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Derbes R, Hakun J, Elbich D, Master L, Berenbaum S, Huang X, Buxton OM, Chang AM, Truica CI, Sturgeon KM. Design and methods of the mobile assessment of cognition, environment, and sleep (MACES) feasibility study in newly diagnosed breast cancer patients. Sci Rep 2024; 14:8338. [PMID: 38594369 PMCID: PMC11004176 DOI: 10.1038/s41598-024-58724-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief performance-based measures of cognition. Newly diagnosed, ER/PR+, stage 0-III, female breast cancer patients, were recruited. Ambulatory assessments were conducted on smart phones and wearable activity monitors were used to monitor sleep and physical activity. Participants were asked to complete five 7-day measurement bursts (one before starting ET and one each month for 4 consecutive months while on ET). We observed a consent rate of 36%, 27 women completed the study. Of the women that withdrew, 91% dropped prior to the midpoint of follow up. There were no significant differences in demographics, clinical breast cancer characteristics, sleep or physical activity patterns, or measures of cognition between women who completed versus withdrew. Women who did not complete the study provided fewer valid days of baseline data. In conclusion, while some women may be overwhelmed with their cancer diagnosis, we did not identify any predictive characteristics of women whom did not complete the study. This novel method enables the prospective study of psychological changes associated with cancer treatment, capturing a wide array of information about behavior, experience, and cognition, thus providing a picture of the lived experiences of cancer patients before and during exposure to ET.
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Affiliation(s)
- Rebecca Derbes
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Jonathan Hakun
- Penn State Milton S. Hershey Medical Center, Department of Neurology, H5508, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, H03717033, USA.
- Department of Psychology, College of Liberal Arts, Pennsylvania State University, University Park, PA, USA.
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, 16802, USA.
- College of Medicine, Translational Brain Research Center, Pennsylvania State University, Hershey, PA, 17033, USA.
| | - Daniel Elbich
- Penn State Milton S. Hershey Medical Center, Department of Neurology, H5508, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, H03717033, USA
- College of Medicine, Translational Brain Research Center, Pennsylvania State University, Hershey, PA, 17033, USA
| | - Lindsay Master
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Sheri Berenbaum
- Department of Psychology, College of Liberal Arts, Pennsylvania State University, University Park, PA, USA
| | - Xuemei Huang
- Penn State Milton S. Hershey Medical Center, Department of Neurology, H5508, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, H03717033, USA
- College of Medicine, Translational Brain Research Center, Pennsylvania State University, Hershey, PA, 17033, USA
| | - Orfeu M Buxton
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Cristina I Truica
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Kathleen M Sturgeon
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, USA
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Schmitz KH, Kanski B, Gordon B, Caru M, Vasakar M, Truica CI, Wang M, Doerksen S, Lorenzo A, Winkels R, Qiu L, Abdullah S. Technology-based supportive care for metastatic breast cancer patients. Support Care Cancer 2023; 31:401. [PMID: 37338627 DOI: 10.1007/s00520-023-07884-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients are living longer. However, symptom burden remains a significant issue. Technology-based interventions may assist. The purpose of this study was to test a virtual assistant for addressing symptoms in MBC using the Amazon Echo Show with Alexa. METHODS In this partial crossover randomized trial, the immediate treatment group was exposed to the intervention, called Nurse AMIE (Addressing Metastatic Individuals Everyday) for 6 months. The comparison group was unexposed for the first 3 months and then exposed for 3 months. The randomized controlled trial (RCT) during the first 3 months allowed for the evaluation of intervention effects on symptoms and function. The partial crossover maximized exposure to the intervention for evaluation of feasibility, usability, and satisfaction. RCT outcome data were collected at baseline and 3 months. Feasibility, usability, and satisfaction data were collected throughout the first 3 months of intervention exposure. RESULTS Forty-two MBC patients were randomized (1:1). Participants were 53 ± 11 years old and 4 ± 7 years from diagnosis with metastatic disease. No significant effects on psychosocial distress, pain, sleep disturbance, fatigue (vitality), quality of life, or chair stands were noted, despite high levels of acceptability (51%), feasibility (65%), and satisfaction (70%). CONCLUSION A high level of participant acceptability, feasibility, usability, and satisfaction all suggest further research on this platform is warranted. The lack of statistically significant effects on symptoms, quality of life, and function may be the result of small sample size. CLINICALTRIALS GOV REGISTRATION NUMBER NCT04673019 (registration date: December 17, 2020).
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Affiliation(s)
- Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Beth Kanski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Brett Gordon
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Maxime Caru
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Monali Vasakar
- Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA, USA
| | - Cristina I Truica
- Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Division of Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shawna Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abby Lorenzo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Renata Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Ling Qiu
- College of Information Sciences and Technology, Penn State University, State College, PA, USA
| | - Saeed Abdullah
- College of Information Sciences and Technology, Penn State University, State College, PA, USA
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Caru M, Abdullah S, Qiu L, Kanski B, Gordon B, Truica CI, Vasakar M, Doerksen S, Schmitz KH. Women with metastatic breast cancer don't just follow step-count trends, they exceed them: an exploratory study. Breast Cancer Res Treat 2023:10.1007/s10549-023-06980-6. [PMID: 37227610 DOI: 10.1007/s10549-023-06980-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients are living longer at the cost of several side effects, affecting their physical and mental health. Physical activity can help women with MBC to improve their wellbeing. Technology-based exercise interventions have shown promising outcomes; however, studies that document their benefits on health behaviors are lacking. Therefore, we aimed to document the impact of virtual assistant technology on enhancing daily step counts in women with MBC. METHODS A total of 38 women with MBC participated in the 90-day Nurse AMIE (Addressing Metastatic Individuals Everyday) for Amazon Echo Show study, an artificial intelligence-based supportive care intervention. Each day, Nurse AMIE asked four symptom questions (sleep, pain, fatigue, and distress) and daily step counts. Based on participants' answers, an algorithm provided an activity to assist with symptom management. RESULTS During the first week of the intervention, mean step counts per day were 4935 ± 2884, and during the last week of the intervention, mean step counts per day were 1044 steps higher, for an average of 5979 ± 2651 steps. Non-significant differences were observed between the first and last week (p = 0.211) and between the first and last day (p = 0.099), despite an improvement of 21.2% over time and significant differences between baseline and the other days. CONCLUSION Women with MBC benefited from the Nurse AMIE for Amazon Echo Show intervention. Despite improvements over time (> 20%), we cannot conclude that the intervention significantly enhanced participants' daily step counts. Larger studies using virtual assistant technologies are required, and this study should be considered a first step in this direction.
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Affiliation(s)
- Maxime Caru
- Division of Hematology and Oncology, Department of Pediatric, Pennsylvania State Health Children's Hospital, Hershey, PA, USA
| | - Saeed Abdullah
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, USA
| | - Ling Qiu
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, USA
| | - Bethany Kanski
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Brett Gordon
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Cristina I Truica
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Monali Vasakar
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Shawna Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, 5150 Centre Ave., Room 549B, Pittsburgh, PA, 15232, USA.
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Danciu OC, Hoskins K, Weiss J, Truica CI, Blaes A, Tamkus D, Rana J, Pavankumar T, Green L, Gao Y, Yu M, Zhao Q, Toppmeyer D, O’Regan R, Wisinski KB. Abstract P4-01-38: A single arm phase II trial of Palbociclib in combination with Tamoxifen as first line therapy for metastatic hormone receptor positive breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-38] [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: 03/06/2023]
Abstract
Abstract
Background: Palbociclib is a CDK4/6 inhibitor used to treat metastatic hormone receptor-positive (HR+) breast cancer (MBC) in combination with endocrine therapy. Tamoxifen is an effective treatment for HR+ MBC, with different toxicity profile compared with aromatase inhibitors (AI) and fulvestrant. Preclinical data demonstrated synergy for the combination of tamoxifen and palbociclib, being effective in a model of acquired tamoxifen resistance.
Methods: We conducted a non-randomized, open-label, single-arm, multicenter, phase II trial of palbociclib in combination with tamoxifen in patients with HR+/HER2 - advanced BC, with no prior therapy for MBC. Ovarian suppression was recommended for pre-menopausal women. Primary objective was progression free survival, PFS. Secondary objectives: objective response rate, ORR (CR or PR) based on RECIST 1.1 or MDA Criteria (for patients with bone only disease); safety and tolerability (using CTCAE v4); clinical benefit rate, CBR (CR, PR or SD lasting min 24 weeks); 2-year overall survival. Correlative objectives: proteomic analysis of plasma exosomes to identify mechanisms of primary and secondary resistance to tamoxifen/palbociclib.
Results: Between 6/30/2016 and 7/02/2019, we enrolled 49 patients (47 evaluable): 23 pts with de-novo metastatic disease and 24 pts with recurrent BC (12 pts were on adjuvant treatment with AI at time of recurrence and 12 pts on surveillance). As of 6/30/2022 data cut-off, 2 pts were still on treatment. This is an updated analysis with median follow-up time of 24 months (range 8-51). Median age was 60 (range 39-82). The median PFS was 19.8 months with 95% CI (8-41) for pts with de-novo MBC and 7 months (2-12) for pts with recurrent BC. The ORR was 30% overall, 39% for pts with de novo MBC, 21% for pts with recurrent BC. CBR was 64% overall, 77% for pts with de novo MBC and 50% for pts with recurrent BC. CBR was 65% for white pts and 55% for AA pts. Best response per RECIST1.1: 14 pts (34%) had PR, 18 pts (44%) had SD, 9 pts (22%) had PD. All 6 pts with bone only disease had SD. The most common drug related grade ≥ 3 AE was neutropenia (51%), transient and manageable by dose modifications, no cases of febrile neutropenia. Four patients (8%) developed thromboembolic events (grades 2, 3, 4) and discontinued treatment. One patient died while on treatment from PD. More than 800 exosome proteins were detected in the samples analyzed so far. Exosomal protein networks in pretreatment samples predicted treatment response with 89% sensitivity and 95% specificity in unsupervised clustering. Data on correlative objectives will be presented in a separate abstract.
Conclusions: The combination of palbociclib and tamoxifen showed tolerable, expected safety profile. This may be an alternative approach for selected patients in first line treatment of HR+ MBC, especially those who present with de-novo metastatic disease and are intolerant to AI; although this small study indicates a lower PFS.
Table 1: Baseline Demographics
Citation Format: Oana C. Danciu, Kent Hoskins, Jennifer Weiss, Cristina I. Truica, Anne Blaes, Deimante Tamkus, Jatin Rana, Tandra Pavankumar, Lauren Green, Yu Gao, Menggang Yu, Qianqian Zhao, Deborah Toppmeyer, Ruth O’Regan, Kari B. Wisinski. A single arm phase II trial of Palbociclib in combination with Tamoxifen as first line therapy for metastatic hormone receptor positive breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-38.
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Affiliation(s)
| | | | | | | | - Anne Blaes
- 5University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Yu Gao
- 10University of Illinois at Chicago
| | - Menggang Yu
- 11University of Wisconsin Carbone Cancer Center
| | | | | | - Ruth O’Regan
- 14University of Rochester Medical Center, Rochester, New York
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Zhang Z, Ma X, Ekiert J, Mohapatra G, Coleman L, Truica CI, Blaes A, Rana J, Pavankumar T, Green L, Yu M, Toppmeyer D, O’Regan R, Wisinski KB, Danciu OC, Hoskins K, Gao Y. Abstract P5-02-47: Quantitative proteomic analysis of plasma exosomes from patients with advanced hormone receptor-positive/HER2-negative breast cancer receiving palbociclib and tamoxifen. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-02-47] [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: 03/06/2023]
Abstract
Abstract
Background: A CDK4/6 inhibitor (CDK4/6i) in combination with endocrine therapy (ET) is standard first-line therapy for advanced, hormone receptor (HR)-positive, HER2-negative breast cancer (BC). However, not all patients respond and responders eventually develop drug resistance and disease progression. Exosomes are small extracellular vesicles that are secreted by both normal and tumor cells as a mechanism for intercellular communication. The protein cargo of exosomes reflects biological processes activated in cancer cells and may serve as predictive biomarkers to select patients most likely to benefit from treatment and to identify mechanisms of resistance. Methods: Whole blood was collected in Streck tubes at baseline and at time points during treatment from patients with advanced, HR+/HER2- BC enrolled in a single arm, phase 2 trial of first line therapy with palbociclib plus tamoxifen that was conducted by The Big Ten Cancer Research Consortium (NCT02668666). Plasma was separated and stored at -80C within 48 hours of collection. Different exosome protein isolation methods were evaluated and optimized to maximize protein recovery. Exosome and plasma proteins were extracted, purified, and digested with trypsin. Tryptic peptides were isotopically labeled with Tandem Mass Tag (TMT) 10plex for protein expression level quantitation. Triplicate samples from each patient were analyzed by LC-MS/MS with QExactive HF Orbitrap mass spectrometer. An unsupervised clustering method was used to classify patients based on exosomal proteomic profiles. Results: We developed a sensitive and efficient exosome extraction method to obtain exosome protein from minimal volumes of patient plasma. The optimized exosome isolation method quantitatively identified 800 proteins from a 100 µl plasma sample. Significant enrichment of exosome-specific markers was observed when comparing patient samples with healthy donor samples. A network model was developed to differentiate responders/stable disease patients from non-responders using exosome proteomics data generated from pretreatment plasma samples. Preliminary data from the first 22 patients analyzed (responders, n= 6; stable disease, n=12, and non-responder, n=4) identified a network of 45 proteins that predicted response/stable disease vs progressive disease with high specificity (95%) and sensitivity (89%). We also noted significant differences in the exosome proteomic profiles of patients with de novo vs. recurrent metastatic disease. A network of 22 proteins differentiated de novo vs recurrent metastatic disease with > 85% sensitivity and 78% specificity, providing molecular evidence differentiating the two disease states. This finding is relevant in light of the higher response rate and improved PFS in patients with de novo metastatic disease in this trial, and confirms that this approach may provide molecular insight into mechanisms of primary resistance to CDK4/6i. Results for the entire trial cohort of 46 patients will be presented, along with analysis of serial samples collected at various time points during treatment. Conclusion: This proof-of-concept study demonstrates that an ultrasensitive exosome proteomics platform combined with deep learning methods is ideally suited for developing predictive protein biomarkers and for exploring molecular mechanisms of drug resistance. If results are confirmed, this novel approach holds great promise for identifying protein biomarkers that could be used to select patients unlikely to respond to ET and CDK4/6i in order to spare them ineffective treatment and for selecting participants for clinical trials of novel agents. Additionally, exosome proteomics data generated from serially collected specimens can be used to identify mechanisms of resistance that emerge during therapy. This approach can be widely applied to other treatment regimens and disease sites. This study was funded by Pfizer.
Citation Format: Ziwei Zhang, Xiuyuan Ma, Julia Ekiert, Gayatry Mohapatra, Louis Coleman, Cristina I. Truica, Anne Blaes, Jatin Rana, Tandra Pavankumar, Lauren Green, Menggang Yu, Deborah Toppmeyer, Ruth O’Regan, Kari B. Wisinski, Oana C. Danciu, Kent Hoskins, Yu Gao. Quantitative proteomic analysis of plasma exosomes from patients with advanced hormone receptor-positive/HER2-negative breast cancer receiving palbociclib and tamoxifen [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-02-47.
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Affiliation(s)
| | | | | | | | | | | | - Anne Blaes
- 7University of Minnesota, Minneapolis, MN
| | | | | | | | - Menggang Yu
- 11University of Wisconsin Carbone Cancer Center
| | | | - Ruth O’Regan
- 13University of Rochester Medical Center, Rochester, New York
| | - Kari B. Wisinski
- 14University of Wisconsin Carbone Cancer Center, MADISON, Wisconsin
| | | | | | - Yu Gao
- 17University of Illinois at Chicago
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Bluethmann SM, Flores E, Grotte M, Heitzenrater J, Truica CI, Olsen NJ, Sciamanna C, Schmitz KH. Adapting an Evidence-Based Exercise and Education Program for Older Breast Cancer Survivors for the REJOIN Trial. J Aging Phys Act 2023; 31:59-67. [PMID: 35700977 PMCID: PMC10903157 DOI: 10.1123/japa.2022-0013] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Eileen Flores
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Meghan Grotte
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Jared Heitzenrater
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Cristina I Truica
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Nancy J Olsen
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, Hershey, PA,USA
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Gordon BR, Qiu L, Doerksen SE, Kanski B, Lorenzo A, Truica CI, Vasekar M, Wang M, Winkels RM, Abdullah S, Schmitz KH. Addressing metastatic individuals everyday: Rationale and design of the nurse AMIE for Amazon Echo Show trial among metastatic breast cancer patients. Contemp Clin Trials Commun 2023; 32:101058. [PMID: 36698743 PMCID: PMC9868339 DOI: 10.1016/j.conctc.2023.101058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/28/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Metastatic Breast Cancer (MBC) patients often feel their symptom-related needs are unmet, despite visiting their doctors up to once a week. Novel approaches are needed to address symptoms without requiring additional appointments. Technology based symptom management approaches to address symptoms have not been well tested. Methods Nurse AMIE (Addressing Metastatic Individuals Everyday) is a technology based supportive care platform that provides guideline-concordant symptom management interventions in response to patient reported symptoms. We have previously successfully implemented a tablet version of Nurse AMIE. However, some eligible patients chose not to participate because they were overwhelmed by the technology. To address this barrier, we translated the Nurse AMIE platform to the Amazon Echo Show, which allowed for voice-based interactions. Forty-two MBC patients were randomized 1:1 to receive the Nurse AMIE for Echo Show immediately for six months, or to receive the same intervention for three months, after a three month delay. The primary outcome was change in physical distress over three months, and secondary outcomes included feasibility, acceptability, patient reported outcomes and usability. Conclusions Results from the Nurse AMIE for Echo Show trial will identify the feasibility, acceptability, and preliminary effects of the Nurse AMIE for Echo Show on patient reported outcomes. Untested novel technologies, particularly voice-based artificial intelligence devices may an effective and scalable vehicle through which we can deliver supportive care interventions. Clinicaltrialsgov identifier NCT04673019.
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Affiliation(s)
- Brett R. Gordon
- Pennylvania State University College of Medicine, Hershey, PA, USA
| | - Ling Qiu
- Pennsylvania State University College of Information and Science Technology, University Park, PA, USA
| | | | - Bethany Kanski
- Pennylvania State University College of Medicine, Hershey, PA, USA
| | - Abigail Lorenzo
- Pennylvania State University College of Medicine, Hershey, PA, USA
| | | | - Monali Vasekar
- Pennylvania State University College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Pennylvania State University College of Medicine, Hershey, PA, USA
| | - Renate M. Winkels
- Pennylvania State University College of Medicine, Hershey, PA, USA,Division of Human Nutrition and Health, Wageningen University, the Netherlands
| | - Saeed Abdullah
- Pennsylvania State University College of Information and Science Technology, University Park, PA, USA
| | - Kathryn H. Schmitz
- Pennylvania State University College of Medicine, Hershey, PA, USA,Corresponding author. 5150 Centre Ave, Room 549B, Pittsburgh, PA, 15232, USA.
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Teslenko I, Trudeau J, Luo S, Watson CJW, Chen G, Truica CI, Lazarus P. Influence of glutathione-S-transferase A1*B allele on the metabolism of the aromatase inhibitor, exemestane, in human liver cytosols and in patients treated with exemestane. J Pharmacol Exp Ther 2022; 382:327-334. [PMID: 35793834 PMCID: PMC9426760 DOI: 10.1124/jpet.122.001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Exemestane (EXE) is used to treat postmenopausal women diagnosed with estrogen receptor positive (ER+) breast cancer. A major mode of metabolism of EXE and its active metabolite, 17β-dihydroexemestane, is via glutathionylation by glutathione-S-transferase (GST) enzymes. The goal of the present study was to investigate the effects of genetic variation in EXE-metabolizing GST enzymes on overall EXE metabolism. Ex vivo assays examining human liver cytosols from 75 subjects revealed the GSTA1 *B*B genotype was associated with significant decreases in S-(androsta-1,4-diene-3,17-dion-6α-ylmethyl)-L-glutathione (P = 0.034) and S-(androsta-1,4-diene-17β-ol-3-on-6α-ylmethyl)-L-gutathione (P = 0.014) formation. In the plasma of 68 ER+ breast cancer patients treated with EXE, the GSTA1 *B*B genotype was associated with significant decreases in both EXE-cysteine (cys) (29%, P = 0.0056) and 17β-DHE-cys (34%, P = 0.032) as compared with patients with the GSTA1*A*A genotype, with significant decreases in EXE-cys (Ptrend = 0.0067) and 17β-DHE-cys (Ptrend = 0.028) observed in patients with increasing numbers of the GSTA1*B allele. A near-significant (Ptrend = 0.060) trend was also observed for urinary EXE-cys levels from the same patients. In contrast, plasma and urinary 17β-DHE-Gluc levels were significantly increased (36%, P = 0.00097 and 52%, P = 0.0089; respectively) in patients with the GSTA1 *B*B genotype. No significant correlations were observed between the GSTM1 null genotype and EXE metabolite levels. These data suggest that the GSTA1*B allele is associated with interindividual differences in EXE metabolism and may play a role in interindividual variability in overall response to EXE.
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Affiliation(s)
- Irina Teslenko
- Pharmaceutical Sciences, Washington State University, United States
| | | | - Shaman Luo
- Washington State University, United States
| | | | - Gang Chen
- Pharmaceutical Sciences, WSU College of Pharmacy, United States
| | | | - Philip Lazarus
- Pharmaceutical Sciences, Washington State University College of Pharmacy, United States
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Zhang Z, Ma X, Ekiert J, Simons Y, Coleman L, Truica CI, Blaes AH, Rana J, Tandra P, Green L, Yu M, Toppmeyer D, O'Regan R, Wisinski KB, Danciu OC, Mohapatra G, Hoskins K, Gao Y. Identification of exosome protein biomarkers in patients with advanced hormone receptor-positive breast cancer treated with palbociclib and tamoxifen. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13014] [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
e13014 Background: The combination of a CDK4/6 inhibitor (CDK4/6i) plus endocrine therapy (ET) doubles progression free survival compared with ET alone in hormone receptor (HR)-positive, advanced breast cancer (BC), although not all patients respond and responders eventually develop resistance and disease progression. Exosomes are membrane-bound extracellular vesicles that are released from tumors for cell-to-cell transfer of lipids, proteins, and nucleic acids. Analysis of exosome cargo provides a dynamic and functional read-out of biological pathways that are activated in cancer cells. We performed deep proteomic analysis of plasma exosomes from patients receiving palbociclib/tamoxifen to identify protein networks that predict response to CDK4/6i and ET and that may contribute to drug resistance. Methods: The Big Ten Cancer Research Consortium conducted a phase II trial of palbociclib plus tamoxifen as first line therapy for patients with advanced, HR+/HER2- BC (NCT02668666). Whole blood was collected in Streck tubes from all participants at baseline and at time points during study treatment. Plasma was separated and stored at -80C within 48 hours of collection. Exosome extraction and purification was optimized for maximum proteomic coverage. Proteins were labeled with tandem mass tag 10plex and quantified with ultrasensitive mass spectrometry. Detected proteins were mapped to pathways with the Reactome Pathway Database. An unsupervised machine learning approach with modified graphic neural networks was used to determine whether differential expression of protein networks in plasma exosomes predicts treatment response. Results: We detected more than 700 exosome proteins from100 μl plasma in 16 study participants (responders, n = 11; non-responders, n = 5). Significant enrichment of exosome-specific markers was observed when comparing patient samples with healthy donor samples. Exosomal protein networks in pretreatment samples predicted treatment response with 95% sensitivity and 85% specificity in unsupervised clustering. The top weighted protein networks in the treatment response model are enriched for membrane attack complex, complement activation and lipoprotein receptor binding pathways. Conclusions: Ultrasensitive proteomic analysis combined with deep learning methods provides a detailed picture of the proteome landscape of plasma exosomes in advanced breast cancer patients and is ideally suited for serial analyses to study emergence of resistance mechanisms. This approach also demonstrated unparalleled accuracy as a predictive biomarker to identify patients unlikely to respond to CDK4/6i and ET. If results are confirmed, this novel approach could hold great promise for identifying protein biomarkers and mechanisms of resistance that emerge during anticancer therapy. Clinical trial information: NCT02668666.
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Affiliation(s)
- Ziwei Zhang
- University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Xiuyuan Ma
- University of Illinois at Chicago, Chicago, IL
| | - Julia Ekiert
- University of Illinois Chicago College of Pharmacy, Chicago, IL
| | | | | | | | | | - Jatin Rana
- Michigan State University, East Lansing, MI
| | | | | | - Menggang Yu
- University of Wisconsin Department of Biostatistics and Medical Informatics, Madison, WI
| | | | - Ruth O'Regan
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Gayatry Mohapatra
- University of Illinois at Chicago College of Medicine, Division of Pathology, Chicago, IL
| | | | - Yu Gao
- University of Illinois Chicago, Chicago, IL
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10
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Truica CI, Schmitz K, Doerksen S, Calo W, Stout NL, Wang M, Lengerich E, Moss J, Vanness DJ. Nurse AMIE: Addressing symptoms in rural patients with advanced cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12148] [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
TPS12148 Background: Prior research has shown that monitoring symptoms in advanced cancer patients may provide a survival benefit. Monitoring is a labor-intensive process that requires nursing staff response and visiting a medical office. This may be more challenging in rural areas, given staffing challenges and distances traveled for care. Lower density of supportive care services has been documented in rural as compared to urban settings in Pennsylvania and West Virginia. We have developed a computer tablet-based supportive care program, called Nurse AMIE, and are investigating its use in symptom management among cancer survivors. Our hypothesis is that a tablet-based supportive care program can improve overall survival of advanced cancer patients in rural Pennsylvania and West Virginia. Methods: This randomized controlled trial will recruit 344 patients residing in a rural county or zip code (RUCC 4-9 or RUCA 4-10) in Pennsylvania or West Virginia, who receive treatment for stage III-IV cancer, are 18 years or older, ECOG 0-3, are fluent in written and spoken English, have sufficient vision/hearing to interact with a computer tablet and staff, and have a clinician-defined life expectancy of 6 months or more. Exclusion criteria: patients on active treatment or behavioral or supportive care trials, or with medical or psychiatric conditions that would impair ability to test study hypotheses. Patients will be randomized on a 1:1 basis to receive either Nurse AMIE or a binder with written supportive care materials. Intervention participants will be asked to log into Nurse AMIE daily, where they will interact with a nurse avatar and answer symptom questions (focusing on sleep, fatigue, pain, and distress). They will receive an empathic response to symptoms and be offered evidence based, guideline concordant self-care interventions to address symptoms (including exercise, nutrition, guided meditation, cognitive behavioral therapy videos, and soothing music). Once weekly, patients will answer 21 questions from the Pro-CTCAE survey. All symptom data will be loaded into a dashboard reviewed daily by study staff. Pain or distress scores of 7+ (out of 10) will be communicated to the care team through the EMR. The trial is powered to detect a 19% difference in overall survival at 2 years follow-up (based on Denis et al JAMA 2019). Secondary outcomes include incidence of chemotherapy toxicities, patient reported outcomes, and cost effectiveness. Enrollment is anticipated to start in March 2022. A community advisory board of 12 cancer patients and stakeholders meet on a quarterly basis to provide feedback on study activities (e.g., usability testing, adaptations, overall implementation) and ensure the project responds to the needs and preferences of rural cancer patients in Pennsylvania and West Virginia. NIH R01-CA254659. Clinical trial information: NCT05221606.
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Affiliation(s)
| | | | | | | | | | - Ming Wang
- Penn State Milton S Hershey Medical Center, Hershey, PA
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11
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Truica CI, Parkes AM, Danciu OC, Vasekar MK, Hoskins K, Wisinski KB. A phase II, single-arm, non-randomized study of alpelisib (BYL719) in combination with continued endocrine therapy following progression on endocrine therapy in hormone receptor–positive, HER2-negative, PIK3CA-mutant metastatic breast cancer: A Big Ten Cancer Research Consortium Study (btcrc-BRE19-409). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps1114] [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
TPS1114 Background: The PI3K pathway is frequently altered in hormone receptor positive (HR+) breast cancer (BC) and 40% of patients have PIK3CA mutations. The PI3Kα-specific inihibitor, Alpelisib, is FDA-approved in combination with fulvestrant for treatment of patients with HR+ HER2 negative (HER2-) PIK3CA mutated, advanced BC following progression on or after a non-fulvestrant endocrine therapy (ET) based regimen. We hypothesized that the benefit seen in the seminal SOLAR-1 study that compared alpelisib plus fulvestrant to placebo with fulvestrant, was due to the addition of alpelisib, rather than the change to fulvestrant, such that addition of alpelisib to ongoing ET at time of progression could lead to similar outcomes. Unlike SOLAR-1, our study continues prior ET at time of progression and requires prior CDK4/6 inhibitor therapy. Methods: We designed a phase II single arm study that tests the efficacy of adding alpelisib to ongoing ET at time of progression on ET. The primary objective is to estimate the progression–free survival (PFS) of alpelisib with continued ET (aromatase inhibitor or fulvestrant) following progression in patients with HR+ HER2-, PIK3CA mutant advanced BC. Secondary objectives are to estimate overall response rate, clinical benefit rate, duration of response, overall survival and safety/tolerability. Correlative studies include evaluation of PIK3CA activity in circulating tumor cell liquid biopsy at baseline, C1D15, C2D1, C4D1 and at progression and correlation with primary and secondary objectives. Eligibility: Men and postmenopausal female patients with histologically confirmed ER and/or PR ≥1%, HER2- metastatic or unresectable BC with PIK3CA mutation and either measurable disease or at least one predominantly lytic bone lesion. No more than two lines of ET and no chemotherapy in the metastatic setting is allowed and patients must have received treatment with a CDK4/6 inhibitor and have progressed on ET as last line of therapy. Exclusions include prior PIK3CA, mTOR or AKT inhibitors in the metastatic setting, symptomatic active CNS metastases or CNS metastases that require therapeutic interventions. Statistical Analysis. The sample size calculation is based on testing the null hypothesis that the median PFS is at most 5 months against the alternative that the PFS is greater than 5 months (based on data from SOLAR-1). An increase of at least 3 months in the median PFS will be considered a sufficient efficacy signal. A sample size of 44 subjects is required to detect an anticipated increase in the median PFS from 5 to 8 months at the one-sided 0.10 significance level with 90% power, assuming a uniform accrual period of 24 months. Clinical trial information: NCT04762979.
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Affiliation(s)
| | - Amanda Marie Parkes
- Department of Medicine, Section of Hematology/Oncology Carbone Comprehensive Cancer Center University of Wisconsin, Madison, WI
| | - Oana Cristina Danciu
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
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12
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Ma X, Gao Y, Mohapatra G, Coleman L, Simons Y, Truica CI, Blaes AH, Rana J, Tandra P, Green L, Liu LC, Yu M, Toppmeyer D, O'Regan R, Wisinski KB, Danciu OC, Hoskins K. Deep proteomic analysis of plasma exosomes in patients with advanced, hormone receptor-positive breast cancer treated with palbociclib and tamoxifen. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1030] [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
1030 Background: Combining a CDK4/6 inhibitor (CDK4/6i) with endocrine therapy (ET) in advanced, hormone receptor (HR)-positive, HER2-negative breast cancer (BC) doubles median progression-free survival, but eventually drug resistance and disease progression occur. For most patients, the mechanism of resistance is unknown. Exosomes are membrane-bound extracellular vesicles that contain lipids, proteins, and nucleic acids, and are released from tumors as a form of intercellular communication. Exosomes can be recovered from plasma, and analysis of their cargo provides a dynamic read-out of biological pathways that are activated in cancer cells. Proteomic analysis of plasma exosomes may provide insight into mechanisms of resistance that emerge during treatment with CDK4/6i-ET. Methods: The Big Ten Cancer Research Consortium conducted a single arm, phase II trial of palbociclib plus tamoxifen as first line therapy for advanced, HR+/HER2- BC (NCT02668666). Whole blood was collected in Streck tubes from study participants (n = 49) at baseline, at disease progression, and at time points during study treatment. Plasma was separated and stored at -80C within 48 hours of collection. Exosomes were isolated from thawed plasma using commercially available kits and ultracentrifugation. Exosome extraction and purification was optimized for protein recovery. Purified exosomes were processed for proteomic analysis and labeled with TMT10 (tandem mass tag 10plex) and quantified with the QExactive HF mass spectrometer. Ultrasensitive mass spectrometry provided deep proteomic coverage of exosomal proteins and detected various post-translational modifications (PTM). Data were analyzed with a pipeline developed in our lab using an improved SEQUEST/ProLuCID database search engine and Percolator data filtering toolchain. Exosome protein expression was determined at baseline, at best response and at the time of progression. Results: With our ultrasensitive proteomic method, we detected more than 500 exosome proteins from as little as 100 ng of purified exosomes. A significant enrichment of exosome specific markers was observed when comparing patient samples with healthy donor samples. Enrichment of surface glycoproteins (e.g. CD44) was seen in BC patient samples, as in previous reports. Ultrasensitive proteomics also detected PTM including phosphorylation, methylation, oxidation, deamidation, and glycosylation. Differential proteomic and PTM profiles comparing samples collected from responding patients at baseline vs. at progression will be presented. Conclusions: Our innovative method provided an unparalleled portrait of the proteomic landscape of plasma exosomes during treatment with CDK4/6i-ET. This powerful approach may provide novel insights into mechanisms of resistance that emerge during treatment. This study was funded by Pfizer. Clinical trial information: NCT02668666 .
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Affiliation(s)
- Xiuyuan Ma
- University of Illinois at Chicago, Chicago, IL
| | - Yu Gao
- University of Illinois at Chicago, CHICAGO, IL
| | - Gayatry Mohapatra
- University of Illinois at Chicago College of Medicine, Division of Pathology, Chicago, IL
| | | | - Yael Simons
- University of Illinois at Chicago, Chicago, IL
| | | | | | - Jatin Rana
- William Beaumont Hospital, Royal Oak, MI
| | | | | | - Li C Liu
- University of Illinois at Chicago School of Public Health, Chicago, IL
| | - Menggang Yu
- University of Wisconsin - Madison Biostatistics and Medical Informatics, Madison, WI
| | | | - Ruth O'Regan
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Oana Cristina Danciu
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
| | - Kent Hoskins
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
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13
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Danciu OC, Hoskins K, Truica CI, Blaes AH, Tamkus D, Rana J, Tandra P, Green L, Yu M, Zhao Q, Toppmeyer D, O'Regan R, Wisinski KB. A single-arm phase II trial of palbociclib in combination with tamoxifen as first-line therapy for metastatic hormone receptor-positive breast cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1056] [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
1056 Background: Palbociclib is a CDK4/6 inhibitor used to treat metastatic hormone receptor-positive (HR+) breast cancer (MBC) in combination with endocrine therapy. Tamoxifen is an effective treatment for HR+ MBC, with different toxicity profile compared with aromatase inhibitors (AI) and fulvestrant. Preclinical data demonstrated synergy for the combination of tamoxifen and palbociclib, being effective in a model of acquired tamoxifen resistance. Methods: We conducted an open-label, single-arm, multicenter phase II trial of palbociclib in combination with tamoxifen in patients with HR+/HER2 - advanced BC, with no prior therapy for MBC. Ovarian suppression was recommended for pre-menopausal women, but not required. Primary objective was progression free survival. Secondary objectives: objective response rate (CR or PR) based on RECIST 1.1 or MDA Criteria (for patients with bone only disease); safety and tolerability (using CTCAE v4); clinical benefit rate (CR, PR or SD lasting min 24 weeks); 2-year overall survival. Correlative objectives: proteomic analysis of plasma exosomes to identify mechanisms of primary and secondary resistance to tamoxifen/palbociclib. Results: Between 6/30/2016 and 7/02/2019, we enrolled 49 patients (47 evaluable): 23 pts with de-novo metastatic disease and 24 pts with recurrent BC (12 pts were on adjuvant treatment with AI at time of recurrence and 12 pts on surveillance). As of 1/5/21 data cut-off, 7 pts were still on treatment. Median follow-up time was 24 months (range 8-42). Median age was 60 (range 39-82). The median PFS was 14.6 months with 95% CI (7-41) for pts with de-novo MBC and 6 months (2-12) for pts with recurrent BC. The ORR was 30% overall, 39% for pts with de novo MBC, 21% for pts with recurrent BC. CBR was 64% overall, 78% for pts with de novo MBC and 50% for pts with recurrent BC. CBR was 65% for white pts and 55% for African American pts. Best response per RECIST1.1: 14 pts (34%) had PR, 18 pts (44%) had SD, 9 pts (22%) had PD. All 6 pts with bone only disease had SD. The most common drug related grade ≥ 3 AE was neutropenia (51%), transient and manageable by dose modifications, no cases of febrile neutropenia. Four patients developed thromboembolic events (1 grade 2, 2 grade 3, 1 grade 4). One patient died while on treatment from PD. Conclusions: The combination of palbociclib and tamoxifen showed tolerable, expected safety profile. This may be an alternative approach for selected patients in first line treatment of HR+ MBC, especially those who are intolerant to AI, although this small study indicates a lower PFS. Clinical trial information: 02668666 .[Table: see text]
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Affiliation(s)
| | - Kent Hoskins
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
| | | | | | | | - Jatin Rana
- William Beaumont Hospital, Royal Oak, MI
| | | | | | - Menggang Yu
- University of Wisconsin - Madison Biostatistics and Medical Informatics, Madison, WI
| | | | | | - Ruth O'Regan
- University of Wisconsin Carbone Cancer Center, Madison, WI
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14
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Schmitz KH, Potiaumpai M, Schleicher EA, Wolf LJ, Doerksen SE, Drabick JJ, Yee NS, Truica CI, Mohamed AA, Shaw BW, Farley DC. The exercise in all chemotherapy trial. Cancer 2020; 127:1507-1516. [PMID: 33332587 DOI: 10.1002/cncr.33390] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. METHODS Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. RESULTS In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per-patient cost of the intervention was $190.68 to $382.40. CONCLUSIONS Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. LAY SUMMARY Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.
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Affiliation(s)
- Kathryn H Schmitz
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Melanie Potiaumpai
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erica A Schleicher
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Laura J Wolf
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
| | - Shawna E Doerksen
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joseph J Drabick
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nelson S Yee
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Cristina I Truica
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ali A Mohamed
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Bethany W Shaw
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
| | - Diane C Farley
- Center for Health Care and Policy Research, Penn State University, University Park, Pennsylvania
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15
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Ali SM, Reising A, Leitzel K, Drabick JJ, Truica CI, Vasekar MK, Menon H, Nagabhairu V, Polimera HV, Pancholy N, Moku PR, Maddukuri A, Schmid H, He W, Millholland J, Lavin M, Hofsess SJ, Sweetman RW, Hortobagyi GN, Lipton A. Serum biomarkers of inflammation (ferritin, IL-8, TNFR1) and outcomes in BOLERO-2, a phase III trial of HR+/HER2- metastatic breast cancer treated with everolimus (mTOR inhibitor). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1067] [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
1067 Background: Everolimus (EVE) plus exemestane (EXE) doubled PFS while maintaining quality of life versus EXE alone in postmenopausal hormone receptor-positive (HR+), HER2-negative metastatic breast cancer (MBC) (BOLERO-2 phase 3; NCT00863655). Here we investigated several serum biomarkers of inflammation: ferritin, interleukin-8 (IL-8), and tumor necrosis factor receptor 1 (TNFR1). Both higher IL-8 (ASCO 2018, #3025) and TNF (Nature 569:428-32, 2019) have been reported to be associated with worsened outcome to immune checkpoint inhibitors (ICI), and IL-8- and TNF-targeted therapies combined with ICIs are in phase I trials. We evaluated the prognostic/predictive ability of serum ferritin, IL-8, and TNFR1 to everolimus in BOLERO-2. Methods: Serum biomarkers were determined on pretreatment serum samples using the ELLA immunoassay platform (ProteinSimple, San Jose, CA). Cox-proportional hazards model was used to assess the efficacy of EVE, and the prognostic and predictive effect on PFS and OS. Results: Pretreatment serum biomarker levels were determined in 510 patients (70 %) of 725 BOLERO-2 patients randomized 2:1 to EVE+EXE or EXE). Serum levels (25%, 50%, 75%) were: ferritin (68.9, 125.5, 253.1 ng/ml); IL-8 (14.5, 19.4, 27.7 pg/ml); and TNFR1 (1205, 1470, 1868 pg/ml). Ferritin correlated significantly with TNFR1 (r=0.45, p<0.0001), while IL-8 correlated weakly with TNFR1 (r=0.10, p=0.023). Higher levels of all 3 biomarkers were prognostic for significantly shorter PFS and OS (table). But no biomarkers were predictive: everolimus was efficacious regardless of the 3 biomarker levels (p>0.05). Conclusions: High levels of serum ferritin, IL-8, and TNFR1 were significantly associated with shorter PFS and OS in HR+/HER2- MBC patients. Everolimus had superior outcomes compared to placebo, regardless of serum biomarker level. These 3 significant prognostic biomarkers are all associated with increased inflammatory processes through different pathways. Anti-inflammatory therapy targeted against these biomarkers should be evaluated based on serum level as potential combination therapy with everolimus or CDK 4/6 inhibitors in HR+ MBC. [Table: see text]
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Affiliation(s)
| | | | - Kim Leitzel
- Penn State Hershey Medical Center, Hershey, PA
| | - Joseph J. Drabick
- Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | | | - Harry Menon
- Penn State Hershey Cancer Institute, Hershey, PA
| | | | | | - Neha Pancholy
- Penn State Milton S Hershey Medical Center, Hershey, PA
| | | | | | | | - Wei He
- Abbvie, North Chicago, IL
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16
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Yin M, Verschraegen C, Vincent VH, Patel SM, George T, Truica CI. Impact of lack of surgery on outcomes in elderly women with nonmetastatic breast cancer-A surveillance, epidemiology, and end results 18 population based study. Medicine (Baltimore) 2020; 99:e18745. [PMID: 32011455 PMCID: PMC7220091 DOI: 10.1097/md.0000000000018745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Elderly women with early-stage, nonmetastatic breast cancer do not always receive recommendations for definitive surgical treatment. The reasons vary and include patient and provider-related reasons.We queried the surveillance, epidemiology, and end results database from 2010 to 2013 for women age 60 and older with stage I/II/III invasive breast cancer for whom local treatment was known. We divided the patients into 3 groups: patients for whom surgery was performed; patients for whom surgery was recommended but not performed; patients for whom surgery was not recommended and not performed. We used Kaplan-Meier method to generate OS curves and the Cox proportional hazard test to compare survival outcomes.A total of 119,404 patients were eligible for study with a median age between 70 and 74 years old. Compared with patients who received breast surgery, patients who did not receive surgery had a worse overall survival (OS) (hazard ratio [HR], 7.39; 95% confidence interval [CI], 6.98-7.83, P < .001). Patients who were recommended but ultimately did not undergo surgery had better OS than those who were recommended against surgery (adjusted HR, 0.60; 95% CI, 0.53-0.69). However, their survival was significantly inferior to patients who underwent surgery (adjusted HR, 2.81; 95% CI 2.48-3.19). Similar results were found regardless of age, tumor stage, estrogen receptor, or human epidermal growth factor receptor 2 status and were recapitulated in analyses of cancer-specific survival.Upfront definitive breast surgery should be performed in medically-fit elderly patients with early-stage, nonmetastatic breast cancer given significant survival benefit.
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Affiliation(s)
- Ming Yin
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Vinh-Hung Vincent
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- University Hospital of Martinique, Martinique, France
| | | | - Tiffany George
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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17
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Nesterova D, Zhu J, Kramer C, Vasekar MK, Collins J, Truica CI, Joshi A, Hayes M, Saunders E, Drabick JJ, Joshi M. Write to recover: The impact of group led creative writing on behavioral health outcomes in cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11536] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11536 Background: The diagnosis of cancer can adversely affect mental wellbeing. In addition to treating cancer, the emotional wellbeing of patients must simultaneously be addressed. A previous pilot exploring the feasibility of creative writing workshop (CWW) in cancer patients showed apositive effect on patients’ mental health. Methods: To longitudinally evaluate the efficacy of CWW on mood, we conducted a phase II study with cancer patients (any stage, any cancer type); randomized 2:1 to CWW vs. active control (AC). Patients in the CWW arm attended at least 4, 1.5-hour bi-monthly CWW x 8 wks, whereas AC patients completed independent writing at home with the help of a book (bi-monthly x 8wks). We used validated tools, [Emotional Thermometer Scales (ETS), PHQ-9, GAD-7] to assess changes in overall mood, depression, and anxiety. Primary end point: a) ETS scores before and after intervention b) Changes in depression and anxiety based on PHQ-9 and GAD-7 scores. We present results from ETS scores. Descriptive statistics were generated for these quantitative scales measured in each group, pre and post intervention. Comparisons between groups (gp) were made using Wilcoxon Rank-sum tests. All tests were two sided and the statistical significance level used was 0.05. Results: Amongst evaluable patients, N of 50 (demographics in table below), twenty-six patients in the CWW gp attended at least one class and 19 attended at least 4 classes. Patients in CWW showed significant mood improvement vs. AC when comparing the final overall ETS (p=0.0063). Three of the five sub-scale ETS scores were significantly lower for the CWW vs. AC gp: anxiety (p=0.0027), depression (p=0.0009), and anger (p=0.0027). Conclusions: Group led CWW have a positive effect on mood. Our results suggest potential therapeutic benefit of this intervention on the emotional wellbeing of cancer patients. Larger studies are needed to evaluate the effect of CWW in cancer patients. Clinical trial information: NCT03536702. [Table: see text]
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Affiliation(s)
| | - Junjia Zhu
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | | | | | | | - Aditya Joshi
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Michael Hayes
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Erika Saunders
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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Zhu J, Hussain M, Joshi A, Truica CI, Nesterova D, Collins J, Saunders EFH, Hayes M, Drabick JJ, Joshi M. Effect of creative writing on mood in patients with cancer. BMJ Support Palliat Care 2019; 10:64-67. [PMID: 30824430 DOI: 10.1136/bmjspcare-2018-001710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the feasibility of conducting creative writing workshops (CWW) for patients with cancer to promote improvement in mood. METHOD We piloted a prospective study to determine the feasibility of conducting CWW over a 4-week period. Patients were randomised 2:1 to either an intervention arm (IA) or to standard of care (SOC). Patients in the IA attended four 2-hour long weekly CWW × 4 weeks, whereas those receiving SOC did not participate in the CWW. We used a validated emotion thermometer scale (ETS) to assess changes in patient's mental health before and after intervention. Patients with metastatic or unresectable cancer were included. PRIMARY ENDPOINT: (1) Feasibility and (2) mood scores before and after CWW using ETS. RESULTS A total of 16 patients were enrolled: 11 in the IA vs 5 in SOC. Seven out of 11 (63%) patients enrolled in the IA attended at least 75% of classes. Patients in the IA showed a trend towards mood improvement relative to the SOC when comparing initial and final ETS scores. Within the IA group significantly lower postclass total ETS scores were observed relative to preclass ETS scores. Also, a significant decreasing trend over time was observed in the preclass total ETS scores for participants in the IA group. CONCLUSIONS It is feasible for patients with cancer to attend CWW. Our results also show a positive effect on mood in the CWW arm. Further prospective clinical studies are needed to evaluate the effect of this intervention in patients with cancer.
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Affiliation(s)
- Junjia Zhu
- Public Health Sciences, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Muhammad Hussain
- Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA.,New York Oncology Hematology PC, Albany, New York, USA
| | - Aditya Joshi
- Department of Psychiatry, Penn State, Hershey, Pennsylvania, USA
| | | | - Darya Nesterova
- Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jolene Collins
- Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | | | - Michael Hayes
- Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA.,Department of Psychiatry, Penn State, Hershey, Pennsylvania, USA
| | - Joseph J Drabick
- Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Monika Joshi
- Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA
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19
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Yardley DA, Hart L, Favret A, Blau S, Diab S, Richards D, Sparano J, Beck JT, Richards P, Ward P, Ramaswamy B, Tsai M, Blackwell K, Pluard T, Tolaney SM, Esteva FJ, Truica CI, Alemany C, Volas-Redd G, Shtivelband M, Purkayastha D, Dalal AA, Miller M, Hortobagyi GN. Efficacy and Safety of Ribociclib With Letrozole in US Patients Enrolled in the MONALEESA-2 Study. Clin Breast Cancer 2019; 19:268-277.e1. [PMID: 31160171 DOI: 10.1016/j.clbc.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/14/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the Mammary Oncology Assessment of LEE011's (Ribociclib's) Efficacy and Safety (MONALEESA-2) study, combination treatment with the selective inhibitor of cyclin-dependent kinases 4/6 ribociclib with letrozole significantly improved progression-free survival (PFS) versus letrozole alone in postmenopausal women with hormone receptor-positive HR+/HER2- advanced breast cancer (ABC). Herein we present results from the subset of US patients enrolled in MONALEESA-2. PATIENTS AND METHODS Postmenopausal women with HR+/HER2- ABC without previous treatment for advanced disease were randomized (1:1) to ribociclib 600 mg/d (3 weeks on/1 week off) with letrozole 2.5 mg/d (continuous) or placebo with letrozole. The primary end point was locally assessed PFS. RESULTS Overall, 213 US patients were enrolled in MONALEESA-2 (ribociclib, n = 100; placebo, n = 113). Baseline characteristics were similar between treatment groups and consistent with the global population. With a median follow-up of 27 months, 38 (38%) and 29 (26%) patients in the ribociclib and placebo groups, respectively, had continued to receive treatment. Median PFS was 27.6 months with ribociclib and 15.0 months with placebo (hazard ratio, 0.53). The most common all-cause adverse events were neutropenia (ribociclib, 72.0% [n = 72]; placebo, 4.6% [n = 5]), nausea (ribociclib, 69.0% [n = 69]; placebo, 44.0% [n = 48]), and fatigue (ribociclib, 60.0% [n = 60]; placebo, 50.5% [n = 55]). Two patients (ribociclib, 2.0%; placebo, 0%) experienced febrile neutropenia. CONCLUSION In the US subset of MONALEESA-2, ribociclib with letrozole showed superior efficacy versus letrozole alone. These findings are consistent with the global population and support first-line use of ribociclib with letrozole in patients with HR+/HER2- ABC.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, Nashville, TN.
| | - Lowell Hart
- Sarah Cannon Research Institute, Nashville, TN; Florida Cancer Specialists, Fort Myers, FL
| | - Anne Favret
- US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Virginia Cancer Specialists, PC, Fairfax, VA
| | - Sibel Blau
- Division of Hematology-Oncology, Northwest Medical Specialties, PLLC, Puyallup, WA
| | - Sami Diab
- US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Rocky Mountain Cancer Centers, LLP, Aurora, CO
| | - Donald Richards
- US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, PA, Tyler, TX
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Center, Bronx, NY
| | | | - Paul Richards
- US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Oncology and Hematology Associates of Southwest Virginia, Inc, DBA Blue Ridge Cancer Care, Salem, VA
| | - Patrick Ward
- US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Oncology Hematology Care, Cincinnati, OH
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/Wexner Medical Center, Columbus, OH
| | - Michaela Tsai
- Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN
| | | | - Timothy Pluard
- Saint Luke's Cancer Institute, Saint Luke's Health Systems, Kansas City, MO
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Francisco J Esteva
- Department of Medicine, Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Cristina I Truica
- Department of Medicine, Pennsylvania State Cancer Institute, Hershey, PA
| | | | - Gena Volas-Redd
- Georgia Cancer Specialists affiliated with Northside Hospital Cancer Institute, Atlanta, GA
| | | | | | - Anand A Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Luo S, Chen G, Truica CI, Baird CC, Xia Z, Lazarus P. Identification and Quantification of Novel Major Metabolites of the Steroidal Aromatase Inhibitor, Exemestane. Drug Metab Dispos 2018; 46:1867-1878. [PMID: 30257855 PMCID: PMC7333658 DOI: 10.1124/dmd.118.081166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/14/2018] [Indexed: 01/03/2023] Open
Abstract
Exemestane (EXE) is an aromatase inhibitor used for the prevention and treatment of estrogen receptor–positive breast cancer. Although the known major metabolic pathway for EXE is reduction to form the active 17β-dihydro-EXE (17β-DHE) and subsequent glucuronidation to 17β-hydroxy-EXE-17-O-β-D-glucuronide (17β-DHE-Gluc), previous studies have suggested that other major metabolites exist for exemestane. In the present study, a liquid chromatography–mass spectrometry (LC-MS) approach was used to acquire accurate mass data in MSE mode, in which precursor ion and fragment ion data were obtained simultaneously to screen novel phase II EXE metabolites in urine specimens from women taking EXE. Two major metabolites predicted to be cysteine conjugates of EXE and 17β-DHE by elemental composition were identified. The structures of the two metabolites were confirmed to be 6-methylcysteinylandrosta-1,4-diene-3,17-dione (6-EXE-cys) and 6-methylcysteinylandrosta-1,4-diene-17β-hydroxy-3-one (6-17β-DHE-cys) after comparison with their chemically synthesized counterparts. Both underwent biosynthesis in vitro in three stepwise enzymatic reactions, with the first involving glutathione conjugation. The cysteine conjugates of EXE and 17β-DHE were subsequently quantified by liquid chromatography–mass spectrometry in the urine and matched plasma samples of 132 subjects taking EXE. The combined 6-EXE-cys plus 6-17β-DHE-cys made up 77% of total EXE metabolites in urine (vs. 1.7%, 0.14%, and 21% for EXE, 17β-DHE, and 17β-DHE-Gluc, respectively) and 35% in plasma (vs. 17%, 12%, and 36% for EXE, 17β-DHE, and 17β-DHE-Gluc, respectively). Therefore, cysteine conjugates of EXE and 17β-DHE appear to be major metabolites of EXE in both urine and plasma.
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Affiliation(s)
- Shaman Luo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Gang Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Cristina I Truica
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Cynthia C Baird
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Zuping Xia
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
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21
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Auer BJ, Sciamanna C, Smyth JM, Truica CI, Cream LV, Mukherjee D. Interest Among Primary Care Patients in Group Problem-Solving Gameplay for Mental Health. Prev Chronic Dis 2018; 15:E86. [PMID: 29935075 PMCID: PMC6016406 DOI: 10.5888/pcd15.170488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Mental health programs to improve problem-solving skills and reduce stress through social gameplay can improve psychiatric outcomes, but little is known about whether adult patients are interested in using them. Primary care patients (n = 467) completed a cross-sectional survey to assess interest in using 2 types of group programs for mental health. A significantly greater percentage (23.7%) of patients expressed interest in a gameplay-based program than in interpersonal therapy (17.6%) (P < .001). Lonely patients and younger patients were more likely to report interest in gameplay. Results suggest that diverse patient populations are interested in using gameplay programs for mental health.
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Affiliation(s)
- Brandon J Auer
- Department of Medicine, Division of Population Health Research and Development, Pennsylvania State University College of Medicine, 500 University Dr, Mail Code H034, Hershey PA, 17033.
| | - Christopher Sciamanna
- Department of Medicine, Division of Population Health Research and Development, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Joshua M Smyth
- Department of Medicine, Division of Population Health Research and Development, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
| | - Cristina I Truica
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Cancer Institute, Hershey, Pennsylvania
| | - Leah V Cream
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Cancer Institute, Hershey, Pennsylvania
| | - Dahlia Mukherjee
- Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Packard E, Campbell-Baird C, Leitzel K, Luo S, Chen G, Zhu J, Cream L, Lazarus P, Truica CI. UGT2B17 deletion polymorphism and exemestane-induced toxicity. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Kim Leitzel
- Penn State Hershey Medical Center, Hershey, PA
| | - Shaman Luo
- College of Pharmacy , Washington University, Spokane, WA
| | - Gang Chen
- College of Pharmacy , Washington University, Spokane, WA
| | - Junjia Zhu
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Leah Cream
- Penn State Hershey Medical Center, Hershey, PA
| | - Philip Lazarus
- College of Pharmacy , Washington University, Spokane, WA
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23
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Kornblum N, Zhao F, Manola J, Klein P, Ramaswamy B, Brufsky A, Stella PJ, Burnette B, Telli M, Makower DF, Cheema P, Truica CI, Wolff AC, Soori GS, Haley B, Wassenaar TR, Goldstein LJ, Miller KD, Sparano JA. Randomized Phase II Trial of Fulvestrant Plus Everolimus or Placebo in Postmenopausal Women With Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer Resistant to Aromatase Inhibitor Therapy: Results of PrE0102. J Clin Oncol 2018; 36:1556-1563. [PMID: 29664714 DOI: 10.1200/jco.2017.76.9331] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose The mammalian target of rapamycin inhibitor everolimus targets aberrant signaling through the PI3K/AKT/mammalian target of rapamycin pathway, a mechanism of resistance to anti-estrogen therapy in estrogen receptor (ER)-positive breast cancer. We hypothesized that everolimus plus the selective ER downregulator fulvestrant would be more efficacious than fulvestrant alone in ER-positive metastatic breast cancer resistant to aromatase inhibitor (AI) therapy. Patients and Methods This randomized, double-blind, placebo-controlled, phase II study included 131 postmenopausal women with ER-positive, human epidermal growth factor receptor 2-negative, AI-resistant metastatic breast cancer randomly assigned to fulvestrant (500 mg days 1 and 15 of cycle 1, then day 1 of cycles 2 and beyond) plus everolimus or placebo. The study was designed to have 90% power to detect a 70% improvement in median progression-free survival from 5.4 months to 9.2 months. Secondary end points included objective response and clinical benefit rate (response or stable disease for at least 24 weeks). Prophylactic corticosteroid mouth rinses were not used. Results The addition of everolimus to fulvestrant improved the median progression-free survival from 5.1 to 10.3 months (hazard ratio, 0.61 [95% CI, 0.40 to 0.92]; stratified log-rank P = .02), indicating that the primary trial end point was met. Objective response rates were similar (18.2% v 12.3%; P = .47), but the clinical benefit rate was significantly higher in the everolimus arm (63.6% v 41.5%; P = .01). Adverse events of all grades occurred more often in the everolimus arm, including oral mucositis (53% v 12%), fatigue (42% v 22%), rash (38% v 5%), anemia (31% v. 6%), diarrhea (23% v 8%), hyperglycemia (19% v 5%), hypertriglyceridemia (17% v 3%), and pneumonitis (17% v 0%), although grade 3 to 4 events were uncommon. Conclusion Everolimus enhances the efficacy of fulvestrant in AI-resistant, ER-positive metastatic breast cancer.
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Affiliation(s)
- Noah Kornblum
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Fengmin Zhao
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Judith Manola
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Paula Klein
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Bhuvaneswari Ramaswamy
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Adam Brufsky
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Phillip J Stella
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Brian Burnette
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Melinda Telli
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Della F Makower
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Puneet Cheema
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Cristina I Truica
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Antonio C Wolff
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Gamini S Soori
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Barbara Haley
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy R Wassenaar
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Lori J Goldstein
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Kathy D Miller
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
| | - Joseph A Sparano
- Noah Kornblum, Della F. Makower, and Joseph A. Sparano, Albert Einstein College of Medicine, Bronx; Paula Klein, Mount Sinai Beth Israel Comprehensive Cancer Center, New York, NY; Fengmin Zhao and Judith Manola, Dana-Farber Cancer Institute, Boston, MA; Bhuvaneswari Ramaswamy, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Adam Brufsky, University of Pittsburgh, Pittsburgh; Cristina I. Truica, Penn State Cancer Institute, Hershey; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Phillip J. Stella, Saint Joseph Mercy (Michigan Cancer Consortium), Ann Arbor, MI; Brian Burnette, Saint Vincent Hospital, Green Bay; Timothy R. Wassenaar, Pro Health Care, Waukesha, WI; Melinda Telli, Stanford University School of Medicine, Stanford, CA; Puneet Cheema, Metro-Minnesota Community Oncology Research Consortium, Saint Louis Park, MN; Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Gamini S. Soori, Missouri Valley Cancer Consortium, Omaha, NE; Barbara Haley, UT Southwestern Medical Center, Dallas, TX; and Kathy D. Miller, Indiana University School of Medicine, Indianapolis, IN
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Hussain MA, Zhu J, Drabick J, Joshi A, Saunders E, Truica CI, Hayes M, Joshi M. Effect of creative writing on mood in cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.178] [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
178 Background: Patients with cancer may have significant mental health comorbidity. Creative writing has a substantial history in providing a wide range of psychological benefits for cancer patients. Methods: We conducted a pilot study to determine feasibility whether cancer patients can be enrolled, randomized and retained for four weeks for creative writing classes (Feasibility was defined as 50% of our enrolled patients on intervention arm (IA) could attend at least 2 classes). We anticipated enrolling 45 patients over the period of 2 months with randomization into 2 arms: IA and standard of care (SOC). “Write from the Heart”, a series of creative writing workshops (CWW) were conducted on IA. Subjects in IA had four, 2-hour weekly CWW whereas SOC arm did not receive any sessions. We used validated Emotional Thermometer Scales (ETS), ranging from 0 (best)-10 (worst), to predict changes in parameters reflecting patient’s mental health pre and post intervention. ETS has five dimensions (distress, anxiety, depression, anger and need help), which are all continuous variables. Results: Total of 16 patients were accrued -11 in IA and 5 in SOC. 7 out of 11 (63%) patients enrolled in IA attended at least 75% of classes. Comparisons were made using two-sample T-tests. Although sample size was small, analysis showed intriguing results. IA did show a decreasing pattern on Total Emotion Score (TES). For each visit, post-class scores were lower than pre-class scores. SOC versus IA and IA intragroup analysis (Paired T-test) did not reveal any statistical significance. Conclusions: We observed that it is feasible for cancer patients to attend focused workshops geared towards mental health wellbeing. Although not statistically significant, IA showed trend towards mood improvement. A second study is planned with a single arm for all cancer patients. In addition to using emotional thermometers, we will include questionnaires to evaluate mental health symptoms effectively. Further prospective clinical studies should be conducted to evaluate effect of this intervention in cancer patients. Clinical trial information: Study 00006541. [Table: see text]
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Affiliation(s)
| | - Junjia Zhu
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Joseph Drabick
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Aditya Joshi
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Erika Saunders
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | - Michael Hayes
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Monika Joshi
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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25
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Jia H, Truica CI, Wang B, Wang Y, Ren X, Harvey HA, Song J, Yang JM. Immunotherapy for triple-negative breast cancer: Existing challenges and exciting prospects. Drug Resist Updat 2017; 32:1-15. [PMID: 29145974 DOI: 10.1016/j.drup.2017.07.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 12/21/2022]
Abstract
Patients with breast tumors that do not express the estrogen receptor, the progesterone receptor, nor Her-2/neu are hence termed "triple negatives", and generally have a poor prognosis, with high rates of systemic recurrence and refractoriness to conventional therapy regardless of the choice of adjuvant treatment. Thus, more effective therapeutic options are sorely needed for triple-negative breast cancer (TNBC), which occurs in approximately 20% of diagnosed breast cancers. In recent years, exploiting intrinsic mechanisms of the host immune system to eradicate cancer cells has achieved impressive success, and the advances in immunotherapy have yielded potential new therapeutic strategies for the treatment of this devastating subtype of breast cancer. It is anticipated that the responses initiated by immunotherapeutic interventions will explicitly target and annihilate tumor cells, while at the same time spare normal cells. Various immunotherapeutic approaches have been already developed and tested, which include the blockade of immune checkpoints using neutralizing or blocking antibodies, induction of cytotoxic T lymphocytes (CTLs), adoptive cell transfer-based therapy, and modulation of the tumor microenvironment to enhance the activity of CTLs. One of the most important areas of breast cancer research today is understanding the immune features and profiles of TNBC and devising novel immune-modulatory strategies to tackling TNBC, a subtype of breast cancer notorious for its poor prognosis and its imperviousness to conventional treatments. On the optimal side, one can anticipate that novel, effective, and personalized immunotherapy for TNBC will soon achieve more success and impact clinical treatment of this disease which afflicts approximately 20% of patients with breast cancer. In the present review, we highlight the current progress and encouraging developments in cancer immunotherapy, with a goal to discuss the challenges and to provide future perspectives on how to exploit a variety of new immunotherapeutic approaches including checkpoint inhibitors and neoadjuvant immunotherapy for the treatment of patients with TNBC.
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Affiliation(s)
- Hongyan Jia
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 03001, China.
| | - Cristina I Truica
- Department of Medicine, The Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Bin Wang
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 03001, China
| | - Yanhong Wang
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, Shanxi, 03001, China
| | - Xingcong Ren
- Department of Pharmacology, The Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Harold A Harvey
- Department of Medicine, The Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Jianxun Song
- Department of Microbiology and Immunology, The Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Jin-Ming Yang
- Department of Pharmacology, The Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
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Felts JL, Zhu J, Han B, Smith SJ, Truica CI. An Analysis of Oncotype DX Recurrence Scores and Clinicopathologic Characteristics in Invasive Lobular Breast Cancer. Breast J 2017; 23:677-686. [DOI: 10.1111/tbj.12751] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Junjia Zhu
- Department of Public Health Sciences; Penn State College of Medicine; Hershey Pennsylvania
| | - Bing Han
- Department of Pathology; Penn State Hershey Medical Center; Hershey Pennsylvania
| | - Stanley J. Smith
- Department of Surgery; Penn State Hershey Medical Center; Hershey Pennsylvania
| | - Cristina I. Truica
- Department of Hematology Oncology; Penn State Cancer Institute; Hershey Pennsylvania
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27
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Matthew EM, Zhou L, Yang Z, Dicker DT, Holder SL, Lim B, Harouaka R, Zheng SY, Drabick JJ, Lamparella NE, Truica CI, El-Deiry WS. A multiplexed marker-based algorithm for diagnosis of carcinoma of unknown primary using circulating tumor cells. Oncotarget 2016; 7:3662-76. [PMID: 26695546 PMCID: PMC4826160 DOI: 10.18632/oncotarget.6657] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/14/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023] Open
Abstract
Real-time, single-cell multiplex immunophenotyping of circulating tumor cells (CTCs) is hypothesized to inform diagnosis of tissue of origin in patients with carcinoma of unknown primary (CUP). In 20 to 50% of CUP patients, the primary site remains unidentified, presenting a challenge for clinicians in diagnosis and treatment. We developed a post-CellSearch CTC assay using multiplexed Q-dot or DyLight conjugated antibodies with the goal of detecting multiple markers in single cells within a CTC population. We adapted our approach to size-based CTC enrichment protocols for capturing CTCs and subsequent immunofluorescence (IF) using a minimal set of markers to predict the primary sites for common metastatic tumors. The carcinomas are characterized with cytokeratin 7 (CK7), cytokeratin 20 (CK20), thyroid transcription factor 1 (TTF-1), estrogen receptor (ER) or prostate-specific antigen (PSA. IF has been optimized in cultured tumor cells with individual antibodies, then with conjugated antibodies to form a multiplex antibody set. With IF, we evaluated antibodies specific to these 5 markers in lung, breast, colorectal, and prostate cancer cell lines and blood from metastatic prostate and breast cancer patients. This advanced technology provides a noninvasive, diagnostic blood test as an adjunct to routine tissue biopsy. Its further implementation requires prospective clinical testing.
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Affiliation(s)
- Elizabeth M Matthew
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute, Hershey, PA, USA.,Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lanlan Zhou
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute, Hershey, PA, USA.,Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Zhaohai Yang
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David T Dicker
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute, Hershey, PA, USA.,Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Sheldon L Holder
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Bora Lim
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute, Hershey, PA, USA.,Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Hershey Cancer Institute, Hershey, PA, USA.,The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramdane Harouaka
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Si-Yang Zheng
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Joseph J Drabick
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Nicholas E Lamparella
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Cristina I Truica
- Division of Hematology-Oncology, Penn State Milton S. Hershey Medical Center and Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Wafik S El-Deiry
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute, Hershey, PA, USA.,Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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28
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29
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Ali SM, Han B, Drabick JJ, Riley MP, Leitzel K, Marks E, Costa L, Makhoul I, Harvey HA, Truica CI, Cream L, Smith JS, Kass R, Widders K, Vasekar MK, Hoke GD, Hoke NN, Ramos C, Cooper J, Lipton A. Reverse-phase protein microarray (RPPA) analysis of PD-L1 and growth factor receptor signal transduction pathways in hormone receptor (HR)-positive primary breast cancer tissue and correlation with relapse. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.558] [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)
| | - Bing Han
- Penn State Hershey Medical Center, Hershey, PA
| | | | | | - Kim Leitzel
- Penn State Hershey Medical Center, Hershey, PA
| | - Eric Marks
- Penn State Hershey Medical Center, Hershey, PA
| | - Luis Costa
- Oncology Division, Hospital de Santa Maria - CHLN and Instituto de Medicina Molecular, Lisbon, Portugal
| | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Leah Cream
- Penn State Hershey Medical Center, Hershey, PA
| | | | - Rena Kass
- Penn State Hershey Medical Center, Hershey, PA
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Matthew EM, Zhou L, Vijayvergia N, Dicker DT, Gustafson KS, Cooper HS, Ross EA, Lim B, Harouaka R, Zheng SY, Lamparella NE, Drabick JJ, Truica CI, Yang Z, El-Deiry WS. Abstract 1600: A multiplexed marker-based algorithm for diagnosis of carcinoma of unknown primary using circulating tumor cells. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract: Real-time, single-cell multiplex immunophenotyping of circulating tumor cells (CTCs) is hypothesized to inform diagnosis of tissue of origin in patients with carcinoma of unknown primary (CUP). In 20 to 50% of CUP patients, the primary site remains unidentified, presenting a challenge for clinicians in diagnosis and treatment. Invasive tissue biopsy is the gold standard for diagnosis but improved methodology is needed. We developed a post-CellSearch CTC assay using multiplexed Q-dot or DyLight conjugated antibodies with the goal of detecting multiple markers in single cells within a CTC population. We adapted our approach to size-based CTC enrichment protocols for capturing CTCs and subsequent immunofluorescence (IF) using a minimal set of markers to predict the primary sites for common metastatic tumors. The carcinomas are diagnosed with cytokeratin 7 (CK7), cytokeratin 20 (CK20), thyroid transcription factor 1 (TTF-1), estrogen receptor (ER) or prostate-specific antigen (PSA) as the minimal set of informative markers. IF has been optimized in cultured tumor cells with individual antibodies, then with conjugated antibodies to form a multiplex antibody set. With IF, we evaluated antibodies specific to these 5 markers in lung, breast, colorectal, and prostate cancer cell lines and blood samples from metastatic prostate and breast cancer patients. Our technological advance provides a noninvasive, inexpensive, diagnostic blood test as an adjunct to routine tissue biopsy. Its further implementation requires prospective clinical testing.
Citation Format: Elizabeth M. Matthew, Lanlan Zhou, Namrata Vijayvergia, David T. Dicker, Karen S. Gustafson, Harry S. Cooper, Eric A. Ross, Bora Lim, Ramdane Harouaka, Si-Yang Zheng, Nicholas E. Lamparella, Joseph J. Drabick, Cristina I. Truica, Zhaohai Yang, Wafik S. El-Deiry. A multiplexed marker-based algorithm for diagnosis of carcinoma of unknown primary using circulating tumor cells. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1600. doi:10.1158/1538-7445.AM2015-1600
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Affiliation(s)
- Elizabeth M. Matthew
- 1Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Lanlan Zhou
- 1Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA
| | | | - David T. Dicker
- 1Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | - Bora Lim
- 3The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramdane Harouaka
- 4Department of Biomedical Engineering, Penn State University, University Park, PA
| | - Si-Yang Zheng
- 4Department of Biomedical Engineering, Penn State University, University Park, PA
| | | | | | | | | | - Wafik S. El-Deiry
- 1Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medical Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA
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Matthew EM, Zhou L, Lim B, Lamparella NE, Dicker DT, Gallant JN, Joshi M, Holder SL, Harouaka R, Zheng S, Drabick JJ, Truica CI, Yang Z, El-Deiry WS. Abstract 4822: Immunophenotyping circulating tumor cells in patients with unknown primary. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-4822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Metastasis is responsible for the majority of cancer-related deaths. A limiting step in metastasis is access to circulation, thus circulating tumor cells (CTCs) should be present in all patients with metastatic tumors, which may have both diagnostic and prognostic value. Accounting for only 3-5%, carcinoma of unknown primary (CUP) presents a challenge for clinicians in diagnosis and therapy. In 20 to 50% of CUP patients, the primary remains undiagnosed even after a full diagnostic work up. Tissue biopsy is the standard for diagnosis but there is need for improved methodology, including a non-invasive blood test that relies on CTC analysis. Our overall objective is to utilize CTCs to provide insight into systemic cancer progression and approaches to therapy, including a CTC blood test as a tool for diagnosis, prognosis and therapy. We hypothesize that real-time, single-cell immunophenotype profiling of CTC populations will inform diagnosis of tissue of origin, reveal prognostic markers such as stem-like properties and predict tumor aggressiveness. We have been developing a post-Veridex CTC analysis method using multiplexed Q-dot conjugated antibodies with the goal of detecting multiple markers in each single cell within a CTC population to aid in CUP diagnosis including tissue of origin. We have adapted this method for use in CTCs captured using the flexible micro spring array (FMSA) size-based CTC enrichment protocol and other approaches for capturing and immunophenotyping live CTCs. Further adaptation of this protocol enables the use of Dye-Light conjugated primary antibodies. For carcinomas we use cytokeratin 7 (CK7), cytokeratin 20 (CK20), thyroid transcription factor (TTF-1), estrogen receptor (ER; for female patients) and prostate specific antigen (PSA; for male patients) as a minimal set of markers for the identification of lung, colon, prostate and breast cancer. Successful validation of antibodies to these five markers has enabled multiplexing after DyLight conjugation in positive and negative cell lines. This approach is currently being tested in CTCs from patients and is being expanded to understand the biology of CTCs through an evaluation of EMT and stem cell markers. Successful application of our CTC-CUP protocol to CTCs in patient samples is expected to provide a noninvasive, relatively quick and inexpensive blood test that can be both diagnostic and prognostic, which may be a valuable adjunct to routine biopsy. Circulating tumor cells may provide insight into the mechanism of systemic cancer progression, the characteristics of metastatic founder cells and changes within these cells as cancer progresses, thereby impacting the efficacy and evaluation of cancer therapy.
Citation Format: Elizabeth M. Matthew, Lanlan Zhou, Bora Lim, Nicholas E. Lamparella, David T. Dicker, Jean-Nicolas Gallant, Monika Joshi, Sheldon L. Holder, Ramdane Harouaka, Siyang Zheng, Joseph J. Drabick, Cristina I. Truica, Zhaohai Yang, Wafik S. El-Deiry. Immunophenotyping circulating tumor cells in patients with unknown primary. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4822. doi:10.1158/1538-7445.AM2014-4822
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Affiliation(s)
| | - Lanlan Zhou
- 1Penn State Hershey Cancer Institute, Hershey, PA
| | - Bora Lim
- 1Penn State Hershey Cancer Institute, Hershey, PA
| | | | | | | | - Monika Joshi
- 1Penn State Hershey Cancer Institute, Hershey, PA
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Harouaka RA, Zhou MD, Yeh YT, Khan WJ, Das A, Liu X, Christ CC, Dicker DT, Baney TS, Kaifi JT, Belani CP, Truica CI, El-Deiry WS, Allerton JP, Zheng SY. Flexible micro spring array device for high-throughput enrichment of viable circulating tumor cells. Clin Chem 2013; 60:323-33. [PMID: 24132944 DOI: 10.1373/clinchem.2013.206805] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The dissemination of circulating tumor cells (CTCs) that cause metastases in distant organs accounts for the majority of cancer-related deaths. CTCs have been established as a cancer biomarker of known prognostic value. The enrichment of viable CTCs for ex vivo analysis could further improve cancer diagnosis and guide treatment selection. We designed a new flexible micro spring array (FMSA) device for the enrichment of viable CTCs independent of antigen expression. METHODS Unlike previous microfiltration devices, flexible structures at the micro scale minimize cell damage to preserve viability, while maximizing throughput to allow rapid enrichment directly from whole blood with no need for sample preprocessing. Device performance with respect to capture efficiency, enrichment against leukocytes, viability, and proliferability was characterized. CTCs and CTC microclusters were enriched from clinical samples obtained from breast, lung, and colorectal cancer patients. RESULTS The FMSA device enriched tumor cells with 90% capture efficiency, higher than 10(4) enrichment, and better than 80% viability from 7.5-mL whole blood samples in <10 min on a 0.5-cm(2) device. The FMSA detected at least 1 CTC in 16 out of 21 clinical samples (approximately 76%) compared to 4 out of 18 (approximately 22%) detected with the commercial CellSearch® system. There was no incidence of clogging in over 100 tested fresh whole blood samples. CONCLUSIONS The FMSA device provides a versatile platform capable of viable enrichment and analysis of CTCs from clinically relevant volumes of whole blood.
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Affiliation(s)
- Ramdane A Harouaka
- Micro & Nano Integrated Biosystem (MINIBio) Laboratory, Department of Biomedical Engineering and Materials Research Institute, Pennsylvania State University, University Park, PA
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Gallant JN, Matthew EM, Cheng H, Harouaka R, Lamparella NE, Kunkel M, Yang Z, Harvey HA, Cream LV, Kumar SM, Robertson GP, Zheng S, Drabick JJ, Truica CI, El-Deiry WS. Predicting therapy response in live tumor cells isolated with the flexible micro spring array device. Cell Cycle 2013; 12:2132-43. [PMID: 23759587 PMCID: PMC3737315 DOI: 10.4161/cc.25165] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cells disseminated from primary epithelial tumors into peripheral blood, called circulating tumor cells (CTCs), can be monitored to assess metastases and to provide a surrogate marker of treatment response. Here, we demonstrate how the flexible micro spring array (FMSA) device—a novel microfluidic device that enriches CTCs by two physical parameters: size and deformability—could be used in the rational development of treatment intervention and as a method to study the fundamental biology of CTCs. Cancer cells of different origins were spiked into healthy samples of donor blood to mimic blood samples of metastatic cancer patients. This spiked human blood was filtered using the FMSA device, and the recovered cells were successfully expanded in vitro and in a novel in vivo system. A series of experiments were performed to characterize these cells and to investigate the effect of chemotherapy on the resulting cultures. As few as 20 colon cancer cells in 7.5 mL blood could be isolated with the FMSA device, expanded both in vitro and in vivo and used at 25 cells per well to obtain significant and reliable chemosensitivity data. We also show that isolating a low number of viable patient CTCs and maintaining them in culture for a few weeks is possible. The isolation of viable cancer cells from human blood using the FMSA device provides a novel and realistic means for studying the biology of viable CTCs and for testing drug efficacy on these rare cells—a hypothesis that can be tested in future clinical trials.
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Affiliation(s)
- Jean-Nicolas Gallant
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Division of Hematology-Oncology, Penn State Hershey Cancer Institute; Hershey, PA, USA
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Matthew EM, Gallant JN, Zhou L, Yang Z, Drabick JJ, Truica CI, Lamparella NE, Dicker DT, El-Deiry WS. Abstract 5104: Isolation, culture and immunophenotyping of live patient-derived circulating tumor cells. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-5104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Metastasis is responsible for the majority of cancer-related deaths. A limiting step in metastasis is access to circulation, thus circulating tumor cells (CTCs) should be present in all patients with metastatic tumors. Tissue biopsy is the standard for diagnosis of carcinoma of unknown primary (CUP) and other metastatic carcinomas but there is a need for improved methodology. Circulating tumor cells not only enable real-time monitoring of cancer progression and response to therapy but may be utilized to provide personalized treatment for patients by evaluating the patients own CTCs in culture with therapeutics prior to systemic administration. Our overall objective is to utilize CTCs to provide insight into systemic cancer progression and approaches to therapy, including a CTC blood test as a tool for diagnosis, prognosis and therapy. We hypothesize that isolation, culture and real-time, single-cell immunophenotype profiling of CTC populations will inform diagnosis of tissue of origin, reveal prognostic markers such as stem-like properties, predict tumor aggressiveness and enable evaluation of potential therapies. We have been developing a post-Veridex CTC analysis method using multiplexed Q-dot conjugated antibodies for detection of multiple markers in each single cell within a CTC population to aid in CUP diagnosis. In parallel, we are developing a flexible micro spring array (FMSA) size-based CTC enrichment protocol and other approaches for capturing, culturing and immunophenotyping live CTCs. We have demonstrated that as few as 20 cancer cells spiked into blood may be captured with the FMSA device and grown into the millions of cells necessary for evaluating potential therapies. Due to the challenges of growing patient-derived tumor cells in culture, minimal progress has been made in this area. Cells captured from a patient with adenocarcinoma of unknown primary that have proliferated in culture on an FMSA device are being be evaluated for CK8,18 expression to identify putative CTCs. Utilizing an alternate approach, we have successfully captured and cultured CK8,18 positive and CD45 negative putative CTCs from the blood of a colorectal cancer patient. In addition to developing our approach for diagnosis of tissue of origin, we will utilize the FMSA device and other approaches for isolating live CTCs to study the biological properties of these cells in the context of metastatic spread. Successful application of our protocol to CTCs in patient samples is expected to provide a noninvasive, relatively quick and inexpensive blood test that can be both diagnostic and prognostic, and provide a platform for personalized therapeutic strategies. Circulating tumor cells may provide insight into the mechanism of systemic cancer progression, the characteristics of metastatic founder cells and changes within these cells as cancer progresses, thereby impacting the efficacy and evaluation of cancer therapy.
Citation Format: Elizabeth M. Matthew, Jean-Nicolas Gallant, Lanlan Zhou, Zhaohai Yang, Joseph J. Drabick, Cristina I. Truica, Nicholas E. Lamparella, David T. Dicker, Wafik S. El-Deiry. Isolation, culture and immunophenotyping of live patient-derived circulating tumor cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5104. doi:10.1158/1538-7445.AM2013-5104
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Affiliation(s)
| | | | - Lanlan Zhou
- 1Penn State Hershey Cancer Institute, Hershey, PA
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Gharwan H, Truica CI. Bortezomib-based chemotherapy for light chain deposition disease presenting as acute renal failure. Med Oncol 2011; 29:1197-201. [DOI: 10.1007/s12032-011-9938-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 03/28/2011] [Indexed: 11/24/2022]
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Chakravarthy AB, Kelley MC, McLaren B, Truica CI, Billheimer D, Mayer IA, Grau AM, Johnson DH, Simpson JF, Beauchamp RD, Jones C, Pietenpol JA. Neoadjuvant concurrent paclitaxel and radiation in stage II/III breast cancer. Clin Cancer Res 2006; 12:1570-6. [PMID: 16533783 DOI: 10.1158/1078-0432.ccr-05-2304] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to determine the safety and pathologic response rates following neoadjuvant paclitaxel and radiation in patients with stage II/III breast cancer and to evaluate the use of sequential biopsies to allow an in vivo assessment of biological markers as potential predictive markers of response to this regimen. PATIENTS AND METHODS Patients with high-risk, operable breast cancer were treated with three cycles of paclitaxel 175 mg/m2 every 3 weeks, followed by twice-weekly paclitaxel 30 mg/m2 and concurrent radiation. Core biopsies were obtained at baseline and 24 to 72 hours after the first cycle of paclitaxel. After completing neoadjuvant treatment, patients underwent definitive surgery. The primary end point was pathologic complete response, which is defined as the absence of any invasive cancer at surgery. Potential markers of therapeutic response were evaluated including markers of proliferation, apoptosis, p21, HER2, estrogen receptor, and progesterone receptor status. RESULTS Of the 38 patients enrolled, 13 (34%) had a pathologic complete response. There was no significant difference in baseline Ki-67 between responders (35%) and nonresponders (28%; P = 0.45). There was also no significant change in Ki-67 following paclitaxel administration. Despite this lack of immunohistologic change in proliferative activity, baseline mitotic index was higher for patients with pathologic complete response over nonresponders (27 versus 10, P = 0.003). Moreover, the increase in mitotic index following paclitaxel administration was associated with pathologic complete response. CONCLUSIONS Neoadjuvant paclitaxel/radiation is effective and well tolerated. Tumor proliferation at baseline and response to chemotherapy as measured by mitotic activity may serve as an important indicator of pathologic response to neoadjuvant paclitaxel/radiation.
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Affiliation(s)
- A Bapsi Chakravarthy
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Abstract
Emerging results from clinical trials with epidermal growth factor receptor (EGFR) inhibitors indicate good tolerability and, at best, modest to no clinical activity in a variety of epithelial tumors, including breast carcinomas. Although the EGFR is widely expressed in epithelial cancers, there is no evidence of frequent EGFR alterations at the DNA level in human tumors. This lack of molecular evidence to suggest a pathogenic role for the EGFR in breast cancer questions the notion that use of single-agent EGFR inhibitors in this disease is a viable therapeutic approach. The lack of selection of EGFR-dependent breast tumors into trials with EGFR inhibitors suggests the possibility that these were not true-negative studies. A point of view regarding challenges in the development of anti-EGFR therapies for patients with breast cancer and possible approaches to overcome them is presented in this article.
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Affiliation(s)
- Carlos L Arteaga
- Department of Medicine, Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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Truica CI, Frankel SR. Acute rhabdomyolysis as a complication of cytarabine chemotherapy for acute myeloid leukemia: case report and review of literature. Am J Hematol 2002; 70:320-3. [PMID: 12210815 DOI: 10.1002/ajh.10152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rhabdomyolysis is an unusual complication of chemotherapy that can lead to substantial morbidity through such complications as renal failure, infections, and disseminated intravascular coagulation. The syndrome has been described after treatment with cyclophosphamide, 5-azacytidine, interleukin-2, and interferon and after bone marrow transplantation. We report a patient with acute myeloid leukemia who developed fulminant rhabdomyolysis after treatment with a cytarabine-containing regimen. The syndrome was complicated by acute renal failure requiring hemodyalisis, respiratory insufficiency, and pancreatitis. We suggest that the muscle damage might be related to the known ability of cytarabine to trigger the release of cytochrome c from the mitochondria, which could lead to uncoupling of the oxidative phosphorylation with subsequent depletion of ATP reserves at the skeletal muscle and rhabdomyolysis.
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Affiliation(s)
- Cristina I Truica
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-7602, USA
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Truica CI, Byers S, Gelmann EP. Beta-catenin affects androgen receptor transcriptional activity and ligand specificity. Cancer Res 2000; 60:4709-13. [PMID: 10987273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
beta-Catenin is a multifunctional molecule with important roles in intercellular adhesion and signal transduction. We reported previously that beta-catenin is mutated in human prostate cancer. In this study, we investigated the role of beta-catenin mutations on androgen receptor (AR) signaling. beta-Catenin significantly enhanced androgen-stimulated transcriptional activation by the AR. beta-Catenin also increased AR transcriptional activation by androstenedione and estradiol and diminished the antagonism of bicalutamide. Coimmunoprecipitation of beta-catenin with AR from LNCaP prostate cancer cells showed that the two molecules are present in the same complex. The amount of beta-catenin in complex with AR was increased by androgen. These findings implicate beta-catenin in the regulation of AR function and support a role for beta-catenin mutations in the pathogenesis of prostate cancer.
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Affiliation(s)
- C I Truica
- Lombardi Cancer Center, Georgetown University, Washington, DC 20007-2197, USA
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Truica CI, Hansen CH, Garvin DF, Meehan KR. Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin‐2 immunotherapy: a case report. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981115)83:10<2239::aid-cncr26>3.0.co;2-#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Interleukin-2 (IL-2) is used in the treatment of solid tumors and hematologic malignancies. Sudden death is a rare complication of IL-2 treatment. METHODS A patient with lymphoma underwent chemoradiotherapy myeloablation and autologous stem cell transplantation. The stem cells were cultured in IL-2 (6000 IU/mL) for 24 hours prior to infusion. After engraftment, treatment with IL-2 (1.8 x 10(6) IU/m2/day administered subcutaneously) was begun. After 4 days of treatment, the patient suddenly died. An autopsy was performed. RESULTS Histologic examination of the myocardium revealed a diffuse, lymphocytic infiltrate with scattered, multinucleated giant cells and foci of myocardial degeneration consistent with giant cell myocarditis. The lymphocytes were predominantly CD4 positive T cells, and the majority of these cells stained with antibodies for perforin, suggesting an unusual cytolytic role for these lymphocytes. DNA end-labeling of myocardial tissue sections revealed numerous apoptotic myocytes within the lymphocytic infiltrate. CONCLUSIONS To the authors' knowledge, this is the first report of giant cell myocarditis in association with high dose chemotherapy, transplantation, and IL-2 immunomodulation. The authors suggest that the cytokine imbalance produced by IL-2 may have initiated a preferential activation of T helper cells and an autoimmune phenomenon manifesting as giant cell myocarditis.
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Affiliation(s)
- C I Truica
- Department of Hematology/Oncology, Georgetown University Medical Center, Washington, DC 20007, USA
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Voeller HJ, Truica CI, Gelmann EP. Beta-catenin mutations in human prostate cancer. Cancer Res 1998; 58:2520-3. [PMID: 9635571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Beta-catenin plays essential roles in both intercellular adhesion and signal transduction. As a signaling molecule, beta-catenin supplies an activating domain to the T-cell factor/lymphoid enhancer-binding factor family of DNA-binding proteins and activates gene transcription. Posttranslational stabilization of beta-catenin, leading to elevated protein levels and constitutive gene activation, has been proposed as an important step in oncogenesis. Stabilization of beta-catenin can occur through mutation to highly conserved amino acids encoded in exon 3 of the beta-catenin gene (CTNNB1). To determine whether this pathway of malignant transformation is important in prostate cancer, we analyzed 104 prostate cancer tissue specimens, 4 prostate cancer cell lines, and 3 prostate tumor xenografts for activating mutations in exon 3 of CTNNB1. Mutations were detected in 5 of the 104 prostate cancer tissue samples. Four of the five mutations involved serine or threonine residues implicated in the degradation of beta-catenin. A fifth tumor had a mutation at codon 32, changing a highly conserved aspartic acid to a tyrosine. Mutational analysis of multiple regions from several tumor samples showed that the beta-catenin mutations were present focally and therefore may occur during tumor progression.
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Affiliation(s)
- H J Voeller
- Division of Hematology/Oncology, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC 20007-2197, USA
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