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Samadder NJ, Kuwada SK, Boucher KM, Byrne K, Kanth P, Samowitz W, Jones D, Tavtigian SV, Westover M, Berry T, Jasperson K, Pappas L, Smith L, Sample D, Burt RW, Neklason DW. Association of Sulindac and Erlotinib vs Placebo With Colorectal Neoplasia in Familial Adenomatous Polyposis: Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 4:671-677. [PMID: 29423501 DOI: 10.1001/jamaoncol.2017.5431] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Patients with familial adenomatous polyposis (FAP) are at markedly increased risk for colorectal polyps and cancer. A combination of sulindac and erlotinib led to a 71% reduction in duodenal polyp burden in a phase 2 trial. Objective To evaluate effect of sulindac and erlotinib on colorectal adenoma regression in patients with FAP. Design, Setting, and Participants Prespecified secondary analysis for colorectal adenoma regression was carried out using data from a double-blind, randomized, placebo-controlled trial, enrolling 92 patients with FAP, conducted from July 2010 to June 2014 in Salt Lake City, Utah. Interventions Patients were randomized to sulindac, 150 mg twice daily, and erlotinib, 75 mg daily (n = 46), vs placebo (n = 46) for 6 months. Main Outcomes and Measurements The total number of polyps in the intact colorectum, ileal pouch anal anastomosis, or ileo-rectum were recorded at baseline and 6 months. The primary outcomes were change in total colorectal polyp count and percentage change in colorectal polyps, following 6 months of treatment. Results Eighty-two randomized patients (mean [SD] age, 40 [13] years; 49 [60%] women) had colorectal polyp count data available for this secondary analysis: 22 with intact colon, 44 with ileal pouch anal anastomosis and 16 with ileo-rectal anastomosis; 41 patients received sulindac/erlotinib and 41 placebo. The total colorectal polyp count was significantly different between the placebo and sulindac-erlotinib group at 6 months in patients with net percentage change of 69.4% in those with an intact colorectum compared with placebo (95% CI, 28.8%-109.2%; P = .009). Conclusion and Relevance In this double-blind, placebo-controlled, randomized trial we showed that combination treatment with sulindac and erlotinib compared with placebo resulted in significantly lower colorectal polyp burden after 6 months of treatment. There was a reduction in polyp burden in both those with an entire colorectum and those with only a rectal pouch or rectum. Trial Registration clinicaltrials.gov Identifier: NCT01187901.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Medicine (Gastroenterology), The University of Utah, Salt Lake City.,Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Kenneth M Boucher
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Medicine (Epidemiology), The University of Utah, Salt Lake City
| | - Kathryn Byrne
- Department of Medicine (Gastroenterology), The University of Utah, Salt Lake City
| | - Priyanka Kanth
- Department of Medicine (Gastroenterology), The University of Utah, Salt Lake City
| | - Wade Samowitz
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Pathology, The University of Utah, Salt Lake City
| | - David Jones
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Oncological Sciences, The University of Utah, Salt Lake City
| | - Sean V Tavtigian
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Oncological Sciences, The University of Utah, Salt Lake City
| | | | - Therese Berry
- Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - Kory Jasperson
- Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - Lisa Pappas
- Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - Laurel Smith
- Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - Danielle Sample
- Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - Randall W Burt
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Medicine (Gastroenterology), The University of Utah, Salt Lake City.,Department of Oncological Sciences, The University of Utah, Salt Lake City
| | - Deborah W Neklason
- Huntsman Cancer Institute, The University of Utah, Salt Lake City.,Department of Oncological Sciences, The University of Utah, Salt Lake City.,Department of Medicine (Genetic Epidemiology), The University of Utah, Salt Lake City
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Neklason DW, Delker DA, Boucher KM, Kanth P, Byrne K, Bernard P, Samowitz W, Done MW, Berry T, Pappas L, Smith L, Sample D, Davis R, Topham MK, Burt RW, Kuwada SK, Samadder NJ. Abstract LB-074: Regression of duodenal neoplasia in familial adenomatous polyposis patients using COX and EGFR inhibition: A randomized placebo-controlled trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-074] [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
The objective of this trial was to test the effect of a combination of COX and EGFR inhibition on duodenal adenoma progression in patients with familial adenomatous polyposis (FAP). FAP is caused by mutations in the APC gene and is characterized by the development of hundreds of colorectal adenomas and colorectal cancer. FAP patients are also at increased risk for duodenal neoplasia with a ∼10% lifetime risk of duodenal carcinoma. Surgical and endoscopic management of duodenal neoplasia is difficult and chemoprevention has not been successful. Preclinical data has illustrated that a combination of cyclooxygenase (COX) and epidermal growth factor (EGFR) inhibition diminishes small intestinal adenoma development by 87% in mice with germline Apc mutations. Therefore, we conducted a double blind, randomized, placebo-controlled trial in which FAP patients received combination therapy with 150 mg sulindac twice per day and 75 mg erlotinib daily or placebo for 6 months (NCT01187901). The total number and diameter of polyps in a 10cm segment of the proximal duodenum were mapped at baseline and 6 months. The primary outcome was change in total polyp burden, calculated as the sum of the diameters of polyps. We also evaluated RNA expression in duodenal tissue and polyps at endpoint from 10 patients on drug and 10 patients on placebo by RNA sequencing. Seventy-three randomized patients were included in the intention to treat analysis. Over six months, the median change in total duodenal polyp burden was an increase of 8.0 mm from baseline burden in the placebo group (23.0 to 31.0 mm) and the median change in the sulindac-erlotinib group was a decrease of 8.5 mm (29.0 to 19.5 mm). The estimated net difference in change between the two groups was -19.0 mm (95% CI: -32.0, -10.9; P<0.001). Grade 1 and 2 adverse events were more common in the sulindac-erlotinib group, with an acne-like rash observed in 87% of patients receiving treatment and 20% of patients receiving placebo (P<0.001). We identified ∼ 750 differentially expressed genes (fold ≥ 2, false discovery rate < 0.05) in polyps from patients on placebo as compared with patient-matched normal duodenum which were unchanged in polyps from patients on drug. These differentially expressed genes suggested increased EGFR, prostaglandin E2 (PGE2 or COX2) and WNT signaling in duodenal polyps from patients on placebo but not on drug. In duodenal tissue from patients on drug when compared to tissue from patients on placebo, we identified differentially expressed genes suggestive of a reactivated immune response including interferon gamma and interleukin 12 signaling; a possible mechanism for the regression of duodenal polyps observed in drug treated patients. In conclusion, combined chemoprevention with sulindac and erlotinib in FAP patients is effective to lower duodenal polyp burden, block COX2 and EGFR activity, and may reactivate immune surveillance. At the doses tested, however, frequent adverse events may limit the use of these medications.
Part of this abstract was presented as part of a preliminary presentation.
Citation Format: Deborah W. Neklason, Don A. Delker, Kenneth M. Boucher, Priyanka Kanth, Kathryn Byrne, Philip Bernard, Wade Samowitz, Michelle W. Done, Therese Berry, Lisa Pappas, Laurel Smith, Danielle Sample, Rian Davis, Matthew K. Topham, Randall W. Burt, Scott K. Kuwada, N Jewel Samadder. Regression of duodenal neoplasia in familial adenomatous polyposis patients using COX and EGFR inhibition: A randomized placebo-controlled trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-074.
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Affiliation(s)
| | | | | | | | | | - Philip Bernard
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | | | - Michelle W. Done
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Therese Berry
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Lisa Pappas
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Laurel Smith
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Danielle Sample
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Rian Davis
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Matthew K. Topham
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | - Randall W. Burt
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
| | | | - N Jewel Samadder
- 1Huntsman Cancer Institute at University of Utah, Salt Lake City, UT
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Samadder NJ, Neklason DW, Boucher KM, Byrne KR, Kanth P, Samowitz W, Jones D, Tavtigian SV, Done MW, Berry T, Jasperson K, Pappas L, Smith L, Sample D, Davis R, Topham MK, Lynch P, Strait E, McKinnon W, Burt RW, Kuwada SK. Effect of Sulindac and Erlotinib vs Placebo on Duodenal Neoplasia in Familial Adenomatous Polyposis: A Randomized Clinical Trial. JAMA 2016; 315:1266-75. [PMID: 27002448 PMCID: PMC5003411 DOI: 10.1001/jama.2016.2522] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Patients with familial adenomatous polyposis (FAP) are at markedly increased risk for duodenal polyps and cancer. Surgical and endoscopic management of duodenal neoplasia is difficult and chemoprevention has not been successful. OBJECTIVE To evaluate the effect of a combination of sulindac and erlotinib on duodenal adenoma regression in patients with FAP. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, placebo-controlled trial, enrolling 92 participants with FAP, conducted from July 2010 through June 2014 at Huntsman Cancer Institute in Salt Lake City, Utah. INTERVENTIONS Participants with FAP were randomized to sulindac (150 mg) twice daily and erlotinib (75 mg) daily (n = 46) vs placebo (n = 46) for 6 months. MAIN OUTCOMES AND MEASURES The total number and diameter of polyps in the proximal duodenum were mapped at baseline and 6 months. The primary outcome was change in total polyp burden at 6 months. Polyp burden was calculated as the sum of the diameters of polyps. The secondary outcomes were change in total duodenal polyp count, change in duodenal polyp burden or count stratified by genotype and initial polyp burden, and percentage of change from baseline in duodenal polyp burden. RESULTS Ninety-two participants (mean age, 41 years [range, 24-55]; women, 56 [61%]) were randomized when the trial was stopped by the external data and safety monitoring board because the second preplanned interim analysis met the prespecified stopping rule for superiority. Grade 1 and 2 adverse events were more common in the sulindac-erlotinib group, with an acne-like rash observed in 87% of participants receiving treatment and 20% of participants receiving placebo (P < .001). Only 2 participants experienced grade 3 adverse events. [table: see text]. CONCLUSIONS AND RELEVANCE Among participants with FAP, the use of sulindac and erlotinib compared with placebo resulted in a lower duodenal polyp burden after 6 months. Adverse events may limit the use of these medications at the doses used in this study. Further research is necessary to evaluate these preliminary findings in a larger study population with longer follow-up to determine whether the observed effects will result in improved clinical outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT 01187901.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City2Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Deborah W Neklason
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City4Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City5Department of Medicine (Epidemiology), University of Utah, Salt Lake City
| | - Kathryn R Byrne
- Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Priyanka Kanth
- Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Wade Samowitz
- Huntsman Cancer Institute, University of Utah, Salt Lake City6Department of Pathology, University of Utah, Salt Lake City
| | - David Jones
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
| | - Sean V Tavtigian
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
| | - Michelle W Done
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Therese Berry
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Kory Jasperson
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Laurel Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Danielle Sample
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Rian Davis
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Matthew K Topham
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City7Department of Medicine (Pulmonary), University of Utah, Salt Lake City
| | - Patrick Lynch
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Randall W Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City2Department of Medicine (Gastroenterology), University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
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Ibrahim NK, Murray JL, Zhou D, Mittendorf EA, Sample D, Tautchin M, Miles D. Abstract P5-16-01: Survival advantage in patients with metastatic breast cancer receiving endocrine therapy plus Sialyl Tn-KLH vaccine: post hoc analysis of a large randomized trial. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A multicenter, double blinded, randomized phase III trial of the therapeutic cancer vaccine STn-KLH was completed in an international cohort of 1,028 women with metastatic breast cancer who had either no evidence of disease or nonprogressive disease following first-line chemotherapy. This trial is registered with ClinicalTrials.gov (No. NCT00003638). The outcomes showed that STn-KLH was safe and relatively well tolerated but had neither a positive nor negative effect on time to progression (TTP) or overall survival (OS) duration in the intent-to-treat population when compared with KLH control alone. The purpose of this post hoc analysis is to explore the potential benefit of combining an antiestrogen with MUC1 vaccines in metastatic breast cancer patients.
Methods: The data were further explored to determine if a retrospective, reassigned endocrine subset patient stratification produces subgroups that may have experienced benefit in TTP or survival compared with the phase III trial ITT analysis.
Results: Women treated with concomitant endocrine therapy, a pre stratified subset comprising approximately one third of the original study population, achieved a clinical benefit both in terms of TTP and survival compared with women who did not receive endocrine therapy. Moreover, women in the endocrine-treatment subset who mounted a median or greater antibody response (titer >1:320 toward bovine submaxillary mucin) to the STn-KLH vaccine experienced significantly longer median survival than their trial counterparts who mounted a below-median antibody response.
Conclusion: Unlike maintenance chemotherapy, with its associated cumulative toxicity, the combination of endocrine and STn-KLH therapy may offer clinical benefit with few adverse effects for women with metastatic breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-16-01.
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Affiliation(s)
- NK Ibrahim
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - JL Murray
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - D Zhou
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - EA Mittendorf
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - D Sample
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - M Tautchin
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
| | - D Miles
- University of Texas MD Anderson Cancer Center, Houston, TX; Biomira, Inc., AB, Canada; Mount Vernon Cancer Center, Northwood, Middlesex, United Kingdom
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Steinbach G, Ford R, Glober G, Sample D, Hagemeister FB, Lynch PM, McLaughlin PW, Rodriguez MA, Romaguera JE, Sarris AH, Younes A, Luthra R, Manning JT, Johnson CM, Lahoti S, Shen Y, Lee JE, Winn RJ, Genta RM, Graham DY, Cabanillas FF. Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial. Ann Intern Med 1999; 131:88-95. [PMID: 10419446 DOI: 10.7326/0003-4819-131-2-199907200-00003] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is related to Helicobacter pylori infection and may depend on this infection for growth. OBJECTIVE To determine the response of gastric MALT lymphoma to antibiotic treatment. DESIGN Prospective, uncontrolled treatment trial. SETTING University hospital referral center and three collaborating university and community hospitals. PATIENTS 34 patients with stage I or stage II N1 gastric MALT lymphoma. INTERVENTION Two of three oral antibiotic regimens--1) amoxicillin, 750 mg three times daily, and clarithromycin, 500 mg three times daily; 2)tetracycline, 500 mg four times daily, and clarithromycin, 500 mg three times daily; or 3) tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily--were administered sequentially (usually in the order written) for 21 days at baseline and at 8 weeks, along with a proton-pump inhibitor (lansoprazole or omeprazole) and bismuth subsalicylate. MEASUREMENTS Complete remission was defined as the absence of histopathologic evidence of lymphoma on endoscopic biopsy. Partial remission was defined as a reduction in endoscopic tumor stage or 50% reduction in the size of large tumors. RESULTS 34 patients were followed for a mean (+/-SD) of 41 +/- 16 months (range, 18 to 70 months) after antibiotic treatment. Of 28 H. pylori-positive patients, 14 (50% [95% CI, 31% to 69%]) achieved complete remission, 8 (29%) achieved partial remission (treatment eventually failed in 4 of the 8), and 10 (36% [CI, 19% to 56%]) did not respond to treatment. Treatment failed in all 6 (100% [CI, 54% to 100%]) H. pylori-negative patients. Patients with endoscopic appearance of gastritis (stage I T1 disease) were most likely to achieve complete remission within 18 months. Tumors in the distal stomach were associated with more favorable response than tumors in the proximal stomach. CONCLUSIONS A subset of H. pylori-positive gastric MALT lymphomas, including infiltrative tumors, may respond to antibiotics. The likelihood of early complete remission seems to be greatest for superficial and distal tumors.
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Affiliation(s)
- G Steinbach
- Department of Gastrointestinal Medical Oncology and Digestive Diseases, The University of Texas, M.D. Anderson Cancer Center, and Houston Veterans Affairs Medical Center, 77030, USA.
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Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH, Sample D, Hankins P, Smith TL, Wolf PJ. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck 1998; 20:138-44. [PMID: 9484945 DOI: 10.1002/(sici)1097-0347(199803)20:2<138::aid-hed7>3.0.co;2-3] [Citation(s) in RCA: 195] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND When to do a neck dissection as part of the surgical treatment for a patient with squamous carcinoma of the oral tongue is controversial, particularly when the primary can be resected without entering the neck. If the patient who is at high risk for having occult nodal disease in the neck can be identified, node dissection with the glossectomy could be justified. To better identify patients for this procedure, we correlated various tumor and patient factors along with preoperative diagnostic studies with the presence or absence of pathologically positive nodes in a group of patients who underwent node dissection. METHODS Ninety-one previously untreated patients with biopsy-proved squamous carcinoma of the oral tongue were prospectively studied. All patients had a glossectomy and neck dissection as their initial treatment. The pathology findings (ie, lymph nodes with squamous cancer) were correlated with many preoperative and intraoperative factors, and a statistical analysis was made. RESULTS The use of computed tomography and ultrasound was not better than the clinical examination in determining the presence or absence of nodal metastases. The best predictors were depth of muscle invasion, double DNA aneuploidy, and histologic differentiation of the tumor. CONCLUSIONS All patients with stage T2-T4 squamous cancers of the oral tongue should have an elective dissection of the neck. Patients with T1N0 cancer who have a double DNA-aneuploid tumor, depth of muscle invasion > 4 mm, or have a poorly differentiated cancer should definitely undergo elective neck dissection. Ultrasound and computed tomography are of little value in predicting which patients have positive nodes.
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Affiliation(s)
- R M Byers
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Spitz MR, Fueger JJ, Halabi S, Schantz SP, Sample D, Hsu TC. Mutagen sensitivity in upper aerodigestive tract cancer: a case-control analysis. Cancer Epidemiol Biomarkers Prev 1993; 2:329-33. [PMID: 7688625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Variability in DNA repair capability may be a determinant of interindividual difference in susceptibility to carcinogenic exposures. A cytogenetic assay which quantifies chromosomal breakage induced by in vitro exposure to a clastogen provides an indirect measure of repair. We report the results of a case-control study of upper aerodigestive tract cancers assessing differences in mutagen sensitivity based on this assay. There were 108 cases with previously untreated squamous cell cancers and 108 age and sex frequency-matched controls selected from blood donors to The University of Texas M. D. Anderson Cancer Center. Sixty-nine% of the cases, compared with 44% of the controls, were classified as mutagen sensitive (breaks per cell > or = 0.8). On multivariate analysis, mutagen sensitivity [odds ratio (OR), 2.5], heavy cigarette smoking (OR, 4.8), and heavy alcohol consumption (OR, 3.1) were associated with significantly increased risk. Stratified analyses showed that the combined effects of cigarette smoking (OR, 8.1) and mutagen sensitivity (OR, 3.2) were suggestive of a multiplicative effect (OR, 23.0). The combined estimate for alcohol use (OR, 3.0) and mutagen sensitivity (OR, 3.0) was 5.8. These data confirm those of a previously published preliminary study of upper aerodigestive cancers and underscore the importance of considering interindividual susceptibility in cancer risk characterization, even for those cancers with well quantified exposures.
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Affiliation(s)
- M R Spitz
- Department of Epidemiology, University of Texas, M.D. Anderson Cancer Center, Houston 77030
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Bondy ML, Spitz MR, Halabi S, Fueger JJ, Schantz SP, Sample D, Hsu TC. Association between family history of cancer and mutagen sensitivity in upper aerodigestive tract cancer patients. Cancer Epidemiol Biomarkers Prev 1993; 2:103-6. [PMID: 7682127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study evaluated the relationship between family history of cancer and bleomycin-induced mutagen sensitivity. The study included 108 patients who registered at The University of Texas M.D. Anderson Cancer Center from June 1987 to June 1991 with histologically confirmed and previously untreated squamous cell carcinoma of the upper aerodigestive tract. All patients underwent the mutagen sensitivity assay and completed a self-administered risk evaluation questionnaire, including a detailed family history. The patients reported having 650 first-degree relatives, including 54 cases with cancers. The patients were classified as mutagen sensitive (> or = 1 chromosome break/cell) or not mutagen sensitive (< or = 0.99 chromosome breaks/cell). Odds ratios (ORs) were calculated to test for significant associations between mutagen sensitivity and family history of cancer. We found a significant OR (OR = 2.63; 95% confidence interval = 1.06-6.53) for patients who were mutagen sensitive and had one first-degree relative affected with cancer. For mutagen-sensitive patients with two or more first-degree relatives affected with cancer, the OR increased to 6.59 (95% confidence interval = 1.69-25.72). Although 88% of the patients were ever smokers, cigarette smoking was not found to be related to mutagen sensitivity. The study findings suggest that patients who have defective DNA repair capability as evidenced by the mutagen sensitivity assay are significantly more likely to report a family history of cancer than patients who are not mutagen sensitive. Further studies are needed to confirm that mutagen-sensitive individuals have inherited an increased risk of cancer.
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Affiliation(s)
- M L Bondy
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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Lydiatt DD, Savage HE, Clayman GL, Liu FJ, Sample D, Schantz SP. Serologic determinants of survival in patients with head and neck cancer: validating a clinical prediction model. Laryngoscope 1993; 103:13-6. [PMID: 8421413 DOI: 10.1288/00005537-199301000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Quantitative measurements of serum C1q-binding macromolecules (C1qBM) and immunoglobulin A (IgA) were done on 162 patients using previously described methodology. The measurements were compared to a previously described head and neck cancer population. Using the Cox Proportional Hazards model, the prognostic implications regarding high C1qBM and subsequent death with disease (P = .02), and regional recurrence (P = .0094) were validated, but not our previous IgA-related prognostic implications. When both study populations were combined, C1qBM was predictive of survival in those patients treated with induction chemotherapy (P = .0001). C1qBM was not a significant predictor of survival in patients treated with surgery plus postoperative radiation therapy in either this second "test" population or in the original "training" population. The findings demonstrate the confounding influence of treatment modalities and the importance of model validation.
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Affiliation(s)
- D D Lydiatt
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston
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