Forastiere AA, Jie C, Cantarel BL, Pham TH, Wang DH. GEAMP, a novel gastroesophageal junction carcinoma cell line derived from a malignant pleural effusion. J Transl Med 2020; 100:16-26. [PMID: 31292541 PMCID: PMC6920545 DOI: 10.1038/s41374-019-0278-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/14/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal junction (GEJ) cancer remains a clinically significant disease in Western countries due to its increasing incidence, which mirrors that of esophageal cancer, and poor prognosis. To develop novel and effective approaches for prevention, early detection, and treatment of patients with GEJ cancer, a better understanding of the mechanisms driving pathogenesis and malignant progression of this disease is required. These efforts have been limited by the small number of available cell lines and appropriate preclinical animal models for in vitro and in vivo studies. We have established and characterized a novel GEJ cancer cell line, GEAMP, derived from the malignant pleural effusion of a previously treated GEJ cancer patient. Comprehensive genetic analyses confirmed a clonal relationship between GEAMP cells and the primary tumor. Targeted next-generation sequencing identified 56 nonsynonymous alterations in 51 genes including TP53 and APC, which are commonly altered in GEJ cancer. In addition, multiple copy-number alterations were found including EGFR and K-RAS gene amplifications and loss of CDKN2A and CDKN2B. Histological examination of subcutaneous flank xenografts in nude and NOD-SCID mice showed a carcinoma with mixed squamous and glandular differentiation, suggesting GEAMP cells contain a subpopulation with multipotent potential. Finally, pharmacologic inhibition of the EGFR signaling pathway led to downregulation of key downstream kinases and inhibition of cell proliferation in vitro. Thus, GEAMP represents a valuable addition to the limited number of bona fide GEJ cancer cell lines.
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Affiliation(s)
- Wei Zhang
- Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taylor A. Williams
- Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankur S. Bhagwath
- Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jared S. Hiermann
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Craig D. Peacock
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - D. Neil Watkins
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Peiguo Ding
- Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason Y. Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth A. Montgomery
- Division of Gastrointestinal and Liver Pathology, Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Arlene A. Forastiere
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chunfa Jie
- Department of Biochemistry and Nutrition, Des Moines University, Des Moines, IA, USA
| | - Brandi L. Cantarel
- Bioinformatics Core Facility, Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thai H. Pham
- Esophageal Diseases Center and Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA,VA North Texas Health Care System, Dallas, TX, USA
| | - David H. Wang
- Esophageal Diseases Center and Division of Hematology-Oncology, Department of Internal Medicine and the Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,VA North Texas Health Care System, Dallas, TX, USA
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9
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Argiris A, Li S, Savvides P, Ohr JP, Gilbert J, Levine MA, Chakravarti A, Haigentz M, Saba NF, Ikpeazu CV, Schneider CJ, Pinto HA, Forastiere AA, Burtness B. Phase III Randomized Trial of Chemotherapy With or Without Bevacizumab in Patients With Recurrent or Metastatic Head and Neck Cancer. J Clin Oncol 2019; 37:3266-3274. [PMID: 31618129 DOI: 10.1200/jco.19.00555] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We evaluated the addition of bevacizumab, a humanized monoclonal antibody that targets vascular endothelial growth factor, to platinum-based chemotherapy in recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Patients with chemotherapy-naïve (or with prior platinum as part of multimodal therapy completed ≥ 4 months earlier) recurrent or metastatic SCCHN were randomly assigned to receive a platinum-based chemotherapy doublet with or without bevacizumab 15 mg/kg given intravenously every 3 weeks until disease progression. Chemotherapy could be discontinued after six cycles if a maximum response was achieved. RESULTS The study randomly assigned 403 patients. Median overall survival (OS) was 12.6 months with bevacizumab plus chemotherapy (BC) and 11.0 months with chemotherapy alone (hazard ratio, 0.87; 95% CI, 0.70 to 1.09; P = .22). At 2, 3, and 4 years, the OS rates were 25.2% v 18.1%, 16.4% v 10.0%, and 11.8% v 6.4% for BC versus chemotherapy, respectively. In an analysis of 365 eligible patients who started treatment, the hazard ratio was 0.82 (95% CI, 0.65 to 1.04; P = .10), with a median OS of 14.2 months on BC v 11.1 months on chemotherapy. Median progression-free survival with BC was 6.0 months v 4.3 months with chemotherapy (P = .0014). Overall response rates were 35.5% with BC and 24.5% with chemotherapy (P = .016). There was increased toxicity, including a higher rate of treatment-related grade 3 to 5 bleeding events (6.7% v 0.5%; P < .001) and treatment-related deaths (9.3% v 3.5%; P = .022) with BC versus chemotherapy. CONCLUSION The addition of bevacizumab to chemotherapy did not improve OS but improved the response rate and progression-free survival with increased toxicities. These results encourage biomarker-driven studies of angiogenesis inhibitors with better toxicity profiles in select patients with SCCHN.
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Affiliation(s)
| | - Shuli Li
- Dana Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | - Barbara Burtness
- Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT
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Park JC, Gourin CG, Kiess AP, Mehra R, Forastiere AA, Kang H. Pattern of planned systemic therapy usage in newly diagnosed, nonmetastatic squamous cell carcinoma of the head and neck in a commercially insured population in the United States. Head Neck 2018; 40:2612-2620. [PMID: 30421818 DOI: 10.1002/hed.25333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/20/2018] [Accepted: 04/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We analyzed systemic therapy plans submitted for commercially insured patients with untreated, newly diagnosed squamous cell carcinoma of the head and neck (SCCHN) to investigate patterns of practice. METHODS Consecutive chemotherapy treatment plans were submitted using Eviti Connect (https://www.marylandphysicianscare.com/content/dam/centene/maryland/pdfs/evitiConnectFactSheet.pdf) portal for preauthorization between June 1, 2011, and June 30, 2015, were analyzed. RESULTS A total of 387 treatment plans were submitted for 340 patients; 68 and 272 patients were from academic centers and community practices, respectively. Single agent cisplatin (57%), cetuximab (18%), and carboplatin (9%) were the most commonly proposed regimens concurrent with definitive radiotherapy (RT). The frequency of cetuximab use was not significantly different between academic centers and community practices. A clinical trial was proposed in only 15% of patients. CONCLUSION Among commercially insured patients with newly diagnosed, nonmetastatic SCCHN, the choice of systemic therapy in initial treatment plans was not significantly different between academic centers and community practices. Clinical trials are underutilized and should be encouraged.
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Affiliation(s)
- Jong Chul Park
- Department of Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Christine G Gourin
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranee Mehra
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene A Forastiere
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,NantHealth, Philadelphia, Pennsylvania
| | - Hyunseok Kang
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yoon H, Karapetyan L, Choudhary A, Kosozi R, Bali GS, Zaidi AH, Atasoy A, Forastiere AA, Gibson MK. Phase II Study of Irinotecan Plus Panitumumab as Second-Line Therapy for Patients with Advanced Esophageal Adenocarcinoma. Oncologist 2018; 23:1004-e102. [PMID: 29769385 PMCID: PMC6192615 DOI: 10.1634/theoncologist.2017-0657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/20/2018] [Indexed: 01/22/2023] Open
Abstract
Lesson Learned. Panitumumab plus irinotecan is not active for the treatment of esophageal adenocarcinoma.
Background. Esophageal adenocarcinoma (EAC) is a lethal cancer with increasing incidence. Panitumumab (Pa) is a fully humanized IgG2 monoclonal antibody against human EGFR. Cetuximab (Cx) combined with irinotecan (Ir) is active for second‐line treatment of colorectal cancer. This phase II study was designed to evaluate Pa plus Ir as second‐line therapy for advanced EAC. Methods. The primary endpoint was response rate (RR). Patients with one prior treatment were given Pa 9 mg/m2 on day 1 and Ir 125 mg/m2 on days 1 and 8 of each 21‐day cycle. Inclusion criteria were confirmed EAC, measurable disease, no prior Ir or Pa, performance status <2, and normal organ function. Results. Twenty‐four patients were enrolled; 18 were eligible and evaluable. These patients were all white, with a median age of 62.5 years (range, 33–79 years), and included 15 men and 3 women. The median number of cycles was 3.5. The most common grade 1–2 adverse events were fatigue, diarrhea, anemia, leukopenia, and hypoalbuminemia. Grade 3–4 adverse events included hematologic, gastrointestinal, electrolyte, rash, fatigue, and weight loss. The median follow‐up was 7.2 months (range, 2.3–14 months). There were no complete remissions. The partial response rate was 6% (1/18; 95% confidence interval [CI], 0.01–0.26). The clinical benefit (partial response [PR] plus stable disease [SD]) rate was 50%. The median overall survival was 7.2 months (95% CI, 4.1–8.9) with an 11.1% 1‐year survival rate. The median progression‐free survival was 2.9 months (95% CI, 1.6–5.3). Conclusion. Irinotecan and panitumumab as second‐line treatment for advanced EAC are not active.
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Affiliation(s)
| | - Lilit Karapetyan
- Department of Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Ramla Kosozi
- Vanderbilt University, Nashville, Tennessee, USA
| | | | - Ali H Zaidi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ajlan Atasoy
- Bristol-Myers Squibb Oncology, New Brunswick, New Jersey, USA
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12
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; Susan G. Fisher, Temple University, Philadelphia, PA; and Gregory T. Wolf, University of Michigan Hospital, Ann Arbor, MI
| | - Susan G Fisher
- Arlene A. Forastiere, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; Susan G. Fisher, Temple University, Philadelphia, PA; and Gregory T. Wolf, University of Michigan Hospital, Ann Arbor, MI
| | - Gregory T Wolf
- Arlene A. Forastiere, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; Susan G. Fisher, Temple University, Philadelphia, PA; and Gregory T. Wolf, University of Michigan Hospital, Ann Arbor, MI
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Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:1143-1169. [PMID: 29172863 DOI: 10.1200/jco.2017.75.7385] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Nofisat Ismaila
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Jan S Lewin
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Cherie Ann Nathan
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David J Adelstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Avraham Eisbruch
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gail Fass
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Susan G Fisher
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Scott A Laurie
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Quynh-Thu Le
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Bernard O'Malley
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - William M Mendenhall
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Snehal Patel
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David G Pfister
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Anthony F Provenzano
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Randy Weber
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory S Weinstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory T Wolf
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
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Forastiere AA, Ismaila N, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Summary. J Oncol Pract 2017; 14:123-128. [PMID: 29172913 DOI: 10.1200/jop.2017.027912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Arlene A Forastiere
- Johns Hopkins University, Baltimore MD; American Society of Clinical Oncology, Alexandria VA; and University of Michigan Hospital, Ann Arbor, MI
| | - Nofisat Ismaila
- Johns Hopkins University, Baltimore MD; American Society of Clinical Oncology, Alexandria VA; and University of Michigan Hospital, Ann Arbor, MI
| | - Gregory T Wolf
- Johns Hopkins University, Baltimore MD; American Society of Clinical Oncology, Alexandria VA; and University of Michigan Hospital, Ann Arbor, MI
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de Bree R, Wolf GT, de Keizer B, Nixon IJ, Hartl DM, Forastiere AA, Haigentz M, Rinaldo A, Rodrigo JP, Saba NF, Suárez C, Vermorken JB, Ferlito A. Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond. Head Neck 2017; 39:2329-2349. [PMID: 28815841 PMCID: PMC5656833 DOI: 10.1002/hed.24883] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/27/2017] [Accepted: 05/31/2017] [Indexed: 01/27/2023] Open
Abstract
Significant correlations between the response to induction chemotherapy and success of subsequent radiotherapy have been reported and suggest that the response to induction chemotherapy is able to predict a response to radiotherapy. Therefore, induction chemotherapy may be used to tailor the treatment plan to the individual patient with head and neck cancer: following the planned subsequent (chemo)radiation schedule, planning a radiation dose boost, or reassessing the modality of treatment (eg, upfront surgery). Findings from reported trials suggest room for improvement in clinical response assessment after induction chemotherapy, but an optimal method has yet to be identified. Historically, indices of treatment efficacy in solid tumors have been based solely on systematic assessment of tumor size. However, functional imaging (eg, fluorodeoxyglucose‐positron emission tomography (FDG‐PET) potentially provides an earlier indication of response to treatment than conventional imaging techniques. More advanced imaging techniques are still in an exploratory phase and are not ready for use in clinical practice.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Dana M Hartl
- Department of Otolaryngology - Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Arlene A Forastiere
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Missak Haigentz
- Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Juan P Rodrigo
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Cmelak A, Flamand Y, Li S, Marur S, Murphy BA, Cella D, Forastiere AA, Burtness B. Assessment of established patient reported outcomes (PROs) instruments measuring toxicities and quality of life (QOL) for patients (pts) with head and neck cancer (HNC) treated on ECOG 1308 and 2399 studies. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6074] [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
6074 Background: HPV HNC pts are younger and have a higher cure rate than smoking-related pts, and therefore carry treatment toxicities longer. Dose deintensification and conformal RT may result in decreased toxicity. We report the impact of these techniques on patient outcomes in E2399 and E1308 as measured through PROs. Methods: Longitudinal data on acute and late toxicities were recorded prospectively at baseline, post-treatment, and at 6, 12, 24 and 30 months in HPV+ pts on E1308 and HIV+/- pts on E2399 using the following measures: E1308: FACT-HN, KATZ Index of Independence (ADL), Brief Fatigue Index (BFI), Instrumental Activities of Daily Living (IADL), and the Vanderbilt Head and Neck Symptom Survey Version 2 (VHNSS V2); on E2399: FACT-HN. We correlated acute and late toxicities with de-escalation of RT dose (69.3Gy to 54Gy) on E1308, and with IMRT (E1308) vs. conformal RT (E2399). Results: 38 pts on E1308 completed 12 mo VHNSS V2; 32 received low dose IMRT and 6 standard dose, and 56 E2399 pts completed 12 mo FACT-HN. Items from the VHNSS V2 showed that difficulty eating solids (40% vs. 89%, p = 0.011) and improved nutrition (10% vs 44%, p = 0.025) were statistically improved at 12 months by lowering IMRT dose from 69.3Gy to 54Gy. The FACT-HN showed an improvement in eating solids at 12 mo when comparing low dose IMRT vs. 3DRT (65% vs. 33% had no or minimal solid food problems, p = 0.057). No other statistically significant reductions in toxicity were noted on any of the other PRO instruments. Conclusions: Both FACT-HN and VHNSS V2 demonstrated an improvement in eating solids by reducing IMRT dose. FACT-HN demonstrated that IMRT is associated with an improvement in eating solids when compared to 3DRT. Analyses are exploratory and need to be validated using randomized data.Future studies should stress accurate and complete PRO data. The KATZ, BFI, and IADL were not sensitive to detecting differences in toxicities from IMRT dose reduction on E1308. The VHNSS V2 and FACT-HN instruments corroborated specific toxicities both by RT technique as well as IMRT dose, and will therefore be utilized in future ECOG-ACRIN HNC studies. Clinical trial information: NCT01084083.
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Affiliation(s)
- Anthony Cmelak
- Vanderbilt University Ingram Cancer Center, Nashville, TN
| | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | - Shanthi Marur
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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Argiris A, Li S, Savvides P, Ohr J, Gilbert J, Levine MA, Haigentz M, Saba NF, Chakravarti A, Ikpeazu C, Schneider C, Pinto H, Forastiere AA, Burtness B. Phase III randomized trial of chemotherapy with or without bevacizumab (B) in patients (pts) with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Survival analysis of E1305, an ECOG-ACRIN Cancer Research Group trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6000 Background: The addition of B, an anti-VEGF monoclonal antibody, to chemotherapy has improved outcomes in several solid tumors. Pemetrexed plus B showed promising efficacy in R/M SCCHN (Argiris et al. JCO 2011). E1305 was designed to evaluate the addition of B to a platinum doublet in R/M SCCHN. Methods: B-eligible pts with performance status 0-1, not having received chemotherapy for R/M SCCHN (prior chemotherapy for locally advanced disease allowed ≥ 4 months) and without factors predisposing to bleeding (history of bleeding due to SCCHN, anticoagulation, central cavitary lung metastasis, carotid invasion) were randomized to: A) one of 4 regimens (investigator's choice) given every 3 weeks: A1, cisplatin (C) 100 mg/m2, 5-FU 1000 mg/m2/day x 4 days; A2, carboplatin (Cb) AUC 6, 5-FU 1000 mg/m2/day x 4 days; A3, C 75 mg/m2, docetaxel (D) 75 mg/m2; A4, Cb AUC 6, D 75 mg/m2, or B) the same regimen (B1, B2, B3, B4) plus B 15 mg/Kg IV, every 3 weeks, until progression. Chemotherapy could be stopped after 6 cycles after maximum response. All pts received prophylactic antibiotics. The primary endpoint was overall survival (OS). Control median OS of 8.5 months (mo) was projected; the addition of B was hypothesized to increase median OS to 11.5 mo with a hazard ratio (HR) of 0.74. Results: 403 pts were randomized (200 in arm A; 203 in arm B). Baseline characteristics were well balanced. 38% in arm A/42% in arm B had an oropharyngeal primary; 87% received C or Cb plus D. With a median follow-up of 23.1 mo, median OS was 11 mo in arm A and 12.6 mo in arm B; HR 0.84 (95% CI 0.67-1.05), p = 0.13. The 1-, 2-, 3-, and 4-year OS were 46% vs 51%, 18% vs 26%, 8% vs 16%, 6% vs 13%, in arm A vs B, respectively. Median PFS was 4.4 mo in arm A and 6.1 mo in arm B (HR 0.71, 95% CI 0.58-0.87; p = 0.0012). Objective response rate was 25% in arm A vs 36% in arm B (p = 0.013). Grade 3-5 bleeding occurred in 3.5% in arm A vs 7.7% in arm B (p = 0.08). Conclusions: B added to a standard platinum doublet improved response rate and PFS but not OS in first-line treatment of R/M SCCHN. The control arm in this study performed better than expected. Clinical trial information: NCT00588770.
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Affiliation(s)
| | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | | | - James Ohr
- University of Pittsburgh Medical Center Cancer Center Pavilion, Pittsburgh, PA
| | - Jill Gilbert
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Missak Haigentz
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | | | - Charles Schneider
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE
| | - Harlan Pinto
- Stanford University Medical Center and VA Palo Alto, Palo Alto, CA
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Kang H, Gourin CG, Kiess AP, Forastiere AA. Analysis of chemotherapy selection for locally advanced squamous cell carcinoma of head and neck (SCCHN) in a commercially insured population in the United States. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6066] [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)
- Hyunseok Kang
- Johns Hopkins University School of Medicine, Baltimore, MD
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Marur S, Forastiere AA. Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment. Mayo Clin Proc 2016; 91:386-96. [PMID: 26944243 DOI: 10.1016/j.mayocp.2015.12.017] [Citation(s) in RCA: 703] [Impact Index Per Article: 87.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022]
Abstract
Squamous cell carcinoma arises from multiple anatomic subsites in the head and neck region. The risk factors for development of cancers of the oral cavity, oropharynx, hypopharynx, and larynx include tobacco exposure and alcohol dependence, and infection with oncogenic viruses is associated with cancers developing in the nasopharynx, palatine, and lingual tonsils of the oropharynx. The incidence of human papillomavirus-associated oropharyngeal cancer is increasing in developed countries, and by 2020, the annual incidence could surpass that of cervical cancer. The treatment for early-stage squamous cell cancers of the head and neck is generally single modality, either surgery or radiotherapy. The treatment for locally advanced head and neck cancers is multimodal, with either surgery followed by adjuvant radiation or chemoradiation as indicated by pathologic features or definitive chemoradiation. For recurrent disease that is not amenable to a salvage local or regional approach and for metastatic disease, chemotherapy with or without a biological agent is indicated. To date, molecular testing has not influenced treatment selection in head and neck cancer. This review will focus on the changing epidemiology, advances in diagnosis, and treatment options for squamous cell cancers of the head and neck, along with data on risk stratification specific to oropharyngeal cancer, and will highlight the direction of current trials.
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Affiliation(s)
- Shanthi Marur
- Department of Oncology, Johns Hopkins University and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
| | - Arlene A Forastiere
- Department of Oncology, Johns Hopkins University and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Kleinberg LR, Catalano PJ, Forastiere AA, Keller SM, Mitchel EP, Anne PR, Benson AB. Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Randomized Phase 2 Trial of Neoadjuvant Preoperative Paclitaxel/Cisplatin/Radiation Therapy (RT) or Irinotecan/Cisplatin/RT in Esophageal Adenocarcinoma: Long-Term Outcome and Implications for Trial Design. Int J Radiat Oncol Biol Phys 2015; 94:738-46. [PMID: 26972646 DOI: 10.1016/j.ijrobp.2015.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Toxicity, pathologic complete response, and long-term outcomes are reported for the neoadjuvant therapies assessed in a randomized phase 2 Eastern Cooperative Oncology Group and American College of Radiology Imaging Network trial for operable esophageal adenocarcinoma, staged as II-IVa by endoscopy/ultrasonography (EUS). METHODS AND MATERIALS A total of 86 eligible patients began treatment. For arm A, preoperative chemotherapy was cisplatin, 30 mg/m(2), and irinotecan, 50 mg/m(2), on day 1, 8, 22, 29 during 45 Gy radiation therapy (RT), 1.8 Gy per day over 5 weeks. Adjuvant therapy was cisplatin, 30 mg/m(2), and irinotecan, 65 mg/m(2) day 1, 8 every 21 days for 3 cycles. Arm B therapy was cisplatin, 30 mg/m(2), and paclitaxel, 50 mg/m(2), day 1, 8, 15, 22, 29 with RT, followed by adjuvant cisplatin, 75 mg/m(2), and paclitaxel, 175 mg/m(2), day 1 every 21 days for 3 cycles. Stratification included EUS stage and performance status. RESULTS In arm A, median overall survival was 35 months, and 5-, 6-, and 7-year survival rates were 46%, 39%, and 35%, respectively, whereas for arm B, they were 21 months and 27%, 27%, and 23%, respectively. Median progression- or recurrence-free survival (PFS) was 39.8 months with a 3-year PFS of 50% for arm A and 12.4 months (P=.046) with 3-year PFS of 28% for arm B. Eighty percent of the observed incidents of progression occurred within 19 months. Survival did not differ significantly by EUS and performance status strata. CONCLUSIONS Long-term survival was similar for both arms and did not appear superior to results achieved with other standard regimens.
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Affiliation(s)
- Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Steven M Keller
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | - Edith P Mitchel
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pramila Rani Anne
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Al B Benson
- Department of Medicine-Hematology/Oncology, Lurie Cancer Center, Northwestern University, Chicago, Illinois
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Abstract
PURPOSE To provide a review of the clinical data, controversies, and limitations that underpin current recommendations for approaches to larynx preservation for locally advanced larynx cancer requiring total laryngectomy. METHODS The key findings from pivotal randomized controlled trials are discussed, including quality of life, late effects, and function assessments. Trials investigating taxane inclusion in induction chemotherapy and trials of epidermal growth factor receptor inhibition for radiosensitization are put into perspective for larynx cancer. Controversies in the management of T4 primaries and the opportunities for conservation laryngeal surgery are reviewed. RESULTS There are data from clinical trials to support induction chemotherapy, followed by radiotherapy (preferred approach in Europe) and concomitant cisplatin plus radiotherapy (preferred in North America) for nonsurgical preservation of the larynx. Treatment intensification by a sequential approach of induction, followed by concomitant treatment, is investigational. Transoral laryngeal microsurgery and transoral robotic partial laryngectomy have application in selected patients. CONCLUSION The management of locally advanced larynx cancer is challenging and requires an experienced multidisciplinary team for initial evaluation, response assessment, and support during and after treatment to achieve optimal function, quality of life, and overall survival. Patient expectations, in addition to tumor extent, pretreatment laryngeal function, and coexisting chronic disease, are critical factors in selecting surgical or nonsurgical primary treatment.
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Randal S Weber
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Andy Trotti
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Kelly RJ, Forde PM, Elnahal SM, Forastiere AA, Rosner GL, Smith TJ. Patients and Physicians Can Discuss Costs of Cancer Treatment in the Clinic. J Oncol Pract 2015; 11:308-12. [PMID: 26015459 DOI: 10.1200/jop.2015.003780] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As one solution to reducing costs and medical bankruptcies, experts have suggested that patients and physicians should discuss the cost of care up front. Whether these discussions are possible in an oncology setting and what their effects on the doctor-patient relationship are is not known. METHODS We used the National Comprehensive Cancer Network (NCCN) Guidelines and the eviti Advisor platform to show patients with metastatic breast, lung, or colorectal cancer the costs associated with their chemotherapy and/or targeted therapy options during an oncology consultation. We measured provider attitudes and assessed patient satisfaction when consultations included discussion of costs. RESULTS We approached 107 patients; 96 (90%) enrolled onto the study, three (3%) asked if they could be interviewed at a later date, and eight (7%) did not want to participate. Only five of 18 oncologists (28%) felt comfortable discussing costs, and only one of 18 (6%) regularly asked patients about financial difficulties. The majority of patients (80%) wanted cost information, and 84% reported that these conversations would be even more important if their co-pays were to increase. In total, 72% of patients responded that no health care professional has ever discussed costs with them. The majority of patients (80%) had no negative feelings about hearing cost information. CONCLUSION In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.
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Affiliation(s)
- Ronan J Kelly
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
| | - Patrick M Forde
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
| | - Shereef M Elnahal
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
| | - Arlene A Forastiere
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA
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Gourin CG, Starmer HM, Herbert RJ, Frick KD, Forastiere AA, Quon H, Eisele DW, Dy SM. Quality of care and short‐ and long‐term outcomes of laryngeal cancer care in the elderly. Laryngoscope 2015; 125:2323-9. [DOI: 10.1002/lary.25378] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Robert J. Herbert
- Department of Health Policy and Managementthe Johns Hopkins Bloomberg School of Public Health
| | - Kevin D. Frick
- Department of Health Policy and Managementthe Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins Carey Business School
| | - Arlene A. Forastiere
- Department of OncologySidney Kimmel Comprehensive Cancer CenterBaltimore Maryland U.S.A
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University
| | | | - Sydney M. Dy
- Department of Health Policy and Managementthe Johns Hopkins Bloomberg School of Public Health
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Marur S, Wang H, Quon H, Chung CH, Gillison ML, Agrawal N, Richmon J, Subramaniam RM, Koch W, Gourin CG, Forastiere AA. A phase I (Ph1) study of dasatinib (D) with cetuximab (Cet) /radiation (IMRT) +/- cisplatin (P) in stage II, III/IV head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hao Wang
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Harry Quon
- The Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | - Wayne Koch
- The Johns Hopkins University School of Medicine, Baltimore, MD
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Argiris A, Li S, Savvides P, Forastiere AA, Burtness B. Safety analysis of a phase III randomized trial of chemotherapy with or without bevacizumab (B) in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6022] [Citation(s) in RCA: 4] [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)
- Athanassios Argiris
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
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Gourin CG, Starmer HM, Herbert RJ, Frick KD, Forastiere AA, Eisele DW, Quon H. Short- and long-term outcomes of laryngeal cancer care in the elderly. Laryngoscope 2014; 125:924-33. [PMID: 25367258 DOI: 10.1002/lary.25012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for laryngeal squamous cell cancer (SCCA). STUDY DESIGN Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. METHODS Longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis. RESULTS Dysphagia (odds ratio [OR] = 1.5 [1.2-1.7]), weight loss (OR = 1.3 [1.1-1.6]), esophageal stricture (OR = 3.8 [2.5-5.9]), airway obstruction (OR = 1.9, [1.6-2.3]), tracheostomy (OR = 1.5 [1.2-1.9]), and pneumonia (OR = 1.8 [1.4-2.2]) increased 1 year after treatment. The odds of airway obstruction, esophageal stricture, and pneumonia increased over subsequent years, with significantly increased risk at 5 years for airway obstruction (OR = 3.3 [1.8-5.8]) and pneumonia (OR = 5.2 [2.5-10.7]). Pretreatment dysphagia, chemoradiation, and salvage surgery were significant predictors of long-term dysphagia, weight loss, tracheostomy, and gastrostomy, with pretreatment dysphagia and salvage surgery also associated with pneumonia. Surgery and postoperative radiation was associated with long-term dysphagia (OR = 1.4 [1.0-1.9]) but reduced odds of long-term pneumonia (OR = 0.7 [0.5-0.9]). Long-term dysphagia, gastrostomy or tracheostomy dependence, weight loss, airway obstruction, and pneumonia were associated with poorer survival, with pneumonia associated with the greatest risk of death at 5 years (hazard ratio = 2.6 [2.4-2.9]). CONCLUSIONS Airway and swallowing impairment is common after laryngeal SCCA treatment in elderly patients, increases over time, and is associated with poorer survival-with pneumonia associated with the highest risk of long-term mortality. Patients with pretreatment dysphagia, initial treatment with chemoradiation, and salvage surgery represent a high-risk group with an increased risk of disability and death.
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Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Curry HA, Forastiere AA, Flood WA, Whyler E, Hertan LM, Sharma S, Jones JA. Utilization of single-fraction radiotherapy for the treatment of bone metastases before and after the “Choosing Wisely” campaign. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.31_suppl.245] [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
245 Background: Multiple studies have demonstrated equivalence of single vs. multi-fraction regimens for palliation of uncomplicated bone metastases, but single fraction (SF) radiotherapy (RT) remains under-utilized in the United States. To increase physician and patient awareness of RT options for bone metastases, both AAHPM and ASTRO participated in the “Choosing Wisely” campaign. AAHPM recommended 8 Gy X 1 for uncomplicated bone metastases. ASTRO recommended against routine use of courses > 10 fractions and supported strong consideration for the use of SF RT for patients with limited prognosis or transportation difficulties. To identify possible changes in prescribing patterns following “Choosing Wisely”, we evaluated utilization rates of SF (8 Gy x 1) for treatment of bone metastases via treatment requests submitted for preauthorization over a 3 year period. Methods: A proprietary web-based application (eviti Connect ) enables oncology providers to obtain real time automated precertification for patients insured by payers across the U.S. that utilize the platform. All preauthorization requests for RT of bone metastases were evaluated for the prescription of 8 Gy X 1. The overall rate of SF use was calculated as were quarterly rates within the study period. Results: From 6/1/11-6/30/14 7,524 requests were submitted; 658 were for bone metastases. Overall SF was used in 7.6 % of cases. Prior to Q4 of 2012 no prescriptions for 8 Gy X 1 were used. In 2013 SF was prescribed in 9.6% of cases (30/314): 2.8%, 7.3%, 7% and 20% for Q1, Q2, Q3, and Q4 respectively. During 2014 use of 8 Gy X 1 was 23.9% in Q1 and 19.5% in Q2. Protracted schedules > 10 treatments were prescribed in 31% of cases, but decreased over the study period (from 40% prior to Q4 2012, to 28% in 2013, and to 23% in the first half of 2014). Conclusions: Within this unique dataset of working aged insured patients, utilization of 8 Gy X 1 for treatment of bone metastases has increased. Increases were most pronounced in 2013. This coincides with the announcement and dissemination of the “Choosing Wisely” initiatives. Longer follow-up is needed to determine if increased provider uptake of SF RT as a componant of patient-centered quality care persists.
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Curry HA, Forastiere AA, Flood WA, Whyler E, Plastaras JP, Vapiwala N. Overutilization of IMRT/IGRT in treatment of rectal cancer: Cost implications of deviation from evidence-based practices. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.30_suppl.34] [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
34 Background: Current evidence-based guidelines for management of rectal cancer (RC) caution against routine use of IMRT and do not address the role of IGRT. To explore patterns of care and cost implications for treatment of RC in commercially insured patients, we assessed treatment requests submitted for preauthorization through eviti Connect. Methods: A proprietary web-based application enables oncology providers to obtain automated precertification for patients insured by payers across the US that use the platform. All requests for pelvic radiation for treatment of RC submitted from 6/1/11-5/31/14 were reviewed. Treatment delivery costs for 3D CRT + weekly port films and for IMRT + IGRT were calculated based on average reimbursement rates from 3 payers for a typical course of 50.4 Gy/28 fractions. Results: A total of 195 cases for treatment of RC were submitted. At submission, 50.3% (98/195) of cases met evidence based standards and received automated preauthorization; 49.7% required treatment justification. Ninety-eight percent of deviations involved use of IMRT and/or IGRT. Upon review, 34.9% (68/195) had a medical rationale for the variance. Justification for IMRT/IGRT use included treatment volumes comparable to anal cancer, inadequate bowel displacement by routine techniques, and obesity. Fifteen percent (29/195) contained unwarranted deviations. In 23/29 cases peer to peer discussion resulted in the provider altering the plan to be compliant. Providers did not agree to changes in the other 6 cases. Cost for a course of 3D CRT + weekly port films was $6,591 vs. $32,292 for IMRT + daily IGRT. For these 195 cases, the estimated cost of overutilization of IMRT/IGRT was $745,000 ($25,700 X 29). Conclusions: Despite lack of endorsement by consensus group guidelines, IMRT and IGRT were prescribed for treatment of RC in nearly 50% of cases. Case review and peer to peer discussion clarified the rationale for treatment deviations from guidelines and allowed providers to bring plans into compliance with evidence based practices, reducing inappropriate use of IMRT/IGRT from 15% to 3%. Reduction in unwarranted use of high cost technologies can improve quality and yield significant cost savings.
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Affiliation(s)
| | | | | | | | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Masica DL, Li S, Douville C, Manola J, Ferris RL, Burtness B, Forastiere AA, Koch WM, Chung CH, Karchin R. Predicting survival in head and neck squamous cell carcinoma from TP53 mutation. Hum Genet 2014; 134:497-507. [PMID: 25108461 DOI: 10.1007/s00439-014-1470-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/17/2014] [Indexed: 12/20/2022]
Abstract
For TP53-mutated head and neck squamous cell carcinomas (HNSCCs), the codon and specific amino acid sequence change resulting from a patient's mutation can be prognostic. Thus, developing a framework to predict patient survival for specific mutations in TP53 would be valuable. There are many bioinformatics and functional methods for predicting the phenotypic impact of genetic variation, but their overall clinical value remains unclear. Here, we assess the ability of 15 different methods to predict HNSCC patient survival from TP53 mutation, using TP53 mutation and clinical data from patients enrolled in E4393 by the Eastern Cooperative Oncology Group (ECOG), which investigated whether TP53 mutations in surgical margins were predictive of disease recurrence. These methods include: server-based computational tools SIFT, PolyPhen-2, and Align-GVGD; our in-house POSE and VEST algorithms; the rules devised in Poeta et al. with and without considerations for splice-site mutations; location of mutation in the DNA-bound TP53 protein structure; and a functional assay measuring WAF1 transactivation in TP53-mutated yeast. We assessed method performance using overall survival (OS) and progression-free survival (PFS) from 420 HNSCC patients, of whom 224 had TP53 mutations. Each mutation was categorized as "disruptive" or "non-disruptive". For each method, we compared the outcome between the disruptive group vs. the non-disruptive group. The rules devised by Poeta et al. with or without our splice-site modification were observed to be superior to others. While the differences in OS (disruptive vs. non-disruptive) appear to be marginally significant (Poeta rules + splice rules, P = 0.089; Poeta rules, P = 0.053), both algorithms identified the disruptive group as having significantly worse PFS outcome (Poeta rules + splice rules, P = 0.011; Poeta rules, P = 0.027). In general, prognostic performance was low among assessed methods. Further studies are required to develop and validate methods that can predict functional and clinical significance of TP53 mutations in HNSCC patients.
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Affiliation(s)
- David L Masica
- Department of Biomedical Engineering, Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD, USA,
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Egloff AM, Lee JW, Langer CJ, Quon H, Vaezi A, Grandis JR, Seethala RR, Wang L, Shin DM, Argiris A, Yang D, Mehra R, Ridge JA, Patel UA, Burtness BA, Forastiere AA. Phase II study of cetuximab in combination with cisplatin and radiation in unresectable, locally advanced head and neck squamous cell carcinoma: Eastern cooperative oncology group trial E3303. Clin Cancer Res 2014; 20:5041-51. [PMID: 25107914 DOI: 10.1158/1078-0432.ccr-14-0051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Treatment with cisplatin or cetuximab combined with radiotherapy each yield superior survival in locally advanced squamous cell head and neck cancer (LA-SCCHN) compared with radiotherapy alone. Eastern Cooperative Oncology Group Trial E3303 evaluated the triple combination. EXPERIMENTAL DESIGN Patients with stage IV unresectable LA-SCCHN received a loading dose of cetuximab (400 mg/m(2)) followed by 250 mg/m(2)/week and cisplatin 75 mg/m(2) q 3 weeks ×3 cycles concurrent with standard fractionated radiotherapy. In the absence of disease progression or unacceptable toxicity, patients continued maintenance cetuximab for 6 to 12 months. Primary endpoint was 2-year progression-free survival (PFS). Patient tumor and blood correlates, including tumor human papillomavirus (HPV) status, were evaluated for association with survival. RESULTS A total of 69 patients were enrolled; 60 proved eligible and received protocol treatment. Oropharyngeal primaries constituted the majority (66.7%), stage T4 48.3% and N2-3 91.7%. Median radiotherapy dose delivered was 70 Gy, 71.6% received all three cycles of cisplatin, and 74.6% received maintenance cetuximab. Median PFS was 19.4 months, 2-year PFS 47% [95% confidence interval (CI), 33%-61%]. Two-year overall survival (OS) was 66% (95% CI, 53%-77%); median OS was not reached. Response rate was 66.7%. Most common grade ≥3 toxicities included mucositis (55%), dysphagia (46%), and neutropenia (26%); one attributable grade 5 toxicity occurred. Only tumor HPV status was significantly associated with survival. HPV was evaluable in 29 tumors; 10 (all oropharyngeal) were HPV positive. HPV(+) patients had significantly longer OS and PFS (P = 0.004 and P = 0.036, respectively). CONCLUSIONS Concurrent cetuximab, cisplatin, and radiotherapy were well tolerated and yielded promising 2-year PFS and OS in LA-SCCHN with improved survival for patients with HPV(+) tumors.
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Affiliation(s)
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Harry Quon
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alec Vaezi
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Lin Wang
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Donghua Yang
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Ranee Mehra
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | - Arlene A Forastiere
- Johns Hopkins University School of Medicine and Sydney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
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Chung CH, Lee JW, Slebos RJ, Howard JD, Perez J, Kang H, Fertig EJ, Considine M, Gilbert J, Murphy BA, Nallur S, Paranjape T, Jordan RC, Garcia J, Burtness B, Forastiere AA, Weidhaas JB. A 3'-UTR KRAS-variant is associated with cisplatin resistance in patients with recurrent and/or metastatic head and neck squamous cell carcinoma. Ann Oncol 2014; 25:2230-2236. [PMID: 25081901 DOI: 10.1093/annonc/mdu367] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A germline mutation in the 3'-untranslated region of KRAS (rs61764370, KRAS-variant: TG/GG) has previously been associated with altered patient outcome and drug resistance/sensitivity in various cancers. We examined the prognostic and predictive significance of this variant in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS We conducted a retrospective study of 103 HNSCCs collected from three completed clinical trials. KRAS-variant genotyping was conducted for these samples and 8 HNSCC cell lines. p16 expression was determined in a subset of 26 oropharynx tumors by immunohistochemistry. Microarray analysis was also utilized to elucidate differentially expressed genes between KRAS-variant and non-variant tumors. Drug sensitivity in cell lines was evaluated to confirm clinical findings. RESULTS KRAS-variant status was determined in 95/103 (92%) of the HNSCC tumor samples and the allelic frequency of TG/GG was 32% (30/95). Three of the HNSCC cell lines (3/8) studied had the KRAS-variant. No association between KRAS-variant status and p16 expression was observed in the oropharynx subset (Fisher's exact test, P = 1.0). With respect to patient outcome, patients with the KRAS-variant had poor progression-free survival when treated with cisplatin (log-rank P = 0.002). Conversely, KRAS-variant patients appeared to experience some improvement in disease control when cetuximab was added to their platinum-based regimen (log-rank P = 0.04). CONCLUSIONS The TG/GG rs61764370 KRAS-variant is a potential predictive biomarker for poor platinum response in R/M HNSCC patients. CLINICAL TRIAL REGISTRATION NUMBERS NCT00503997, NCT00425750, NCT00003809.
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Affiliation(s)
- C H Chung
- Department of Oncology; Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore.
| | - J W Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | | | | | | | | | | | | | - J Gilbert
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville
| | - B A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville
| | - S Nallur
- Department of Therapeutic Radiology
| | | | - R C Jordan
- Department of Pathology, University of California, San Francisco
| | | | - B Burtness
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven
| | | | - J B Weidhaas
- Department of Therapeutic Radiology; Department of Radiation Oncology, University of California, Los Angeles
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Wanebo HJ, Lee J, Burtness BA, Ridge JA, Ghebremichael M, Spencer SA, Psyrri D, Pectasides E, Rimm D, Rosen FR, Hancock MR, Tolba KA, Forastiere AA. Induction cetuximab, paclitaxel, and carboplatin followed by chemoradiation with cetuximab, paclitaxel, and carboplatin for stage III/IV head and neck squamous cancer: a phase II ECOG-ACRIN trial (E2303). Ann Oncol 2014; 25:2036-2041. [PMID: 25009013 DOI: 10.1093/annonc/mdu248] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND E2303 evaluated cetuximab, paclitaxel, and carboplatin used as induction therapy and concomitant with radiation therapy in patients with stage III/IV head and neck squamous cell carcinoma (HNSCC) determining pathologic complete response (CR), event-free survival (EFS), and toxicity. PATIENTS AND METHODS Patients with resectable stage III/IV HNSCC underwent induction therapy with planned primary site restaging biopsies (at week 8 in clinical complete responders and at week 14 if disease persisted). Chemoradiation (CRT) began week 9. If week 14 biopsy was negative, patients completed CRT (68-72 Gy); otherwise, resection was carried out. p16 protein expression status was correlated with response/survival. RESULTS Seventy-four patients were enrolled; 63 were eligible. Forty-four (70%) were free of surgery to the primary site, progression, and death 1-year post-treatment. Following induction, 41 (23 CR) underwent week 8 primary site biopsy and 24 (59%) had no tumor (pathologic CR). Week 14 biopsy during chemoradiation (50 Gy) in 34 (15 previously positive biopsy; 19 no prior biopsy) was negative in 33. Thus 90% of eligible patients completed CRT. Overall survival and EFS were 78% and 55% at 3 years, respectively. Disease progression in 23 patients (37%) was local only in 10 (16%), regional in 5 (8%), local and regional in 2 (3%), and distant in 5 patients (8%). There were no treatment-related deaths. Toxicity was primarily hematologic or radiation-related. p16 AQUA score was not associated with response/survival. CONCLUSIONS Induction cetuximab, paclitaxel, and carboplatin followed by the same drug CRT is safe and induces high primary site response and promising survival. CLINICAL TRIALS NUMBER NCT 00089297.
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Affiliation(s)
- H J Wanebo
- Department of Surgery, Landmark Medical Center, Woonsocket.
| | - J Lee
- Department of Biostatistics & Computational Biology, Dana Farber Cancer Institute, Boston
| | - B A Burtness
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | - J A Ridge
- Department of Surgery, Fox Chase Cancer Center, Philadelphia
| | - M Ghebremichael
- Department of Biostatistics & Computational Biology, Dana Farber Cancer Institute, Boston
| | - S A Spencer
- Department of Radiation Oncology, University of Alabama, Birmingham
| | - D Psyrri
- Department of Medicine, Yale University, New Haven
| | - E Pectasides
- Department of Medicine, Yale University, New Haven
| | - D Rimm
- Department of Medicine, Yale University, New Haven
| | - F R Rosen
- Department of Medical Oncology, John H. Stroger Hospital of Cook County, Chicago
| | - M R Hancock
- Department of Medical Oncology, Porter Memorial Hospital, Denver
| | - K A Tolba
- Department of Medicine, University of Miami, Miami
| | - A A Forastiere
- Department of Medical Oncology, Johns Hopkins University and Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
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Argiris A, Li S, Ghebremichael M, Egloff AM, Wang L, Forastiere AA, Burtness B, Mehra R. Prognostic significance of human papillomavirus in recurrent or metastatic head and neck cancer: an analysis of Eastern Cooperative Oncology Group trials. Ann Oncol 2014; 25:1410-1416. [PMID: 24799460 PMCID: PMC4071756 DOI: 10.1093/annonc/mdu167] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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: 10/23/2013] [Revised: 03/27/2014] [Accepted: 04/16/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this article was to study the association of human papillomavirus (HPV) with clinical outcomes in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Archival baseline tumor specimens were obtained from patients treated on two clinical trials in recurrent or metastatic SCCHN: E1395, a phase III trial of cisplatin and paclitaxel versus cisplatin and 5-fluorouracil, and E3301, a phase II trial of irinotecan and docetaxel. HPV DNA was detected by in situ hybridization (ISH) with a wide-spectrum probe. p16 status was evaluated by immunohistochemistry. Clinical outcomes of interest were objective response, progression-free survival (PFS) and overall survival (OS). RESULTS We analyzed 64 patients for HPV ISH and 65 for p16. Eleven tumors (17%) were HPV+, 12 (18%) were p16+, whereas 52 (80%) were both HPV- and p16-. The objective response rate was 55% for HPV-positive versus 19% for HPV-negative (P = 0.022), and 50% for p16-positive versus 19% for p16-negative (P = 0.057). The median survival was 12.9 versus 6.7 months for HPV-positive versus HPV-negative patients (P = 0.014), and 11.9 versus 6.7 months for p16-positive versus p16-negative patients (P = 0.027). After adjusting for other covariates, hazard ratio for OS was 2.69 (P = 0.048) and 2.17 (P = 0.10), favoring HPV-positive and p16-positive patients, respectively. The other unfavorable risk factor for OS was loss of ≥5% weight in previous 6 months (P = 0.0021 and 0.023 for HPV and p16 models, respectively). CONCLUSION HPV is a favorable prognostic factor in recurrent or metastatic SCCHN that should be considered in the design of clinical trials in this setting. CLINICAL TRIAL IDENTIFIER NCT01487733 Clinicaltrials.gov.
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Affiliation(s)
- A Argiris
- Division of Hematology/Oncology Cancer Therapy and Research Center, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio.
| | - S Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - M Ghebremichael
- Ragon Institute of Harvard, MIT and MGH and Harvard Medical School, Boston
| | | | - L Wang
- Department of Pathology, University of Pittsburgh, Pittsburgh
| | - A A Forastiere
- Department of Medical Oncology, Johns Hopkins University, Baltimore
| | - B Burtness
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - R Mehra
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
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34
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Psyrri A, Lee JW, Pectasides E, Vassilakopoulou M, Kosmidis EK, Burtness BA, Rimm DL, Wanebo HJ, Forastiere AA. Prognostic biomarkers in phase II trial of cetuximab-containing induction and chemoradiation in resectable HNSCC: Eastern cooperative oncology group E2303. Clin Cancer Res 2014; 20:3023-32. [PMID: 24700741 PMCID: PMC4049169 DOI: 10.1158/1078-0432.ccr-14-0113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We sought to evaluate the correlation between tissue biomarker expression (using standardized, quantitative immunofluorescence) and clinical outcome in the E2303 trial. EXPERIMENTAL DESIGN Sixty-three eligible patients with operable stage III/IV head and neck squamous cell cancer (HNSCC) participated in the Eastern Cooperative Oncology Group (ECOG) 2303 phase II trial of induction chemotherapy with weekly cetuximab, paclitaxel, and carboplatin followed by chemoradiation with the same regimen. A tissue microarray (TMA) was constructed and EGF receptor (EGFR), ERK1/2, Met, Akt, STAT3, β-catenin, E-cadherin, EGFR Variant III, insulin-like growth factor-1 receptor, NF-κB, p53, PI3Kp85, PI3Kp110a, PTEN, NRAS, and pRb protein expression levels were assessed using automated quantitative protein analysis (AQUA). For each dichotomized biomarker, overall survival (OS), progression-free survival (PFS), and event-free survival (EFS) were estimated by the Kaplan-Meier method and compared using log-rank tests. Multivariable Cox proportional hazards models were used to estimate HRs and test for significance. RESULTS Forty-two of 63 patients with TMA data on at least one biomarker were included in the biomarker analysis. Tumor extracellular signal-regulated kinase (ERK)1/2 levels were significantly associated with PFS [HR (low/high), 3.29; P = 0.026] and OS [HR (low/high), 4.34; P = 0.008]. On multivariable Cox regression analysis, ERK1/2 remained significantly associated with OS (P = 0.024) and PFS (P = 0.022) after controlling for primary site (oropharynx vs. non-oropharynx) and disease stage (III vs. IV), respectively. Clustering analysis revealed that clusters indicative of activated RAS/MAPK/ERK and/or PI3K/Akt pathways were associated with inferior OS and/or PFS and maintained significance in multivariable analysis. CONCLUSIONS These results implicate PI3K/Akt and RAS/MAPK/ERK pathways in resistance to cetuximab-containing chemoradiation in HNSCC. Large prospective studies are required to validate these results.
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Affiliation(s)
- Amanda Psyrri
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ju-Whei Lee
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Pectasides
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Vassilakopoulou
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios K Kosmidis
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Barbara A Burtness
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David L Rimm
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Harold J Wanebo
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arlene A Forastiere
- Authors' Affiliations: Yale University School of Medicine, New Haven, Connecticut; Dana-Farber Cancer Institute, Boston, Massachusetts; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Landmark Medical Center, Woonsocket, Rhode Island; Johns Hopkins University, Baltimore, Maryland; and Aristotle University of Thessaloniki, Thessaloniki, Greece
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35
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Forastiere AA, Flood WA, Kozlovsky V, Whyler E, Alley EW. Prescribing patterns for management of newly diagnosed squamous cancers of the head and neck (HNSCC) and opportunities to improve quality. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17701] [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)
| | | | | | | | - Evan W. Alley
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
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36
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Schulman P, Whyler E, Kozlovsky V, Alley EW, Gilman P, Forastiere AA. The patterns of care of follicular lymphoma: First-line treatment in academic and community practice setting. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19515] [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)
| | | | | | - Evan W. Alley
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Paul Gilman
- Main Line Hematology and Oncology Associates, Wynnewood, PA
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37
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Kelly RJ, Forde PM, Bagheri A, Ahn J, Forastiere AA, Elnahal S, Rosner GL, Smith TJ. Patients and physicians can discuss the actual costs of cancer treatment with high interest and little conflict. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6563] [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)
- Ronan Joseph Kelly
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Patrick M. Forde
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ashley Bagheri
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jenny Ahn
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Shereef Elnahal
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Gary L. Rosner
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Thomas J. Smith
- The Johns Hopkins University School of Medicine, Baltimore, MD
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Masica D, Li S, Douville C, Manola J, Ferris RL, Burtness B, Forastiere AA, Koch W, Karchin R, Chung CH. Evaluation of computational tools to determine prognostic significance of TP53 mutation in head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6035] [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)
- David Masica
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | - Chris Douville
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Wayne Koch
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rachel Karchin
- The Johns Hopkins University School of Medicine, Baltimore, MD
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Gourin CG, Frick KD, Blackford AL, Herbert RJ, Quon H, Forastiere AA, Eisele DW, Dy SM. Quality indicators of laryngeal cancer care in the elderly. Laryngoscope 2014; 124:2049-56. [DOI: 10.1002/lary.24593] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/30/2013] [Accepted: 01/10/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
| | - Kevin D. Frick
- Johns Hopkins Carey Business School; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
- Department of Health Policy and Management; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
| | - Amanda L. Blackford
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
| | - Robert J. Herbert
- Department of Health Policy and Management; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Arlene A. Forastiere
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
| | - Sydney M. Dy
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
- Department of Health Policy and Management; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
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Gourin CG, Dy SM, Herbert RJ, Blackford AL, Quon H, Forastiere AA, Eisele DW, Frick KD. Treatment, survival, and costs of laryngeal cancer care in the elderly. Laryngoscope 2014; 124:1827-35. [DOI: 10.1002/lary.24574] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/21/2013] [Accepted: 12/24/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medicine; Baltimore Maryland
| | - Sydney M. Dy
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine; Baltimore Maryland
- Department of Health Policy and Management; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - Robert J. Herbert
- Department of Health Policy and Management; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
| | - Amanda L. Blackford
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine; Baltimore Maryland
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins Medicine; Baltimore Maryland
| | - Arlene A. Forastiere
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine; Baltimore Maryland
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medicine; Baltimore Maryland
| | - Kevin D. Frick
- Department of Health Policy and Management; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
- Johns Hopkins Carey Business School (k.d.f.); Baltimore Maryland U.S.A
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41
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Tam V, Hooker CM, Molena D, Hulbert A, Lee B, Kleinberg L, Yang SC, Forastiere AA, Brock M. Clinical response to neoadjuvant therapy to predict success of adjuvant chemotherapy for esophageal adenocarcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
137 Background: Evidence informing current guidelines advising postoperative chemotherapy following trimodality therapy for esophageal cancer are limited. Our objective was to identify patients with locally advanced esophageal adenocarcinoma treated with trimodality therapy who may benefit from adjuvant chemotherapy. Methods: A single institution retrospective study was performed in 308 patients with esophageal adenocarcinoma who underwent neoadjuvant chemoradiation followed by surgery between 1989-2012. Kaplan-Meier analysis compared postoperative survival by clinical response to trimodality therapy and the use of adjuvant chemotherapy. Cox proportional hazards regression models estimated the association of adjuvant chemotherapy with survival. Results: After trimodality treatment, 93 out of 308 patients(30%) received adjuvant chemotherapy. Partial response to trimodality treatment was observed in 150(48%) patients; 50 of whom received adjuvant therapy. The median survival for partial responders who received adjuvant therapy vs. those receiving trimodality therapy alone was 53.2 vs. 27.6 months, respectively (p=0.047). Patients with complete response or no response to trimodality therapy showed no difference in median survival with the addition of adjuvant chemotherapy. Univariate Cox regression revealed a 26% decrease in relative hazard for long-term survival amongst patients who received adjuvant chemotherapy compared to no adjuvant therapy (HR=0.74, 95% CI 0.55-0.98). This association remained stable after adjusting for clinical response to trimodality therapy, age, and ASA score (aHR=0.75, 95% CI 0.55-1.01). Conclusions: Adjuvant therapy for patients with locally advanced esophageal adenocarcinoma was associated with a 26% decrease in relative hazard for mortality compared to trimodality treatment alone. Long-term survival following adjuvant therapy was dependent on initial response to trimodality therapy. Partial responders may benefit most from adjuvant chemotherapy.
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Affiliation(s)
| | - Craig M. Hooker
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Alicia Hulbert
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Beverly Lee
- The Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | | | - Malcolm Brock
- The Johns Hopkins Medical Institutions, Baltimore, MD
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Kelly RJ, Forde PM, Bagheri A, Ahn J, Forastiere AA, Frick KD, Rosner GL, Dy SM, Smith TJ. Measuring the impact of chemotherapy cost discussions between patients and providers at the time of prescribing. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.257] [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
257 Background: In 2007, the ASCO Cost of Care Task Force was established to deal with the soaring costs of cancer treatment in the United States. One of the key recommendations was that the cost of chemotherapy should be introduced into the patient-physician discussion from the outset. It is unknown if these discussions are occurring in academic Institutions and what if any is the impact on the doctor/patient relationship. Methods: The National Comprehensive Cancer Network (NCCN) Guidelines and the Eviti advisor platform were jointly used in an academic oncology center during the patient/doctor consultation to demonstrate treatment options to patients and display the costs at the time of prescribing to providers and patients alike. Questionnaires measured oncology providers attitudes to cost discussions and assessed physician satisfaction with the shared decision making process when costs are introduced into the patient/doctor relationship. Patients were interviewed before and after their doctor consultation to measure their satisfaction with the process using modifications of the shared decision making scale, satisfaction with decision scale and decisional conflict scale. Basic descriptive statistics were applied. Results: Only 5/18 oncologists (28%) reported feeling comfortable discussing costs with patients and just one (6%) admitted to regularly asking patients about financial difficulties. The majority (83%) of doctors reported that the NCCN guidelines should contain cost information. Seventy-one patients (42 females, 29 males) with metastatic breast (27%), lung (49%), and colorectal cancer (24%) have been interviewed. Interestingly, 70% of patients responded that no health care professional has ever discussed costs with them despite 57/71 (80%) rating this as very important information. The majority of patients (75%) had no negative feelings to hearing cost information. Only 4% admitted to developing significant negative feelings. Conclusions: In an era of rising co-pays, patients want cost of treatment discussions and these do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.
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Affiliation(s)
- Ronan Joseph Kelly
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Patrick M. Forde
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Ashley Bagheri
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Jenny Ahn
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | - Kevin D. Frick
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Sydney Morss Dy
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas J. Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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Curry HA, Forastiere AA, Jagsi R, Palladino ML. Compliance with evidence-based guidelines for radiation of vertebral metastases. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
36 Background: Evidence based guidelines pertaining to the management of bony metastases have been published. However, up to 30% of oncology treatments deviate from evidence based standards and widespread variations in clinical practice continue to exist. To explore patterns of care in the treatment of vertebral metastases in a group of working age, insured patients, we assessed treatment plans submitted for preauthorization through eviti Connect. Methods: Eviti Connect is a web-based application that enables oncology providers to obtain automated precertification for patients. The platform evaluates treatment plans for consistency with EBM and compliance with payer policies and plan language. All requests for radiation treatment submitted during a two year period from 6/1/11-5/31/13 were reviewed. Peer to peer discussions were conducted in cases that deviated from EBM. Results: A total of 229 cases for the treatment of vertebral metastases were submitted. 46/229 plans (19.8%) did not meet EBM standards. Some cases displayed more than one deviation. Reasons for non-compliance included atypical treatment schedules (8.69%), SRS/SBRT (36.9%), IMRT (32.6%), and IGRT (58.7%). In 26/46 cases (56.5%) the treating physician provided a medical rationale for the deviation. In 9 cases the physician altered the plan to be compliant; in 5 cases the physician did not agree to a change. The most common dose fractionation schedules were 30 Gy/10 fractions (48.9%) and 37.5 Gy/15 fractions (20.5%). 17 cases were treated using 20 Gy/5 fractions and only 2 cases were treated using 8 Gy X 1. Conclusions: Radiation of vertebral metastases was prescribed in accordance with EBM in the majority of cases. The main reasons for deviation were patient-specific issues that justified the medical necessity of the variance. Case review and peer to peer discussion contributed to understanding the rationale for treatment deviation from guidelines and allowed providers to bring plans into compliance with EBM. Overall only 5% of plans were non-evidence based or lacked a medical justification for deviation. Consistent with patterns of care across the US, within this group of patients, single fraction and hypofractionated radiation regimens were underutilized.
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Affiliation(s)
| | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
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Forastiere AA, Zhang Q, Weber RS, Ridge JA. Reply to E.G. Russi et al and R. Haddad. J Clin Oncol 2013; 31:3171. [DOI: 10.1200/jco.2013.50.7137] [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)
- Arlene A. Forastiere
- Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Qiang Zhang
- Radiation Therapy Oncology Group, Statistical Office, Philadelphia, PA
| | - Randal S. Weber
- The University of Texas, MD Anderson Cancer Center, Houston, TX
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Forastiere AA, Adelstein DJ, Manola J. Induction Chemotherapy Meta-Analysis in Head and Neck Cancer: Right Answer, Wrong Question. J Clin Oncol 2013; 31:2844-6. [DOI: 10.1200/jco.2013.50.3136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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)
- Arlene A. Forastiere
- Johns Hopkins University and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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46
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Burtness B, Lee JW, Yang D, Zhu F, Garcia JJ, Forastiere AA, Chung CH. Activity of cetuximab (C) in head and neck squamous cell carcinoma (HNSCC) patients (pts) with PTEN loss or PIK3CA mutation treated on E5397, a phase III trial of cisplatin (CDDP) with placebo (P) or C. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6028] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Abstract
6028 Background: Abnormalities in EGFR signaling targets are associated with C resistance but no biomarker of C resistance has been identified in HNSCC. We hypothesized that cases with loss of PTEN protein expression (PTEN null) or PIK3CA mutation would display C resistance in HNSCC. Methods: E5397 was a phase III trial of CDDP plus P or CDDP plus C and enrolled 117 eligible and evaluable pts. PIK3CA and PTEN were analyzed for 52 and 67 consented pts, respectively. PTEN expression (PTEN Cell Signaling Technology, Cat. 9559) was determined by automated quantitative analysis (AQUA) on the PM-2000 (HistoRx, New Haven) using a cutpoint generated in 5 HNSCC tissue microarrays, each consisting of HNSCC as well as positive (small intestine, median AQUA score 2833.2) and negative controls (breast and colon carcinoma, median AQUA score 205.5). A cutpoint of 570 provides 100% specificity, 100% sensitivity, and identified 30% of the HNSCCs as PTEN null, consonant with the literature. The 3 most common PIK3CA mutations (E542K and E545K in exon 9 and H1047R in exon 20) were determined by BEAMing (Inostics, Heidelberg, Germany). Response, overall survival (OS) and progression-free survival (PFS) were compared between PTEN null or PIK3CA mutated pts and all others. Log rank and multivariable Cox proportional hazards modeling were used to calculate p values. Results: 23/67 (34%) tumors were PTEN null and 2/52 (4%) had PIK3CA mutations (E542K and E545K). Both tumors with PIK3CA mutation had PTEN expression. No statistically significant differences in response, OS or PFS were noted in this small sample. However, among PTEN expressing/PIK3CA WT pts, median PFS increased to 4.2 months (m) for C (N=22) from 2.9 m for P (N=26) (Wald p=0.07), compared with 4.6 m for C (N=12) and 3.5 m for P (n=13) among the PTEN null/PIK3CA mutated (Wald p=0.60). Conclusions: The PTEN loss or PIK3CA mutation signature warrants further investigation as a predictor of C resistance.
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Affiliation(s)
| | | | | | - Fang Zhu
- Fox Chase Cancer Center, Philadelphia, PA
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47
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Weidhaas JB, Lee JW, Slebos R, Howard J, Perez J, Gilbert J, Nallur S, Paranjape T, Garcia JJ, Burtness B, Forastiere AA, Chung CH. Association of the 3'-untranslated region KRAS-variant with cisplatin resistance in patients with recurrent and/or metastatic head and neck squamous cell carcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6016 Background: A germline mutation in let-7 complementary site 6 (LCS6) within the KRAS 3'-untranslated region (rs61764370, the KRAS-variant: TG/GG) is known to associate with poor outcome and drug resistance in various cancers compared to the wild type allele (TT). We examine the prognostic significance of the KRAS-variant in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). Methods: The KRAS-variant was determined in 116 tumor DNA samples from HNSCC patients enrolled in 3 clinical trials and a tissue collection study using a previously validated PCR-based assay. Results: KRAS-variant status could be determined in 108/116 (93%) samples and an allele frequency of TG/GG was 28.7%. These results were correlated with patient demographics, p16/human papillomavirus (HPV) status and clinical outcome. There was no association between p16/HPV status and the KRAS-variant status (Fisher’s exact test, p=1.0). The KRAS-variant was associated with poor progression-free survival in patients treated with cisplatin+/-cetuximab (log-rank p=0.002) but this association was not observed in docetaxel/bortezomib treated patients (log-rank p=0.89). Conclusions: KRAS-variant is a potentially promising biomarker of poor prognosis and a predictive biomarker of cisplatin resistance in R/M HNSCC. Prospective validation is warranted. Clinical trial information: NCT00003809.
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Mehra R, Egloff AM, Li S, Yang D, Wang L, Zhu F, Forastiere AA, Burtness B, Argiris A. Analysis of HPV and ERCC1 in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6006 Background: We studied the association of human papillomavirus (HPV) and excision repair cross-complementation group 1 (ERCC1) tumor expression with clinical outcomes in patients (pts) with R/M SCCHN. Methods: Archival baseline specimens were obtained from pts on ECOG trials: E1395, phase III trial of cisplatin/paclitaxel (CP) vs. cisplatin/5-FU (CF), and E3301, phase II trial of docetaxel/irinotecan. HPV DNA was detected by in situ hybridization (ISH) with a wide spectrum HPV probe. Tumor p16 status was defined as positive if immunohistochemical staining for p16 was strong and present in >80% of tumor cells. ERCC1 expression was measured (HistoRx PM-2000) and data analyzed using AQUA algorithms, after tissue was stained with ERCC1 ab (1:5000 HPA0297731, Sigma), and a wide-spectrum cytokeratin ab (Dako Z0622) for tumor mask. A prior determined cut point for nuclear staining was utilized. Fisher's exact test and log-rank test were used to compare categorical variables and survival. Stratified logistic regression and Cox regression model were used to estimate odds ratio (OR) and hazard ratio (HR), respectively, adjusting for potential confounding factors. p-values were two-sided. Results: Tissue was evaluable from 65 tumors (T) for HPV, 66 for p16 (E1395 and E3301), and 43 for ERCC1 expression (E1395). 11 T were HPV+ (12 p16+), and 54 were HPV-/p16-. HPV+ tumors were similarly represented in all treatment groups (p=0.58). Objective response rates (RR): 67% for HPV+, 22% for HPV- (p=0.013); 60% p16+, 22% p16- (p=0.05). RR rates were calculated excluding cases with unevaluable/unknown responses. HR for OS was 2.66 (HPV, p=0.02) and 2.27 (p16, p=0.04), favoring HPV+/p16+ pts. 18 T were ERCC1 high (H) and 25 ERCC1 low (L). HR for OS (H vs. L) was 1.96 (p=.11) RR: CF, 58% (L), 29% (H); CP, 33% (L), 56% (H). A test of ERCC1 by treatment interaction (p=0.12) suggested the effect of ERCC1 may be different for taxane vs. non-taxane regimens. Conclusions: This is the first study to show that HPV+/p16+ status is associated with a significant improvement in RR and OS among pts treated for R/M SCCHN. ERCC1 L was associated with a trend towards a better OS.
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Affiliation(s)
| | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Lin Wang
- University of Pittsburgh, Pittsburgh, PA
| | - Fang Zhu
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - Athanassios Argiris
- University of Texas Health Science Center at San Antonio Cancer Therapy and Research Center, San Antonio, TX
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Psyrri A, Lee JW, Vasilakopoulou M, Pectasides E, Burtness B, Rimm D, Wanebo HJ, Forastiere AA. Predictive biomarkers in a phase II trial of weekly carboplatin (CBDCA), paclitaxel (P), and cetuximab (C) induction and chemoradiation (CRT) in patients (pts) with resectable stage III/IVa,b head and neck squamous cell carcinoma (HNSCC): Eastern Cooperative Oncology Group E2303. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6081] [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
6081 Background: We studied the addition of C to a sequential regimen of weekly CBDCA and P followed by CBDCA-P-radiation in pts with locally advanced resectable HNSCC. Tissue-based biomarkers may aid in pt selection for such approaches. Methods: Sixty-three eligible pts withoperablestage III/IV HNSCC participated in E2303, an Eastern Cooperative Oncology Group (ECOG) phase II trial of induction chemotherapy with weekly C, P and CBDCA x 6 followed by CRT with concurrent weekly C, paclitaxel, carboplatin. A tissue microarray was constructed and b-catenin, E-cadherin, Epidermal Growth Factor Receptor Variant III (EGFRVIII), insulin-like growth factor-1 receptor (IGF1R), NF-kappa b, p53, PI3Kp85, PI3Kp110a, PTEN, ΝRAS, and pRb protein expression levels were assessed using automated quantitative protein analysis (AQUA). For each marker, time-to-event distributions (OS, PFS, and EFS) were estimated by Kaplan-Meier estimates and compared using log-rank tests. Multivariable Cox proportional hazards models were used to estimate hazard ratios and test for significance, with primary site (oropharynx vs. non-oropharynx), disease stage (III vs. IV), and other important markers adjusted in the model. All p-values are two-sided. A level of p < 0.05 is considered statistically significant. Results: Based on the continuous scale, pRb tended to association with EFS (p=0.05). On multivariable analysis, low pRb level was a significant predictor for improved EFS (p=0.048). Our pRb data analysis was based on 32 pts with marker data available. Conclusions: pRb level is a potential predictive biomarker for response to cetuximab. HPV E7 oncoprotein binds and degrades pRb; therefore, low pRb protein level might be a surrogate marker for HPV association.Large prospective studies will be required to determine the association between pRb, HPV status and response to cetuximab in HNSCC.
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Affiliation(s)
| | | | | | | | | | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT
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Forastiere AA, Flood WA, Yedwab E, Kozlovsky V, Whyler E, Alley EW, Frick KD. The cost per patient of deviations from evidence-based standards of oncology care. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6515] [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
6515 Background: Practice variation contributes to the high cost of healthcare and wasteful spending; by contrast, adherence to evidence-based (EB) clinical guidelines is advocated to improve quality and potentially lower cost. We sought to estimate the average cost per patient associated with unjustified deviations from EB national standards for use of chemotherapy, supportive drugs, and radiotherapy. Methods: The ITA Partners/eviti, Inc. database of oncology treatment plans (TPs) reviewed for payers for adherence to national guideline recommendations (e.g. ASCO, ASTRO, NCI, NCCN Compendium, FDA) was used to calculate the variance in cost between submitted TPs with unwarranted deviations from EB standards and EB care. For prospective reviews, the final EB treatment given was known and for retrospective reviews, the variance was estimated based on the EB alternative with the lowest cost. AWP pricing was used to calculate chemotherapy and supportive drug costs, and Medicare pricing for radiotherapy. First order savings were calculated. An annual trend of 8% was applied from the mid-data period to 2013 (Milliman Client Report 2010). Results: From March 2009 to March 2012, a total of 2775 consecutive patients had TPs submitted and of these, 730 patients had unjustified, non-EB TPs. All cancer types, stage and treatment intent (curative, non-curative) were included. The cost of EB treatment was less than the submitted TP for 622 (85%) patients, more for 9 (1%), and zero (could not be taken due to payer plan definitions) for 99 (14%). Descriptive statistics for the cost per patient of non-EB TPs trended to 2013 showed: mean $25,579, median $13,882, standard deviation $40,958. Conclusions: In this unselected population comprising all cancers, 26% had TPs that did not conform to EB standards or could not be medically justified. Our conservative estimate of the average per patient overspend (first order) on inappropriate treatment validates the potential for quality care to lower cost and deliver huge value to patients, physicians, and payers. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Evan W. Alley
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Kevin D. Frick
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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