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Weidhaas JB, Hu C, Komaki R, Masters GA, Blumenschein GR, Chang JY, Lu B, Dicker AP, Bogart JA, Garces YI, Narayan S, Robinson CG, Kavadi VS, Greenberger JS, Koprowski CD, Welsh J, Gore EM, MacRae RM, Paulus R, Bradley JD. The Inherited KRAS-variant as a Biomarker of Cetuximab Response in NSCLC. Cancer Res Commun 2023; 3:2074-2081. [PMID: 37728512 PMCID: PMC10566451 DOI: 10.1158/2767-9764.crc-23-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE RTOG 0617 was a phase III randomized trial for patients with unresectable stage IIIA/IIIB non-small cell lung cancer comparing standard-dose (60 Gy) versus high-dose (74 Gy) radiotherapy and chemotherapy, plus or minus cetuximab. Although the study was negative, based on prior evidence that patients with the KRAS-variant, an inherited germline mutation, benefit from cetuximab, we evaluated KRAS-variant patients in RTOG 0617. EXPERIMENTAL DESIGN From RTOG 0617, 328 of 496 (66%) of patients were included in this analysis. For time-to-event outcomes, stratified log-rank tests and multivariable Cox regression models were used. For binary outcomes, Cochran-Mantel-Haenzel tests and multivariable logistic regression models were used. All statistical tests were two sided, and a P value <0.05 was considered significant. RESULTS A total of 17.1% (56/328) of patients had the KRAS-variant, and overall survival rates were similar between KRAS-variant and non-variant patients. However, there was a time-dependent effect of cetuximab seen only in KRAS-variant patients-while the hazard of death was higher in cetuximab-treated patients within year 1 [HR = 3.37, 95% confidence interval (CI): 1.13-10.10, P = 0.030], death was lower from year 1 to 4 (HR = 0.33, 95% CI: 0.11-0.97, P = 0.043). In contrast, in non-variant patients, the addition of cetuximab significantly increased local failure (HR = 1.59, 95% CI: 1.11-2.28, P = 0.012). CONCLUSIONS/DISCUSSION Although an overall survival advantage was not achieved in KRAS-variant patients, there is potential impact of cetuximab for this genetic subset of patients. In contrast, cetuximab seems to harm non-variant patients. These findings further support the importance of genetic patient selection in trials studying the addition of systemic agents to radiotherapy. SIGNIFICANCE The KRAS-variant is the first functional, inherited miRNA-disrupting variant identified in cancer. Our findings support that cetuximab has a potentially beneficial impact on KRAS-variant patients treated with radiation. The work confirms prior evidence that KRAS-variant patients are a subgroup who are especially sensitive to radiation. These findings further support the potential of this class of variants to enable true treatment personalization, considering the equally important endpoints of response and toxicity.
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Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Gregory A. Masters
- Helen F Graham Cancer Center and Research Institute and Medical Oncology Hematology Consultants Pa, Newark, Delaware
| | | | | | - Bo Lu
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam P. Dicker
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeffrey A. Bogart
- Upstate Medical University (accruals Thomas Jefferson University Hospital), Syracuse, New York
| | | | - Samir Narayan
- St. Joseph Mercy Cancer Center (accruals Michigan Cancer Research Consortium CCOP), Ypsilanti, Michigan
| | | | | | | | - Christopher D. Koprowski
- Helen F Graham Cancer Center (accruals Christiana Care Health Services, Inc. CCOP), Newark, Delaware
| | | | - Elizabeth M. Gore
- Medical College of Wisconsin and the Zablocki VAMC, Milwaukee, Wisconsin
| | | | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Bulen BJ, Khazanov NA, Hovelson DH, Lamb LE, Matrana M, Burkard ME, Yang ESH, Edenfield WJ, Claire Dees E, Onitilo AA, Buchschacher GL, Miller AM, Parsons BM, Wassenaar TR, Suga JM, Siegel RD, Irvin W, Nair S, Slim JN, Misleh J, Khatri J, Masters GA, Thomas S, Safa MM, Anderson DM, Mowers J, Dusenbery AC, Drewery S, Plouffe K, Reeder T, Vakil H, Patrias L, Falzetta A, Hamilton R, Kwiatkowski K, Johnson DB, Rhodes DR, Tomlins SA. Validation of Immunotherapy Response Score as Predictive of Pan-solid Tumor Anti-PD-1/PD-L1 Benefit. Cancer Res Commun 2023; 3:1335-1349. [PMID: 37497337 PMCID: PMC10367935 DOI: 10.1158/2767-9764.crc-23-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Immunotherapy response score (IRS) integrates tumor mutation burden (TMB) and quantitative expression biomarkers to predict anti-PD-1/PD-L1 [PD-(L)1] monotherapy benefit. Here, we evaluated IRS in additional cohorts. Patients from an observational trial (NCT03061305) treated with anti-PD-(L)1 monotherapy were included and assigned to IRS-High (-H) versus -Low (-L) groups. Associations with real-world progression-free survival (rwPFS) and overall survival (OS) were determined by Cox proportional hazards (CPH) modeling. Those with available PD-L1 IHC treated with anti-PD-(L)1 with or without chemotherapy were separately assessed. Patients treated with PD-(L)1 and/or chemotherapy (five relevant tumor types) were assigned to three IRS groups [IRS-L divided into IRS-Ultra-Low (-UL) and Intermediate-Low (-IL), and similarly assessed]. In the 352 patient anti-PD-(L)1 monotherapy validation cohort (31 tumor types), IRS-H versus IRS-L patients had significantly longer rwPFS and OS. IRS significantly improved CPH associations with rwPFS and OS beyond microsatellite instability (MSI)/TMB alone. In a 189 patient (10 tumor types) PD-L1 IHC comparison cohort, IRS, but not PD-L1 IHC nor TMB, was significantly associated with anti-PD-L1 rwPFS. In a 1,103-patient cohort (from five relevant tumor types), rwPFS did not significantly differ in IRS-UL patients treated with chemotherapy versus chemotherapy plus anti-PD-(L)1, nor in IRS-H patients treated with anti-PD-(L)1 versus anti-PD-(L)1 + chemotherapy. IRS associations were consistent across subgroups, including both Europeans and non-Europeans. These results confirm the utility of IRS utility for predicting pan-solid tumor PD-(L)1 monotherapy benefit beyond available biomarkers and demonstrate utility for informing on anti-PD-(L)1 and/or chemotherapy treatment. Significance This study confirms the utility of the integrative IRS biomarker for predicting anti-PD-L1/PD-1 benefit. IRS significantly improved upon currently available biomarkers, including PD-L1 IHC, TMB, and MSI status. Additional utility for informing on chemotherapy, anti-PD-L1/PD-1, and anti-PD-L1/PD-1 plus chemotherapy treatments decisions is shown.
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Affiliation(s)
| | | | | | | | - Marc Matrana
- Ochsner Cancer Institute, New Orleans, Louisiana
| | - Mark E. Burkard
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Eddy Shih-Hsin Yang
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | | | - Adedayo A. Onitilo
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | | | | | | | | | | | | | - Suresh Nair
- Lehigh Valley Topper Cancer Institute, Allentown, Pennsylvania
| | | | | | - Jamil Khatri
- ChristianaCare Oncology Hematology, Newark, Delaware
| | - Gregory A. Masters
- Medical Oncology Hematology Consultants, Helen F Graham Cancer Center and Research Institute, Newark, Delaware
| | - Sachdev Thomas
- Kaiser Permanente Northern California, Oakland, California
| | | | - Daniel M. Anderson
- Metro-Minnesota Community Oncology Research Consortium, St. Louis Park, Minnesota
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Ligibel JA, Pierce LJ, Bender CM, Crane TE, Dieli-Conwright C, Hopkins JO, Masters GA, Schenkel C, Garrett-Mayer E, Katta S, Merrill JK, Salamone JM, Brewster AM. Attention to diet, exercise, and weight in oncology care: Results of an American Society of Clinical Oncology national patient survey. Cancer 2022; 128:2817-2825. [PMID: 35442532 DOI: 10.1002/cncr.34231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) surveyed cancer patients to assess practice patterns related to weight, diet, and exercise as a part of cancer care. METHODS An online survey was distributed between March and June 2020 through ASCO channels and patient advocacy organizations. Direct email communication was sent to more than 25,000 contacts, and information about the survey was posted on Cancer.Net. Eligibility criteria included being aged at least 18 years, living in the United States, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. RESULTS In total, 2419 individuals responded to the survey. Most respondents were female (60.1%), 61.1% had an early-stage malignancy, and 48.4% were currently receiving treatment. Breast cancer was the most common cancer (35.7%). The majority of respondents consumed ≤2 servings of fruits and vegetables/d (50.5%) and exercised ≤2 times/wk (50.1%). Exercise was addressed at most or some oncology visits in 56.8% of respondents, diet in 50.1%, and weight in 28.0%. Respondents whose oncology provider provided diet and/or exercise recommendations were more likely to report changes in these behaviors vs. those whose oncology provider did not (exercise: 79.6% vs 69.0%, P < .001; diet 81.1% vs 71.3%, P < .001; weight 81.0% vs 73.3%, P = .003). CONCLUSIONS In a national survey of oncology patients, slightly more than one-half reported attention to diet and exercise during oncology visits. Provider recommendations for diet, exercise, and weight were associated with positive changes in these behaviors, reinforcing the importance of attention to these topics as a part of oncology care.
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Affiliation(s)
- Jennifer A Ligibel
- Department of Medical Oncology, Division of Breast Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tracy E Crane
- Division of Medical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Christina Dieli-Conwright
- Department of Medical Oncology, Division of Breast Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Judith O Hopkins
- Novant Health Cancer Institute/SCOR NCORP, Winston Salem, North Carolina, USA
| | - Gregory A Masters
- Deptartment of Medicine, Division of Medical Oncology, Helen F. Graham Cancer Center, Newark, Delaware, USA
| | - Caroline Schenkel
- Center for Research and Analytics, American Society of Clinical of Oncology, Alexandria, Virginia, USA
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical of Oncology, Alexandria, Virginia, USA
| | - Sweatha Katta
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | | | | | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, Gerber DE, Hamad L, Hansen E, Johnson DB, Lacouture ME, Masters GA, Naidoo J, Nanni M, Perales MA, Puzanov I, Santomasso BD, Shanbhag SP, Sharma R, Skondra D, Sosman JA, Turner M, Ernstoff MS. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021; 9:e002435. [PMID: 34172516 PMCID: PMC8237720 DOI: 10.1136/jitc-2021-002435] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.
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Affiliation(s)
- Julie R Brahmer
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Hamzah Abu-Sbeih
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Paolo Antonio Ascierto
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - Jill Brufsky
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura C Cappelli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank B Cortazar
- Massachusetts General Hospital, Boston, Massachusetts, USA
- New York Nephrology Vasculitis and Glomerular Center, Albany, New York, USA
| | - David E Gerber
- Department of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lamya Hamad
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Eric Hansen
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory A Masters
- Department of Medicine, Helen F. Graham Cancer Center, Newark, Delaware, USA
| | - Jarushka Naidoo
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
- Department of Oncology, Beaumont Hospital Dublin, The Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Michele Nanni
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Bianca D Santomasso
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Satish P Shanbhag
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Cancer Specialist of North Florida, Fleming Island, Florida, USA
| | - Rajeev Sharma
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Michelle Turner
- Department of Oncology and the Thoracic Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Marc S Ernstoff
- Division of Cancer Treatment & Diagnosis, National Cancer Institute, Rockville, Maryland, USA
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Bogart JA, Wang XF, Masters GA, Gao J, Komaki R, Kuzma CS, Heymach J, Petty WJ, Gaspar LE, Waqar SN, Stinchcombe T, Bradley JD, Vokes EE. Phase 3 comparison of high-dose once-daily (QD) thoracic radiotherapy (TRT) with standard twice-daily (BID) TRT in limited stage small cell lung cancer (LSCLC): CALGB 30610 (Alliance)/RTOG 0538. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8505] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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
8505 Background: Although level 1 evidence is lacking, the majority of patients (pts) with LSCLC are treated with a high dose QD TRT regimen in clinical practice. CALGB 30610/RTOG 0538 was designed to determine if administering high dose TRT would improve overall survival (OS), compared with standard 45 Gy BID TRT, in LSCLC pts treated with chemoradiotherapy. Methods: Eligible pts had LSCLC, ECOG performance status (PS) 0-2 and regional lymph node involvement excluding contralateral hilar or supraclavicular nodes. This phase 3 trial was conducted in 2 stages. In the first stage, pts were randomized 1:1:1 to 45 Gy BID over 3 weeks, 70 Gy QD over 7 weeks, or 61.2 Gy concomitant boost (CB) over 5 weeks. For the second stage, the study planned discontinuation of one high dose arm based on interim toxicity analysis with patients then randomized 1:1 in the two remaining arms. TRT was given starting with either the 1st or 2nd (of 4 total) chemotherapy cycles. The primary endpoint was OS measured from date of randomization. Results: The trial opened 03/15/2008 and closed 12/01/2019 upon completing accrual, with the CB arm discontinued 3/11/2013 after interim analysis. This analysis includes 638 pts randomized to 45 Gy BID TRT (n = 313) or 70 Gy QD TRT (n = 325). Median age was 63 years (range 37-81), the majority of pts were Caucasian (86%), female (52%), and with ECOG PS 0-1 (95%). After median follow-up of 2.84 years (IQR:1.35 -5.61) for surviving pts, QD compared to BID did not result in a significant difference in OS (HR 0.94, 95% CI: 0.76-1.2, p = 0.9). Median, 2- and 4-year OS for QD were 30.5 months (95% CI: 24.4-39.6), 56% (95% CI: 0.51-0.62), and 39% (95% CI: 0.33-0.45), and for BID 28.7 months (95% CI: 26.2-35.5), 59% (95% CI: 0.53-0.65), and 35% (95% CI: 0.29-0.42). QD also did not result in a significant difference in PFS (HR 0.96, 95% CI: 0.78-1.18, p = 0.94). Most grade 3+ hematologic and non-hematologic adverse events (AEs) were similar between cohorts. Rates of grade 3+ febrile neutropenia, dyspnea, esophageal pain and dysphagia for QD were 12.6%,7%, 11.6% and 11.3%, and for BID 13.6%, 4%, 11.2 % and 9.5%. Grade 5 AEs were reported in 3.7% and 1.7% of the QD and BID cohorts, respectively. Results will be updated at presentation. Conclusions: High dose QD TRT to 70 Gy did not significantly improve OS compared with standard 45 Gy BID TRT. Nevertheless, favorable outcomes on the QD arm provide the most robust evidence available supporting high dose once-daily TRT as an acceptable option in LSCLC. Outcomes from this study, the largest conducted in LSCLC to date, will help guide TRT decisions for this patient population. Support: U10CA180821, U10CA180882; Clinical trial information: NCT00632853.
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Affiliation(s)
| | | | | | | | - Ritsuko Komaki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J. Petty
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston Salem, NC
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Varlotto JM, Sun Z, Ramalingam SS, Wakelee HA, Lovly CM, Oettel KR, Masters GA, Pennell N. Randomized phase III Trial of MEDI4736 (durvalumab) as concurrent and consolidative therapy or consolidative therapy alone for unresectable stage 3 NSCLC: A trial of the ECOG-ACRIN Cancer Research Group (EA5181). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps8584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8584 Background: Platinum-based concurrent chemoradiation(CRT) followed by one year of the human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody, durvalumab, which blocks the interaction of PD-L1 with its receptors PD-1 and CD80, is the standard of care for locally advanced, unresectable non-small cell lung cancer (NSCLC). Early studies have noted the feasibility of concomitant administration of radiotherapy and immune checkpoint inhibition in NSCLC. EA5181 will evaluate the use of concomitant durvalumab with chemo-radiotherapy for locally advanced NSCLC. Methods: EA5181 is a randomized, multi-center, phase III study for patients with unresectable Stage III NSCLC comparing the efficacy of CRT with concomitant durvalumab to CRT, followed by one year of durvalumab. Eligibility criteria include: an ECOG PS of 0-1, adequate pulmonary function (FEV1 and DLCO both > 40%), no history of auto-immune disease and no past chemotherapy or RT for this lung cancer. Stratification factors include age, sex, stage, and planned concurrent chemotherapy type. Eligible patients with be randomized 1:1 to receive 60Gy RT (2Gy fractions) CRT and durvalumab (Arm A) or 60Gy CRT (Arm B). Investigators will be allowed to choose from three different chemotherapy options: cisplatin/etoposide q 28 days, Pemetrexed/cisplatin q 21 days, and weekly paclitaxel/Carboplatin. Arm A will use 750mg fixed of durvalumab (considered equivalent to 10mg/kg) on days 1, 11, and 21 of RT. Assuming no disease progression, patients in both arms will be followed by monthly (q28 days) fixed dose of 1500mg durvalumab for one year which will be given optimally within 14 days of radiation or when (non)hematologic toxicity is < Grade 2. The primary endpoint is overall survival. Secondary endpoints include progression-free survival, incidence of local/distant progression and toxicity. The target sample size is 660 patients, anticipated to recruit over 55 months, with follow up for an additional 42 months. This provides approximately 82% power if the true hazard ratio for overall survival was 0.75 or less, with 2-sided alpha of 0.05, and assuming a median survival of 42.5 months in the control arm. The study was activated on 04/09/20 and has currently accrued 90 patients on 02/03/21. Clinical trial information: NCT04092283.
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Affiliation(s)
| | | | | | | | - Christine M. Lovly
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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7
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Ligibel JA, Pierce LJ, Bender CM, Crane TE, Dieli-Conwright CM, Hopkins JO, Korde LA, Masters GA, Schenkel C, Garrett-Mayer L, Katta S, Merrill JK, Salamone JM, Brewster AM. Attention to diet, exercise, and weight in the oncology clinic: Results of a national patient survey. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.
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Affiliation(s)
| | | | | | | | | | - Judith O. Hopkins
- NSABP/NRG Oncology, and Novant Helath Forsyth Medical Center/Southeast Clinical Oncology Research Consortium, Winston Salem, NC
| | - Larissa A. Korde
- Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | | | | | | | - Sweatha Katta
- American Society of Clinical Oncology, Alexandria, VA
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Bogart JA, Wang X, Masters GA, Gao J, Komaki R, Gaspar LE, Heymach JV, Dobelbower MC, Kuzma C, Stinchcombe TE, Vokes EE. Short Communication: Interim toxicity analysis for patients with limited stage small cell lung cancer (LSCLC) treated on CALGB 30610 (Alliance) / RTOG 0538. Lung Cancer 2021; 156:68-71. [PMID: 33894496 DOI: 10.1016/j.lungcan.2021.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The CALGB 30610/RTOG 0538 randomized trial was designed to test whether high-dose thoracic radiotherapy (TRT) would improve survival compared with 45 Gy twice-daily (BID) TRT in limited stage small cell lung cancer (LSCLC). Two piloted experimental TRT regimens were of interest to study, 70 Gy daily (QD) and 61.2 Gy concomitant boost (CB). Driven by concerns about adequate patient accrual, a study design was employed that eliminated one experimental TRT arm based on early interim toxicity and tolerability, with the study then continuing as a traditional 2-arm phase III study. METHODS Patients with LSCLC were assigned to receive four cycles of cisplatin and etoposide chemotherapy with one of 3 TRT regimens starting with either the first or second cycle of chemotherapy. The interim endpoint was the cumulative highest toxicity calculated from a scoring system based on treatment-related grade 3 and higher toxicity and the ability to complete therapy in the experimental arms. RESULTS The final interim analysis was performed after 70 patients accrued to each experimental cohort, and a difference in treatment related toxicity scoring was not found (p = 0.739). Severe esophageal toxicity was comparable in both cohorts. Pulmonary toxicity was low overall, though 4 patients (5.7 %) on the 61.2 Gy arm developed grade 4 dyspnea, which was not observed in the 70 Gy arm. A protocol mandated decision was made to discontinue the 61.2 Gy arm following review of toxicity with the Data and Safety Monitoring Board. CONCLUSION A randomized trial design using a planned early interim toxicity analysis to discriminate between experimental treatment arms is feasible in a phase III setting. Refinement of the design could increase the likelihood of detecting clinically meaningful differences in toxicity in future studies.
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Affiliation(s)
- Jeffrey A Bogart
- State University of New York Upstate Medical University, Syracuse, NY, United States.
| | - Xiaofei Wang
- Alliance Statistics and Data Center, Duke University, Durham, NC, United States
| | | | - Junheng Gao
- Alliance Statistics and Data Center, Duke University, Durham, NC, United States
| | | | - Laurie E Gaspar
- Banner MD Anderson Cancer Center, Greeley, CO, United States
| | - John V Heymach
- MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | | | - Charles Kuzma
- FirstHealth of the Carolinas-Moore Regional Hospital, Pinehurst, NC, United States
| | - Thomas E Stinchcombe
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Everett E Vokes
- University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
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9
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Bardia A, Messersmith WA, Kio EA, Berlin JD, Vahdat L, Masters GA, Moroose R, Santin AD, Kalinsky K, Picozzi V, O'Shaughnessy J, Gray JE, Komiya T, Lang JM, Chang JC, Starodub A, Goldenberg DM, Sharkey RM, Maliakal P, Hong Q, Wegener WA, Goswami T, Ocean AJ. Sacituzumab govitecan, a Trop-2-directed antibody-drug conjugate, for patients with epithelial cancer: final safety and efficacy results from the phase I/II IMMU-132-01 basket trial. Ann Oncol 2021; 32:746-756. [PMID: 33741442 DOI: 10.1016/j.annonc.2021.03.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sacituzumab govitecan (SG), a trophoblast cell surface antigen-2 (Trop-2)-directed antibody-drug conjugate, has demonstrated antitumor efficacy and acceptable tolerability in a phase I/II multicenter trial (NCT01631552) in patients with advanced epithelial cancers. This report summarizes the safety data from the overall safety population (OSP) and efficacy data, including additional disease cohorts not published previously. PATIENTS AND METHODS Patients with refractory metastatic epithelial cancers received intravenous SG (8, 10, 12, or 18 mg/kg) on days 1 and 8 of 21-day cycles until disease progression or unacceptable toxicity. Endpoints for the OSP included safety and pharmacokinetic parameters with investigator-evaluated objective response rate (ORR per RECIST 1.1), duration of response, clinical benefit rate, progression-free survival, and overall survival evaluated for cohorts (n > 10 patients) of small-cell lung, colorectal, esophageal, endometrial, pancreatic ductal adenocarcinoma, and castrate-resistant prostate cancer. RESULTS In the OSP (n = 495, median age 61 years, 68% female; UGT1A1∗28 homozygous, n = 46; 9.3%), 41 (8.3%) permanently discontinued treatment due to adverse events (AEs). Most common treatment-related AEs were nausea (62.6%), diarrhea (56.2%), fatigue (48.3%), alopecia (40.4%), and neutropenia (57.8%). Most common treatment-related serious AEs (n = 75; 15.2%) were febrile neutropenia (4.0%) and diarrhea (2.8%). Grade ≥3 neutropenia and febrile neutropenia occurred in 42.4% and 5.3% of patients, respectively. Neutropenia (all grades) was numerically more frequent in UGT1A1∗28 homozygotes (28/46; 60.9%) than heterozygotes (69/180; 38.3%) or UGT1A1∗1 wild type (59/177; 33.3%). There was one treatment-related death due to an AE of aspiration pneumonia. Partial responses were seen in endometrial cancer (4/18, 22.2% ORR) and small-cell lung cancer (11/62, 17.7% ORR), and one castrate-resistant prostate cancer patient had a complete response (n = 1/11; 9.1% ORR). CONCLUSIONS SG demonstrated a toxicity profile consistent with previous published reports. Efficacy was seen in several cancer cohorts, which validates Trop-2 as a broad target in solid tumors.
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Affiliation(s)
- A Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | | | - E A Kio
- Goshen Center for Cancer Care, Goshen, USA
| | - J D Berlin
- Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - L Vahdat
- Weill Cornell Medicine, New York, USA
| | - G A Masters
- Helen F Graham Cancer Center and Research Institute, Newark, USA
| | - R Moroose
- Orlando Health UF Health Cancer Center, Orlando, USA
| | - A D Santin
- Yale University School of Medicine, New Haven, USA
| | - K Kalinsky
- Columbia University Irving Medical Center-Herbert Irving Comprehensive Cancer Center, New York, USA
| | - V Picozzi
- Virginia Mason Cancer Center, Seattle, USA
| | - J O'Shaughnessy
- Texas Oncology, Baylor University Medical Center, US Oncology, Dallas, USA
| | - J E Gray
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - T Komiya
- Parkview Cancer Institute, Fort Wayne, USA
| | - J M Lang
- University of Wisconsin Carbone Cancer Center, Madison, USA
| | - J C Chang
- Houston Methodist Cancer Center, Houston, USA
| | - A Starodub
- Riverside Peninsula Cancer Institute, Newport News, USA
| | - D M Goldenberg
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - R M Sharkey
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - P Maliakal
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - Q Hong
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - W A Wegener
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - T Goswami
- Immunomedics, Inc., a Subsidiary of Gilead Sciences, Inc., Morris Plains, USA
| | - A J Ocean
- Weill Cornell Medicine, New York, USA.
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10
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Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, Bogart JA, Forster KM, Magliocco AM, Kavadi VS, Narayan S, Iyengar P, Robinson CG, Wynn RB, Koprowski CD, Olson MR, Meng J, Paulus R, Curran WJ, Choy H. Long-Term Results of NRG Oncology RTOG 0617: Standard- Versus High-Dose Chemoradiotherapy With or Without Cetuximab for Unresectable Stage III Non-Small-Cell Lung Cancer. J Clin Oncol 2020; 38:706-714. [PMID: 31841363 PMCID: PMC7048161 DOI: 10.1200/jco.19.01162] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE RTOG 0617 compared standard-dose (SD; 60 Gy) versus high-dose (HD; 74 Gy) radiation with concurrent chemotherapy and determined the efficacy of cetuximab for stage III non-small-cell lung cancer (NSCLC). METHODS The study used a 2 × 2 factorial design with radiation dose as 1 factor and cetuximab as the other, with a primary end point of overall survival (OS). RESULTS Median follow-up was 5.1 years. There were 3 grade 5 adverse events (AEs) in the SD arm and 9 in the HD arm. Treatment-related grade ≥3 dysphagia and esophagitis occurred in 3.2% and 5.0% of patients in the SD arm v 12.1% and 17.4% in the HD arm, respectively (P = .0005 and < .0001). There was no difference in pulmonary toxicity, with grade ≥3 AEs in 20.6% and 19.3%. Median OS was 28.7 v 20.3 months (P = .0072) in the SD and HD arms, respectively, 5-year OS and progression-free survival (PFS) rates were 32.1% and 23% and 18.3% and 13% (P = .055), respectively. Factors associated with improved OS on multivariable analysis were standard radiation dose, tumor location, institution accrual volume, esophagitis/dysphagia, planning target volume and heart V5. The use of cetuximab conferred no survival benefit at the expense of increased toxicity. The prior signal of benefit in patients with higher H scores was no longer apparent. The progression rate within 1 month of treatment completion in the SD arm was 4.6%. For comparison purposes, the resultant 2-year OS and PFS rates allowing for that dropout rate were 59.6% and 30.7%, respectively, in the SD arms. CONCLUSION A 60-Gy radiation dose with concurrent chemotherapy should remain the standard of care, with the OS rate being among the highest reported in the literature for stage III NSCLC. Cetuximab had no effect on OS. The 2-year OS rates in the control arm are similar to the PACIFIC trial.
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Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Pittsburgh, PA
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritsuko R. Komaki
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - George R. Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Puneeth Iyengar
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Joanne Meng
- Ottawa Hospital and Cancer Center, Ottawa, Ontario, Canada
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Pittsburgh, PA
| | | | - Hak Choy
- The University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
Lung cancer remains second most common cancer in men and women in the United States. More than 50% of patients are diagnosed in the advanced stage. Traditionally, chemotherapy has been the backbone of management of stage IV lung cancer. A better understanding of the molecular pathogenesis has led to rapid development of targeted therapy and immunotherapy. This has led to significant improvement in survival of patients with lung cancer stages III to IV. These drugs are being studied in early stage lung cancer. Several trials are ongoing to improve the survival and quality of life of our patients.
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Affiliation(s)
- Dhaval R Shah
- Helen F. Graham Cancer Center and Research Institute, 4701 Ogletown-Stanton Road, Newark, DE 19713, USA
| | - Gregory A Masters
- Helen F. Graham Cancer Center and Research Institute, 4701 Ogletown-Stanton Road, Newark, DE 19713, USA; Thomas Jefferson University Medical School, Philadelphia, PA, USA.
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12
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Rashid AS, Venigalla S, Dzeda M, Masters GA. A Case Report of the Clinico-radiologic Challenges of Assessing Treatment Response after Stereotactic Radiation of Oligometastases Preceded by Immunotherapy: Pseudoprogression, Mixed Response Patterns, and Opportunities for Precision Radiation. Cureus 2019; 11:e4264. [PMID: 31139523 PMCID: PMC6519981 DOI: 10.7759/cureus.4264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As immunotherapy continues to translate to the clinic and is combined with existing modalities, such as radiation therapy, novel treatment response patterns have been observed which complicate conventional clinical assessment and management. Herein, we describe a case study of a patient with non-small cell lung cancer treated initially with definitive chemoradiation who subsequently developed oligorecurrent disease which was managed with nivolumab and then comprehensive salvage stereotactic radiation. Serial radiographic assessment had shown worsening at these limited sites of disease after initiating immunotherapy, improvement after radiation, and then heterogeneous response behavior across sites during longer-term follow-up. Given the dual effects ablative radiation may have in the context of global immune checkpoint inhibition, both cytotoxic and synergistic immune-related, assessment of treatment response to such treatment is complicated. Such assessment is further complicated by novel immunotherapy response phenomena, e.g. pseudoprogression, which are being uncovered and are not fully characterized. Current clinical and radiologic assessment strategies are inadequate to interrogate and discern between immunomodulation-influenced response behavior and further diagnostic innovation is warranted to meet the needs of evolving clinical practice in the era of immunotherapy.
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Affiliation(s)
- Arif S Rashid
- Radiation Oncology, Hahnemann University Hospital, Philadelphia, USA
| | - Sriram Venigalla
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Michael Dzeda
- Radiation Oncology, Helen F. Graham Cancer Center - Christiana Care Health System, Newark, USA
| | - Gregory A Masters
- Oncology, Helen F. Graham Cancer Center - Christiana Care Health System, Newark, USA
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13
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Laslett NF, Park S, Masters GA, Biggs DD, Schneider CJ, Misleh JG, Suppiah K, Simpson PS, Grubbs S, Wozniak TF, Guarino M. Phase II study of carboplatin, pemetrexed, and bevacizumab in advanced nonsquamous non-small-cell lung cancer. Cancer Med 2018; 7:2969-2973. [PMID: 29905018 PMCID: PMC6051222 DOI: 10.1002/cam4.1569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/07/2022] Open
Abstract
Lung cancer remains the leading cause of cancer death throughout the world. Despite new chemotherapeutic, immunomodulating and molecularly targeted agents, patients with locally advanced or metastatic disease still have a poor prognosis. This trial looked to combine antiangiogenic therapy with a first‐line cytotoxic chemotherapy doublet, hoping to extend median progression‐free survival (PFS) while minimizing toxicity in patients with advanced nonsquamous non–small‐cell lung cancer (NSCLC). In this single institution, single‐arm study, 51 patients (age >18 yo) were followed from 2007 to 2012. Patients with stage IV nonsquamous NSCLC and patients with recurrent unresectable disease (nonradiation candidates) were eligible. Treatment consisted of carboplatin AUC 5 IV 30‐60 minutes, pemetrexed 500/mg2IV 10 minutes, bevacizumab 15 mg/kg IV (90 minutes 1st dose, 60 minutes 2nd dose, 30 minutes subsequent doses). Treatment was administered every 21 days and planned for 6 cycles, in the absence of disease progression or unacceptable toxicities. Growth factor support was not permitted prophylactically but allowed for toxicities, as were dose reductions. Maintenance treatment for those with stable disease or better consisted of Bevacizumab 15 mg/kg every 3 weeks for up to 1 year. Between November 2007 and March 2012, 51 patients were followed in the phase II trial of carboplatin, pemetrexed, and bevacizumab. Patients were enrolled over a 24‐month period. After the end of treatment visits, subjects were followed at least every 3 months for survival data. The median follow‐up period was 49 weeks (6 weeks to 178), and the median number of treatment cycles was 6 (range, 1‐6). Among the 50 patients assessable for response, median overall survival was 49 weeks (95% CI, 0‐62.7) with median PFS of 28 weeks (95% CI, 0‐132.4). A complete or partial response was seen in 28 (59.5%) patients. Grade 3‐4 treatment‐related adverse events occurred in 9 (17.6%) of 51 patients; the most common were thrombocytopenia (4 [7.8%]) and neutropenia (3 [5.9%]). Three (5.8%) of 51 patients were discontinued because of treatment‐related adverse events (grade 3 diarrhea, thrombocytopenia, dehydration, fatigue, and grade 4 respiratory distress), and 1 patient (1.9%) was found to be ineligible due to anticoagulation use. A novel 3‐drug combination for advanced nonsquamous NSCLC shows promising efficacy with modest toxicity.
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Affiliation(s)
- Nicole F Laslett
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - SuJung Park
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Gregory A Masters
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - David D Biggs
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Charles J Schneider
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Jamal G Misleh
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Kathir Suppiah
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Pamela S Simpson
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Stephen Grubbs
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Timothy F Wozniak
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Michael Guarino
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
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14
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Jalal SI, Hanna N, Zon R, Masters GA, Borghaei H, Koneru K, Badve S, Prasad N, Somaiah N, Wu J, Yu Z, Einhorn L. Phase I Study of Amrubicin and Cyclophosphamide in Patients With Advanced Solid Organ Malignancies: HOG LUN 07-130. Am J Clin Oncol 2017; 40:329-335. [PMID: 25503432 DOI: 10.1097/coc.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Relapsed small cell lung cancer (SCLC) has limited treatment options. Anthracyclines and cyclophosphamide have shown synergy in many tumors. Amrubicin (AMR) and cyclophosphamide both have single-agent activity in SCLC. This phase I trial evaluated the combination of AMR and cyclophosphamide in refractory solid organ malignancies and in relapsed SCLC. MATERIALS AND METHODS The primary endpoint was to determine maximum-tolerated dose and dose-limiting toxicities of the combination. Eligible patients were enrolled in sequential dose escalation cohorts in a standard 3+3 design. Treatment consisted of cyclophosphamide IV at 500 mg/m on day 1 with escalating doses of AMR IV on days 1 to 3 (25 to 40 mg/m with increments of 5 mg/m per cohort). Cycles were repeated every 21 days. Exploratory objectives analyzed the presence of NQO1 polymorphisms and topoisomerase IIA amplification and correlation with response. RESULTS Thirty-six patients were enrolled, of whom 18 patients had SCLC (50%). Maximum-tolerated dose was determined to be dose level 2 (cyclophosphamide 500 mg/m, AMR 30 mg/m) due to grade 4 thrombocytopenia. The main grade 3 to 4 toxicities were hematologic. Efficacy results are available for 34 patients. Partial responses, stable disease, and progressive disease rates in the overall study population were 20.6% (n=7), 38.2% (n=13), and 41.2% (n=14), respectively. Partial response, stable disease, and progressive disease rates in the SCLC patients and 1 patient with extrathoracic small cell were 36.8% (n=7), 26.3% (n=5), and 36.8% (n=7), respectively. There was no correlation between topoisomerase IIA amplification or NQO1 polymorphisms and response. CONCLUSIONS AMR and cyclophosphamide can be safely combined with little activity observed in heavily pretreated SCLC patients.
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Affiliation(s)
- Shadia I Jalal
- Departments of *Medicine, Division of Hematology/Oncology #Pathology and Laboratory Medicine ††Biostatistics, Indiana University School of Medicine †Indiana University Melvin and Bren Simon Cancer Center, Indianapolis ¶Cancer Care Center of Southern Indiana, Bloomington ‡Northern Indiana Cancer Research Consortium, South Bend, IN §Christiana Care Health Services, Newark, DE ∥Fox Chase Cancer Center, Philadelphia, PA **The University of Texas MD Anderson Cancer Center, Houston, TX
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15
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Gray JE, Heist RS, Starodub AN, Camidge DR, Kio EA, Masters GA, Purcell WT, Guarino MJ, Misleh J, Schneider CJ, Schneider BJ, Ocean A, Johnson T, Gandhi L, Kalinsky K, Scheff R, Messersmith WA, Govindan SV, Maliakal PP, Mudenda B, Wegener WA, Sharkey RM, Goldenberg DM. Therapy of Small Cell Lung Cancer (SCLC) with a Topoisomerase-I-inhibiting Antibody-Drug Conjugate (ADC) Targeting Trop-2, Sacituzumab Govitecan. Clin Cancer Res 2017; 23:5711-5719. [PMID: 28679770 DOI: 10.1158/1078-0432.ccr-17-0933] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/22/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We evaluated a Trop-2-targeting antibody conjugated with SN-38 in metastatic small cell lung cancer (mSCLC) patients.Experimental Design: Sacituzumab govitecan was studied in patients with pretreated (median, 2; range, 1-7) mSCLC who received either 8 or 10 mg/kg i.v. on days 1 and 8 of 21-day cycles. The primary endpoints were safety and objective response rate (ORR); duration of response, progression-free survival (PFS), and overall survival (OS) were secondary endpoints.Results: Sixty percent of patients showed tumor shrinkage from baseline CTs. On an intention-to-treat basis (N = 50), the ORR was 14% (17% for the 10-mg/kg group); the median response duration, 5.7 months; the clinical benefit rate (CBR ≥4 months), 34%; median PFS, 3.7 months; and median OS, 7.5 months. There was a suggested improvement in PR, CBR, and PFS with sacituzumab govitecan in second-line patients who were sensitive to first-line therapy, but no difference between first-line chemosensitive versus chemoresistant patients in the overall population. There was a statistically significant higher OS in those patients who received prior topotecan versus no topotecan therapy in a small subgroup. Grade ≥3 adverse events included neutropenia (34%), fatigue (13%), diarrhea (9%), and anemia (6%). Trop-2 tumor staining was not required for patient selection. No antibodies to the drug conjugate or its components were detected on serial blood collections.Conclusions: Sacituzumab govitecan appears to have a safe and effective therapeutic profile in heavily pretreated mSCLC patients, including those who are chemosensitive or chemoresistant to first-line chemotherapy. Additional studies as a monotherapy or combination therapy are warranted. Clin Cancer Res; 23(19); 5711-9. ©2017 AACR.
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Affiliation(s)
- Jhanelle E Gray
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
| | - Rebecca S Heist
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ebenezer A Kio
- Indiana University Health Center for Cancer Care, Goshen, Indiana
| | - Gregory A Masters
- Helen F. Graham Cancer Center & Research Institute, Newark, Delaware
| | | | - Michael J Guarino
- Helen F. Graham Cancer Center & Research Institute, Newark, Delaware
| | - Jamal Misleh
- Helen F. Graham Cancer Center & Research Institute, Newark, Delaware
| | | | | | | | - Tirrell Johnson
- University of Florida Health Cancer Center, Orlando, Florida
| | - Leena Gandhi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kevin Kalinsky
- Columbia University Medical Center-Herbert Irving Comprehensive Cancer Center, New York, New York
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16
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Khan SA, Puligandla M, Dahlberg SE, Masters GA, Langer CJ, Brahmer JR, Hanna NH, Bonomi P, Gerber DE, Johnson DH, Schiller JH, Ramalingam SS. Impact of prior radiation on survival in metastatic lung cancer ECOG-ACRIN trials. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9051] [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
9051 Background: Up to 50% of advanced NSCLC patients receive radiation therapy at some point in their course. We sought to determine whether patients with prior radiation demonstrate altered outcomes on subsequent metastatic clinical trials. Methods: We reviewed 8 ECOG-ACRIN advanced non-small cell lung cancer studies conducted between 1993 and 2011 in which information was collected about receipt of prior radiation. Whether radiotherapy was given with curative or palliative intent, or to specific sites was not recorded. Median follow-up among all trials was 66 months. We used the log-rank, Wilcoxon and Fisher’s exact tests to compare patients, and Cox Model and Kaplan-Meier method to calculate survival. Results: 574/3041 (18.9%) patients had received prior radiation. These patients were more likely to be male (64% vs 58%), have squamous histology (20% vs 14%) and have had prior surgery (48% vs 33%) compared to those with no prior radiation. At registration, prior radiation patients were more likely to have an ECOG PS of 1 (66% vs 58%), while they were less likely to have a PS of 0 (24% vs 36%) or have a pleural effusion (23% vs 37%). Patients who received radiation were more likely to have been registered on to studies between 1993-1999 than 2000-2011 (69% vs 31%) (all p < 0.001). Median Overall Survival (OS) for patients with prior radiation was 7.6 months (range 7-8.3) vs 9.5 (9.1-9.8) for those without (p < 0.001). Median Progression Free Survival (PFS) for those with prior radiation was 3.5 months (3-3.9) vs 4.2 (4.1-4.4) for those without (p < 0.001). In multivariable analysis controlling for stage IIIB/IV, sex, PS, histology, and prior surgery, the impact of prior radiation on overall survival remained significant (p = 0.042, HR (95% CI) = 1.11 (1.00, 1.22)). Conclusions: Almost one-fifth of lung cancer patients on systemic therapy trials for advanced disease previously received radiation. They are more likely to be male, have squamous histology, have an ECOG PS of 1 and have had prior surgery. Prior radiation is significantly associated with inferior OS and PFS. For advanced NSCLC clinical trials, documentation of whether curative intent/palliative intent radiation was given and stratification by prior radiation exposure should be considered.
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Affiliation(s)
- Saad A. Khan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Corey J. Langer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Julie R. Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - David E. Gerber
- The University of Texas Southwestern Medical Center, Dallas, TX
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17
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Finelli NC, Baig SA, Masters GA. Successful Therapy with Nivolumab in Metastatic Renal Cell Carcinoma After Multiple Prior Treatments. Del Med J 2017; 89:14-17. [PMID: 29714832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Renal cell carcinoma (RCC) is responsible for 80 to 85 percent of all primary renal malignancies. In the United State%, there are about 63,000 new cases and almost :14,000 deaths per year from RCC. Surgical resection of localized RCC can be curative but many patients eventually recur. Immunotherapy appears to be a promising new modality for many malignancies, including RCC. Nivolumab, a specific immunotherapy agent indicated for advanced RCC, may restore antitumor immunity and allow for greater progression-free survival by targeting proteins that negatively regulate T cell immunity. This case study aims to demonstrate the integration of nivolumab into the management of a patient with advanced RCC and provide a stimulus for further investigation and research into this treatment modality.
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Sanborn RE, Patel JD, Masters GA, Jayaram N, Stephens A, Guarino M, Misleh J, Wu J, Hanna N. A randomized, double-blind, phase 2 trial of platinum therapy plus etoposide with or without concurrent vandetanib (ZD6474) in patients with previously untreated extensive-stage small cell lung cancer: Hoosier Cancer Research Network LUN06-113. Cancer 2016; 123:303-311. [DOI: 10.1002/cncr.30287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Center; Portland Oregon
| | - Jyoti D. Patel
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | | | - Nagesh Jayaram
- Southeastern Medical Oncology; Jacksonville North Carolina
| | - Anthony Stephens
- Oncology Hematology Associates Southwest Indiana; Newburgh Indiana
| | | | | | - Jingwei Wu
- Department of Biostatistics; Indiana University; Indianapolis Indiana
| | - Nasser Hanna
- Indiana University Simon Cancer Center; Indianapolis Indiana
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Hirsch FR, Redman MW, Herbst RS, Kim ES, Semrad TJ, Bazhenova L, Masters GA, Oettel KR, Guaglianone P, Reynolds CM, Karnad AB, Arnold SM, Varella-Garcia M, Moon J, Mack PC, Blanke CD, Kelly K, Gandara DR. Biomarker-enriched efficacy of cetuximab-based therapy: Squamous subset analysis from S0819, a phase III trial of chemotherapy with or without cetuximab in advanced NSCLC. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Roy S. Herbst
- Yale University School of Medicine, Yale Cancer Center, New Haven, CT
| | - Edward S. Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | | | - Lyudmila Bazhenova
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA
| | | | | | | | | | - Anand B. Karnad
- The University of Texas Health Science Center San Antonio, San Antonio, TX
| | | | | | - James Moon
- Fred Hutchinson Cancer Resaerch Center, Seattle, WA
| | | | | | - Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
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Camidge DR, Heist RS, Masters GA, Scheff RJ, Starodub A, Messersmith WA, Bardia A, Ocean AJ, Horn L, Berlin J, Maliakal PP, Sharkey RM, Wilhelm F, Goldenberg DM, Guarino MJ. Therapy of metastatic, non-small cell lung cancer (mNSCLC) with the anti-Trop-2-SN-38 antibody-drug conjugate (ADC), sacituzumab govitecan (IMMU-132). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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)
| | | | | | | | | | | | - Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Leora Horn
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Michael J. Guarino
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE
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Starodub A, Camidge DR, Scheff RJ, Thomas SS, Guarino MJ, Masters GA, Kalinsky K, Gandhi L, Bardia A, Messersmith WA, Ocean AJ, Maliakal PP, Sharkey RM, Wilhelm F, Goldenberg DM, Heist RS. Trop-2 as a therapeutic target for the antibody-drug conjugate (ADC), sacituzumab govitecan (IMMU-132), in patients (pts) with previously treated metastatic small-cell lung cancer (mSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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)
| | | | | | | | - Michael J. Guarino
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE
| | | | | | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA
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Semrad TJ, Redman MW, Herbst RS, Kim ES, Bazhenova L, Masters GA, Oettel KR, Guaglianone P, Reynolds CM, Karnad AB, Arnold SM, Varella-Garcia M, Moon J, Mack PC, Blanke CD, Hirsch FR, Kelly K, Gandara DR. Outcomes for patients treated with or without bevacizumab on SWOG S0819: A randomized, phase III study comparing carboplatin/Paclitaxel or carboplatin/Paclitaxel/bevacizumab with or without concurrent cetuximab in patients with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9082] [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)
| | | | - Roy S. Herbst
- Yale University School of Medicine, Yale Cancer Center, New Haven, CT
| | - Edward S. Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Lyudmila Bazhenova
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, CA
| | | | | | | | | | - Anand B. Karnad
- The University of Texas Health Science Center San Antonio, San Antonio, TX
| | | | | | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | - Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
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Masters GA, Johnson DH, Temin S. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Oncol Pract 2016; 12:90-93. [PMID: 29424582 DOI: 10.1200/jop.2015.008524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gregory A Masters
- Helen F. Graham Cancer Center, Newark, DE; University of Texas Southwestern Medical Center at Dallas, Dallas, TX; and American Society of Clinical Oncology, Alexandria, VA
| | - David H Johnson
- Helen F. Graham Cancer Center, Newark, DE; University of Texas Southwestern Medical Center at Dallas, Dallas, TX; and American Society of Clinical Oncology, Alexandria, VA
| | - Sarah Temin
- Helen F. Graham Cancer Center, Newark, DE; University of Texas Southwestern Medical Center at Dallas, Dallas, TX; and American Society of Clinical Oncology, Alexandria, VA
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Abstract
Inflammatory myofibroblastic tumor (IMT) of the lung is a rare malignancy with few cases reported in the literature. Histologically, it is composed by spindle cells and an infiltrate of inflammatory cells. Children and young, non-smoking adults constitute the majority of cases, the clinical behavior ranges from a benign entity to a malignant process with rapid recurrence and metastatic progression. We present a case of epithelioid inflammatory myofibroblastic sarcoma (EIMS) of the pleura, a malignant variant of IMT, which was initially treated with debulking surgical resection followed by systemic chemotherapy. The tumor was found to have an anaplastic lymphoma kinase (ALK) gene rearrangement. An ALK directed tyrosine kinase inhibitor was used with an impressive response, the patient remains in remission nearly 1 year after presentation. The pathogenesis, pathologic findings, clinical behavior and imaging of pulmonary EIMS are discussed.
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Affiliation(s)
- Daniel E Sarmiento
- 1 Department of Surgery, 2 Department of Pathology, Christiana Care Health System, Newark, DE 19718, USA ; 3 Department of Medical Oncology, 4 Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute, Newark, DE 19713, USA
| | - Jessica A Clevenger
- 1 Department of Surgery, 2 Department of Pathology, Christiana Care Health System, Newark, DE 19718, USA ; 3 Department of Medical Oncology, 4 Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute, Newark, DE 19713, USA
| | - Gregory A Masters
- 1 Department of Surgery, 2 Department of Pathology, Christiana Care Health System, Newark, DE 19718, USA ; 3 Department of Medical Oncology, 4 Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute, Newark, DE 19713, USA
| | - Thomas L Bauer
- 1 Department of Surgery, 2 Department of Pathology, Christiana Care Health System, Newark, DE 19718, USA ; 3 Department of Medical Oncology, 4 Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute, Newark, DE 19713, USA
| | - Brian T Nam
- 1 Department of Surgery, 2 Department of Pathology, Christiana Care Health System, Newark, DE 19718, USA ; 3 Department of Medical Oncology, 4 Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute, Newark, DE 19713, USA
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Masters GA, Temin S, Azzoli CG, Giaccone G, Baker S, Brahmer JR, Ellis PM, Gajra A, Rackear N, Schiller JH, Smith TJ, Strawn JR, Trent D, Johnson DH. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2015; 33:3488-515. [PMID: 26324367 PMCID: PMC5019421 DOI: 10.1200/jco.2015.62.1342] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non-small-cell lung cancer (NSCLC). METHODS An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. RESULTS This guideline update reflects changes in evidence since the previous guideline. RECOMMENDATIONS There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki.
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Affiliation(s)
- Gregory A Masters
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sarah Temin
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Christopher G Azzoli
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Giuseppe Giaccone
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Sherman Baker
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Julie R Brahmer
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Peter M Ellis
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Ajeet Gajra
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Nancy Rackear
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Joan H Schiller
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - Thomas J Smith
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - John R Strawn
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David Trent
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
| | - David H Johnson
- Gregory A. Masters, Helen F. Graham Cancer Center, Newark, DE; Sarah Temin, American Society of Clinical Oncology, Alexandria; Sherman Baker Jr, Virginia Commonwealth University; David Trent, Virginia Cancer Center, Richmond, VA; Christopher G. Azzoli, Massachusetts General Hospital Cancer Center, Boston, MA; Giuseppe Giaccone, Lombardi Cancer Center, Georgetown University, Washington, DC; Julie R. Brahmer and Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD; Peter M. Ellis, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Ajeet Gajra, Upstate Medical University, Syracuse, NY; Nancy Rackear, Uniting Against Lung Cancer, Fort Lauderdale, FL; Joan H. Schiller, University of Texas Southwestern; David H. Johnson, University of Texas Southwestern Medical Center at Dallas, Dallas; and John R. Strawn, patient representative, Houston, TX
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Guarino MJ, Starodub A, Masters GA, Heist RS, Messersmith WA, Bardia A, Ocean AJ, Thomas SS, Maliakal PP, Wegener WA, Sharkey RM, Wilhelm F, Goldenberg DM. Therapy of advanced metastatic lung cancer with an anti-Trop-2-SN-38 antibody-drug conjugate (ADC), sacituzumab govitecan (IMMU-132): Phase I/II clinical experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael J. Guarino
- Helen F. Graham Cancer Center at Christiana Care Health System, Newark, DE
| | | | | | | | | | - Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - David M. Goldenberg
- Center for Molecular Medicine and Immunology/Garden State Cancer Center and Immunomedics Inc., Morris Plains, NJ
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Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom M, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol 2015; 33:1660-5. [PMID: 25732163 DOI: 10.1200/jco.2014.57.3105] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of maintenance sunitinib after chemotherapy for small-cell lung cancer (SCLC). PATIENTS AND METHODS The Cancer and Leukemia Group B 30504 trial was a randomized, placebo-controlled, phase II study that enrolled patients before chemotherapy (cisplatin 80 mg/m(2) or carboplatin area under the curve of 5 on day 1 plus etoposide 100 mg/m(2) per day on days 1 to 3 every 21 days for four to six cycles). Patients without progression were randomly assigned 1:1 to placebo or sunitinib 37.5 mg per day until progression. Cross-over after progression was allowed. The primary end point was progression-free survival (PFS) from random assignment for maintenance placebo versus sunitinib using a one-sided log-rank test with α = .15; 80 randomly assigned patients provided 89% power to detect a hazard ratio (HR) of 1.67. RESULTS One hundred forty-four patients were enrolled; 138 patients received chemotherapy. Ninety-five patients were randomly assigned; 10 patients did not receive maintenance therapy (five on each arm). Eighty-five patients received maintenance therapy (placebo, n = 41; sunitinib, n = 44). Grade 3 adverse events with more than 5% incidence were fatigue (19%), decreased neutrophils (14%), decreased leukocytes (7%), and decreased platelets (7%) for sunitinib and fatigue (10%) for placebo; grade 4 adverse events were GI hemorrhage (n = 1) and pancreatitis, hypocalcemia, and elevated lipase (n = 1; all in same patient) for sunitinib and thrombocytopenia (n = 1) and hypernatremia (n = 1) for placebo. Median PFS on maintenance was 2.1 months for placebo and 3.7 months for sunitinib (HR, 1.62; 70% CI, 1.27 to 2.08; 95% CI, 1.02 to 2.60; one-sided P = .02). Median overall survival from random assignment was 6.9 months for placebo and 9.0 months for sunitinib (HR, 1.28; 95% CI, 0.79 to 2.10; one-sided P = .16). Three sunitinib and no placebo patients achieved complete response during maintenance. Ten (77%) of 13 patients evaluable after cross-over had stable disease on sunitinib (6 to 27 weeks). CONCLUSION Maintenance sunitinib was safe and improved PFS in extensive-stage SCLC.
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Affiliation(s)
- Neal E Ready
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY.
| | - Herbert H Pang
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Lin Gu
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Otterson
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Sachdev P Thomas
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Antonius A Miller
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Maria Baggstrom
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Masters
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Stephen L Graziano
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Crawford
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Bogart
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Everett E Vokes
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
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Masters GA, Krilov L, Bailey HH, Brose MS, Burstein H, Diller LR, Dizon DS, Fine HA, Kalemkerian GP, Moasser M, Neuss MN, O'Day SJ, Odenike O, Ryan CJ, Schilsky RL, Schwartz GK, Venook AP, Wong SL, Patel JD. Clinical Cancer Advances 2015: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2015; 33:786-809. [DOI: 10.1200/jco.2014.59.9746] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gregory A. Masters
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Lada Krilov
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Howard H. Bailey
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Marcia S. Brose
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Harold Burstein
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Lisa R. Diller
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Don S. Dizon
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Howard A. Fine
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Gregory P. Kalemkerian
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Mark Moasser
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Michael N. Neuss
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Steven J. O'Day
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Olatoyosi Odenike
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Charles J. Ryan
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Richard L. Schilsky
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Gary K. Schwartz
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Alan P. Venook
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Sandra L. Wong
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
| | - Jyoti D. Patel
- Gregory Masters, Helen F. Graham Cancer Center, Newark, DE; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Howard H. Bailey, University of Wisconsin Hospital and Clinics, Madison, WI; Marcia S. Brose, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Harold Burstein and Lisa R. Diller, Dana-Farber Cancer Institute; Don S. Dizon, Massachusetts General Hospital, Boston, MA; Howard A. Fine, New York University Langone Medical Center; Gary K
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30
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Jalal SI, Hanna NH, Zon R, Masters GA, Borghaei H, Koneru K, Badve SS, Prasad NK, Somaiah N, Wu J, Yu Z, Einhorn LH. Final results of a phase I study of amrubicin and cyclophosphamide in patients with advanced solid organ malignancies: HOG LUN 07-130. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7594] [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)
| | - Nasser H. Hanna
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
| | - Robin Zon
- Michiana Hematology Oncology PC, South Bend, IN
| | | | | | | | | | - Nagendra K Prasad
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology. The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jingwei Wu
- Indiana University School of Medicine, Indianapolis, IN
| | - Zhangsheng Yu
- Indiana University School of Medicine, Indianapolis, IN
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31
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Sanborn RE, Patel JD, Masters GA, Jayaram N, Stephens AW, Guarino MJ, Misleh JG, Williams CE, Wu J, Hanna NH. A randomized double-blind phase II trial of platinum (P) plus etoposide (E) with or without concurrent ZD6474 (Z) in patients (pts) with previously untreated extensive-stage (ES) small cell lung cancer (SCLC): Hoosier Oncology Group LUN06-113. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rachel E. Sanborn
- Earle A. Chiles Research Institute and Providence Cancer Center, Portland, OR
| | - Jyoti D. Patel
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory A. Masters
- Thomas Jefferson University Medical School, Medical Oncology Hematology Consultants, PA, Newark, DE
| | | | | | | | | | | | | | - Nasser H. Hanna
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
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32
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Patel JD, Krilov L, Adams S, Aghajanian C, Basch E, Brose MS, Carroll WL, de Lima M, Gilbert MR, Kris MG, Marshall JL, Masters GA, O'Day SJ, Polite B, Schwartz GK, Sharma S, Thompson I, Vogelzang NJ, Roth BJ. Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2014; 32:129-60. [DOI: 10.1200/jco.2013.53.7076] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A MESSAGE FROM ASCO'S PRESIDENTSince its founding in 1964, the American Society of Clinical Oncology (ASCO) has been committed to improving cancer outcomes through research and the delivery of quality care. Research is the bedrock of discovering better treatments—providing hope to the millions of individuals who face a cancer diagnosis each year.The studies featured in “Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology” represent the invaluable contributions of thousands of patients who participate in clinical trials and the scientists who conduct basic and clinical research. The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable.The scientific process is thoughtful, deliberate, and sometimes slow, but each advance, while helping patients, now also points toward new research questions and unexplored opportunities. Both dramatic and subtle breakthroughs occur so that progress against cancer typically builds over many years. Success requires vision, persistence, and a long-term commitment to supporting cancer research and training.Our nation's longstanding investment in federally funded cancer research has contributed significantly to a growing array of effective new treatments and a much deeper understanding of the drivers of cancer. But despite this progress, our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials. This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients.Despite this extremely challenging economic environment, we continue to make progress. Maintaining and accelerating that progress require that we keep our eyes on the future and pursue a path that builds on the stunning successes of the past. We must continue to show our policymakers the successes in cancer survival and quality of life (QOL) they have enabled, emphasizing the need to sustain our national investment in the remarkably productive US cancer research enterprise.We must also look to innovative methods for transforming how we care for—and learn from—patients with cancer. Consider, for example, that fewer than 5% of adult patients with cancer currently participate in clinical trials. What if we were able to draw lessons from the other 95%? This possibility led ASCO this year to launch CancerLinQ, a groundbreaking health information technology initiative that will provide physicians with access to vast quantities of clinical data about real-world patients and help achieve higher quality, higher value cancer care.As you read the following pages, I hope our collective progress against cancer over the past year inspires you. More importantly, I hope the pride you feel motivates you to help us accelerate the pace of scientific advancement.Clifford A. Hudis, MD, FACPPresidentAmerican Society of Clinical Oncology
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Affiliation(s)
- Jyoti D. Patel
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Lada Krilov
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Sylvia Adams
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Carol Aghajanian
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Ethan Basch
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Marcia S. Brose
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - William L. Carroll
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Marcos de Lima
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Mark R. Gilbert
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Mark G. Kris
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - John L. Marshall
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Gregory A. Masters
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Steven J. O'Day
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Blasé Polite
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Gary K. Schwartz
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Sunil Sharma
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Ian Thompson
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Nicholas J. Vogelzang
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
| | - Bruce J. Roth
- Jyoti D. Patel, Northwestern University; Blasé Polite, University of Chicago Medicine, Chicago, IL; Lada Krilov, American Society of Clinical Oncology, Alexandria, VA; Sylvia Adams and William L. Carroll, New York University Cancer Institute; Carol Aghajanian, Mark G. Kris, and Gary K. Schwartz, Memorial Sloan-Kettering Cancer Center, New York, NY; Ethan Basch, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Marcia S. Brose, University of Pennsylvania Abramson Cancer
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Goss GD, O'Callaghan C, Lorimer I, Tsao MS, Masters GA, Jett J, Edelman MJ, Lilenbaum R, Choy H, Khuri F, Pisters K, Gandara D, Kernstine K, Butts C, Noble J, Hensing TA, Rowland K, Schiller J, Ding K, Shepherd FA. Gefitinib versus placebo in completely resected non-small-cell lung cancer: results of the NCIC CTG BR19 study. J Clin Oncol 2013; 31:3320-6. [PMID: 23980091 DOI: 10.1200/jco.2013.51.1816] [Citation(s) in RCA: 254] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Survival of patients with completely resected non-small-cell lung cancer (NSCLC) is unsatisfactory, and in 2002, the benefit of adjuvant chemotherapy was not established. This phase III study assessed the impact of postoperative adjuvant gefitinib on overall survival (OS). PATIENTS AND METHODS Patients with completely resected (stage IB, II, or IIIA) NSCLC stratified by stage, histology, sex, postoperative radiotherapy, and chemotherapy were randomly assigned (1:1) to receive gefitinib 250 mg per day or placebo for 2 years. Study end points were OS, disease-free survival (DFS), and toxicity. RESULTS As a result of early closure, 503 of 1,242 planned patients were randomly assigned (251 to gefitinib and 252 to placebo). Baseline factors were balanced between the arms. With a median of 4.7 years of follow-up (range, 0.1 to 6.3 years), there was no difference in OS (hazard ratio [HR], 1.24; 95% CI, 0.94 to 1.64; P = .14) or DFS (HR, 1.22; 95% CI, 0.93 to 1.61; P = .15) between the arms. Exploratory analyses demonstrated no DFS (HR, 1.28; 95% CI, 0.92 to 1.76; P = .14) or OS benefit (HR, 1.24; 95% CI, 0.90 to 1.71; P = .18) from gefitinib for 344 patients with epidermal growth factor receptor (EGFR) wild-type tumors. Similarly, there was no DFS (HR, 1.84; 95% CI, 0.44 to 7.73; P = .395) or OS benefit (HR, 3.16; 95% CI, 0.61 to 16.45; P = .15) from gefitinib for the 15 patients with EGFR mutation-positive tumors. Adverse events were those expected with an EGFR inhibitor. Serious adverse events occurred in ≤ 5% of patients, except infection, fatigue, and pain. One patient in each arm had fatal pneumonitis. CONCLUSION Although the trial closed prematurely and definitive statements regarding the efficacy of adjuvant gefitinib cannot be made, these results indicate that it is unlikely to be of benefit.
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Affiliation(s)
- Glenwood D Goss
- Glenwood D. Goss and Ian Lorimer, Ottawa Hospital Cancer Center, University of Ottawa, Ottawa; Chris O'Callaghan and Keyue Ding, NCIC CTG, Queens University, Kingston; Ming-Sound Tsao and Frances A. Shepherd, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto; Jonathan Noble, Northeast Cancer Center, Sudbury, Ontario; Charles Butts, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Gregory A. Masters, Christiana Care's Helen F. Graham Cancer Center, Newark, DE; James Jett, National Jewish Health, Division of Oncology, Denver, CO; Martin J. Edelman, Greenebaum Cancer Center, University of Maryland, Baltimore, MD; Rogerio Lilenbaum, Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT; Hak Choy, Kemp Kernstine, and Joan Schiller, The University of Texas, Southwestern Medical Center, Dallas; Katherine Pisters, The University of Texas MD Anderson Cancer Center, Houston, TX; Fadlo Khuri, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA; David Gandara, University of California, Davis Cancer Center, Sacramento, CA; Thomas A. Hensing, NorthShore University Health System, The University of Chicago, Chicago; and Kendrith Rowland, Carle Cancer Center, Urbana, IL
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Abstract
Stage III non-small cell lung cancer represents a heterogeneous group of patients who are best managed with a multidisciplinary approach, including evaluation for surgical, radiation, and chemotherapeutic options.
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Affiliation(s)
- Anthony Scarpaci
- Medical Oncology, Albert Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA.
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Bradley JD, Paulus R, Komaki R, Masters GA, Forster K, Schild SE, Bogart J, Garces YI, Narayan S, Kavadi V, Nedzi LA, Michalski JM, Johnson D, MacRae RM, Curran WJ, Choy H. A randomized phase III comparison of standard-dose (60 Gy) versus high-dose (74 Gy) conformal chemoradiotherapy with or without cetuximab for stage III non-small cell lung cancer: Results on radiation dose in RTOG 0617. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7501] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7501 Background: The first objective of RTOG 0617 was to compare the overall survival(OS) of patients(pts) treated with standard-dose(SD)(60Gy) versus high-dose(HD)(74Gy) radiotherapy with concurrent chemotherapy(CT). Methods: This Phase III Intergroup trial randomized 464 pts with Stage III NSCLC to the SD(60Gy) vs. HD(74Gy) arms prior to closure of the HD arm. Concurrent CT included weekly paclitaxel(45 mg/m2) and carboplatin(AUC=2). Pts randomized to cetuximab received a 400 mg/m2 loading dose on Day 1 followed by weekly doses of 250 mg/m2. All pts were to receive consolidation CT. We are reporting the final results on radiation dose. Results: 464 pts were accrued prior to closure of the HD arm in 6/11, of which 419 were eligible for analysis. Median follow up was 17.2 months. There were 2 and 10 grade 5 treatment-related adverse events(AEs) on the SD and HD arms, respectively. Grade 3+AEs were 74.2% and 78.2% on SD and HD arms, respectively (p=0.34). The median survival times and 18-month OS rates for the SD and HD arms were 28.7 vs 19.5 months, and 66.9% vs 53.9% respectively (p=0.0007). The primary cause of death was lung cancer (72.2% vs 73.5%)(p=0.84). Local failure rates at 18 months were 25.1% vs 34.3% for SD and HD patients, respectively(p=0.03). Local-regional and distant failures at 18 months were 35.3% vs 44%(p=0.04) and 42.4% vs 47.8%(p=0.16) for SD and HD arms, respectively. Factors predictive of less favorable OS on multivariate analysis were higher radiation dose, higher esophagitis/dysphagia grade, greater gross tumor volume, and heart volume >5 Gy. Conclusions: In this setting of chemoradiation for locally-advanced Stage III NSCLC, 60 Gy is superior to 74 Gy in terms of OS and local-regional control. The effect of the anti-EGFR antibody (cetuximab) awaits further follow up. This project was supported by RTOG grant U10 CA21661, CCOP grant U10 CA37422, and ATC U24 CA 81647 from the National Cancer Institute (NCI) and Eli Lilly and Company. Clinical trial information: NCT00533949.
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Affiliation(s)
- Jeffrey D Bradley
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rebecca Paulus
- Radiation Therapy Oncology Group, Statistical Center, Philadelphia, PA
| | - Ritsuko Komaki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Jeff M. Michalski
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - Hak Choy
- The University of Texas Southwestern Medical Center, Dallas, TX
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Ready N, Pang H, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom MQ, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy with or without maintenance sunitinib for untreated extensive-stage small cell lung cancer: A randomized, placebo controlled phase II study CALGB 30504 (ALLIANCE). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7506 Background: Sunitinib (S) inhibits small cell lung cancer (SCLC) targets VEGFR1-3, PDGFR, and KIT. We tested whether giving S after chemotherapy (C) for extensive stage SCLC improves progression free survival (PFS). Methods: CALGB 30504 was a randomized, double-blind, placebo (P) controlled phase II study for untreated SCLC, performance status 0-2, adequate organ function, and no S risk factors: bleeding, hypertension, or brain metastases. Enrollment was prior to C: cisplatin 80 mg/m2 or carboplatin AUC5 day 1 plus etoposide 100 mg/m2days 1-3 every 21 days 4-6 cycles. Patients without progression after C were stratified cisplatin vs carboplatin, and 4-5 vs 6 cycles C, and randomized 1:1 to P or S 37.5 mg daily until progression assessed every 6 weeks. Prophylactic cranial irradiation was offered to responders (CR or PR) to start about 4-6 weeks after C. S was held during radiation. Crossover from P to S was allowed at progression. Primary endpoint was PFS (from time of randomization) for maintenance (M) P vs S using a 1-sided log rank test with a=0.15; 80 randomized and treated patients provide »89% power to detect a hazard ratio (HR) of 1.67. Results: Between 5/09 and 12/11, 144 enrolled and 138 received C. Ninety five were randomized to P vs S; 10 did not receive M due to progression, refusal, and AE (5 each arm). Eighty five received M, 41 P and 44 S. Demographics were balanced. M toxicities grade > 3 and incidence > 5% included (%): grade 3 (S: fatigue 19, neutrophils 10, leukocytes 7, platelets 7) (P: fatigue 5); grade 4 (S: 1case GI hemorrhage, 1case lipase) P zero; grade 5 zero both arms. Efficacy (90% CI): PFS on maintenance after C was P 2.3 mo (CI: 1.7-2.6) and S 3.8 mo (2.7-4.4) (HR=1.54, CI 1.03-2.32, p=0.04). Overall survival (OS) was P 6.7 mo (5.5-9.5) and S 8.8 mo (8.0-9.8) (HR=1.10, CI 0.71-1.70, p=0.36). At progression on P, 17 received S and among 14 evaluable 10 (71%) had stable disease receiving 2-9 cycles S. Conclusions: The primary objective was met showing improved PFS for maintenance S. There was a non-significant trend toward improved OS despite crossover design. S was well tolerated. Further study of sunitinib after chemotherapy for SCLC is justified. Clinical trial information: NCT00453154.
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Affiliation(s)
- Neal Ready
- Duke University Medical Center, Durham, NC
| | | | - Lin Gu
- Cancer and Leukemia Group B Statistical Center, Durham, NC
| | - Gregory Alan Otterson
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | | | | | - Everett E. Vokes
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
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Masters GA. Multidisciplinary care of the cancer patient. Surg Oncol Clin N Am 2013; 22:xiii-xiv. [PMID: 23453343 DOI: 10.1016/j.soc.2012.12.010] [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: 10/27/2022]
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Guarino MJ, Masters GA, Biggs D, Schneider C, Misleh JG, Simpson PS, Suppiah K, Wozniak TF, Grubbs SS. Phase II trial of carboplatin, pemetrexed, and bevacizumab in metastatic nonsquamous (NSC) lung cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18122] [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
e18122 Background: The trial was designed to examine PFS, OS and toxicities of a novel 3 drug combination in advanced NSC lung cancer. The first patient was entered 3/08 and the last in 5/11. Methods: Treatment consisted of Carboplatin AUC 5,Pemetrexed %00mg/m2, Bevacizumab 15mg/kg q21d x 6 cycles; then Bev maintenaince q3wk for up to one year. Eligibile pts. had metastatic non-squamous NSC lung ca, EGOG 0-1, first line Rx. Fifty patients were entered, all available for response and toxicity analysis: 26 M, median age 64, 45 white. Results: 52% RR by RECIST (2% CR, 50% PR); 26% SD. Median PFS 24 wks; median overall survival will be in excess of 49 weeks. 62% of patients received all planned 6 cycles and went on to maintenance. Treatment was out-patient and well tolerated with modest toxicities, including 2 DVT's, one PE, one TIA and one episode of F+N Conclusions: The 3 drug combination of Carboplatin, Pemetrxed and Bevacizumab for met NSC lung cancer is effective and well tolerated; and is a resonable choice of Rx for patients with non-squamous tumors hoping to avoid more neurotoxic or myelotoxic options.
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Affiliation(s)
| | | | - David Biggs
- Helen F. Graham Cancer Center, Christiana Care, Newark, DE
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Gervais R, Hainsworth JD, Blais N, Besse B, Laskin J, Hamm JT, Lipton A, Albain KS, Masters GA, Natale RB, Selaru P, Kim ST, Chao RC, Page RD. Phase II study of sunitinib as maintenance therapy in patients with locally advanced or metastatic non-small cell lung cancer. Lung Cancer 2011; 74:474-80. [DOI: 10.1016/j.lungcan.2011.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/15/2011] [Accepted: 05/01/2011] [Indexed: 10/18/2022]
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Masters GA, Wang X, Hodgson L, Shea T, Vokes E, Green M. A phase II trial of high dose carboplatin and paclitaxel with G-CSF and peripheral blood stem cell support followed by surgery and/or chest radiation in patients with stage III non-small cell lung cancer: CALGB 9531. Lung Cancer 2011; 74:258-63. [PMID: 21529989 DOI: 10.1016/j.lungcan.2011.03.015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 03/18/2011] [Accepted: 03/27/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE We designed a phase II trial to evaluate the efficacy and tolerability of high dose induction chemotherapy with carboplatin and paclitaxel with G-CSF and stem cell support followed by surgical resection and/or chest radiotherapy in patients with stage III non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients had pathologically confirmed stage IIIA-IIIB NSCLC, adequate end-organ function, no prior chemotherapy or radiation, and performance status 0-1. Peripheral stem cells were mobilized with G-CSF stimulation on days 1-5 and collected prior to chemotherapy. Chemotherapy consisted of 2 cycles of paclitaxel 250 mg/m(2) over 3h and carboplatin at an AUC 18 on days 11 and 32, each followed by stem cell reinfusion. Stable and responding patients went on to surgical resection (in patients deemed resectable) followed by post-operative radiation, or to conventional chest radiotherapy to 66 Gy in unresectable patients. RESULTS Twelve patients (11 eligible) were accrued from 1996 to 1999. The 11 patients were predominately male (64%), white (82%), of performance status 0 (64%), and with weight loss less than 5% (55%). The median age was 51 (range 31-63). Ten (10) patients (91%) experienced grade 4 toxicity. There were no lethal toxicities. Grade 3-4 toxicities most commonly reported included: platelets (100%), lymphocytopenia (91%), leukopenia (91%), neutropenia (73%), anemia (55%), pain (45%), and nausea (27%). Three patients (27%) had a partial response to induction chemotherapy. Of the 11 patients, 7 underwent surgical exploration, and 10 received radiation. Two patients were completely resected, 3 patients had incomplete resections, and 2 patients had no resection. There were 4 complete responses and 3 partial responses following surgery and/or radiation. The median overall survival time was 17.8 months. The median failure-free survival time was 8.3 months. One-year and 2-year overall survival are estimated at 64% and 27%, respectively. CONCLUSIONS High dose induction chemotherapy with carboplatin and paclitaxel and stem cell support in patients with stage IIIA-IIIB NSCLC produced response rates and survival similar to standard therapy. Excessive toxicity (and cost) suggests that this approach does not merit further investigation.
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Affiliation(s)
- Gregory A Masters
- Thomas Jefferson University Medical School, Medical Oncology Hematology Consultants, Helen Graham Cancer Center, 4701 Ogletown-Stanton Rd, Suite 3400, Newark, DE 19713, USA.
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Socinski MA, Blackstock AW, Bogart JA, Wang X, Munley M, Rosenman J, Gu L, Masters GA, Ungaro P, Sleeper A, Green M, Miller AA, Vokes EE. Randomized phase II trial of induction chemotherapy followed by concurrent chemotherapy and dose-escalated thoracic conformal radiotherapy (74 Gy) in stage III non-small-cell lung cancer: CALGB 30105. J Clin Oncol 2008; 26:2457-63. [PMID: 18487565 DOI: 10.1200/jco.2007.14.7371] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate 74 Gy thoracic radiation therapy (TRT) with induction and concurrent chemotherapy in stage IIIA/B non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with stage IIIA/B NSCLC were randomly assigned to induction chemotherapy with either carboplatin (area under the curve [AUC], 6; days 1 and 22) with paclitaxel (225 mg/m(2); days 1 and 22; arm A) or carboplatin (AUC, 5; days 1 and 22) with gemcitabine (1,000 mg/m(2); days 1, 8, 22, and 29; arm B). On day 43, arm A received weekly carboplatin (AUC, 2) and paclitaxel (45 mg/m(2)) while arm B received biweekly gemcitabine (35 mg/m(2)) both delivered concurrently with 74 Gy of TRT utilizing three-dimensional treatment planning. The primary end point was survival at 18 months. RESULTS Forty-three and 26 patients were accrued to arms A and B, respectively. Arm B was closed prematurely due to a high rate of grade 4 to 5 pulmonary toxicity. The overall response rate was 66.6% (95% CI, 50.5% to 80.4%) and 69.2% (95% CI, 48.2% to 85.7%) on arm A and B, respectively. The median survival time (MST) and 1-year survival rate was 24.3 months (95% CI, 12.3 to 36.4) and 66.7% (95% CI, 50.3 to 78.7) and 12.5 months (95% CI, 9.4 to 27.6) and 50.0% (95% CI, 29.9 to 67.2) for arms A and B, respectively. The primary toxicities included esophagitis, pulmonary, and fatigue. CONCLUSION Arm A reached the primary end point with an estimated MST longer than 18 months and will be compared with a standard dose of TRT in a planned randomized phase III trial in the United States cooperative groups.
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Affiliation(s)
- Mark A Socinski
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, NC 27599, USA.
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Edelman MJ, Watson D, Wang X, Morrison C, Kratzke RA, Jewell S, Hodgson L, Mauer AM, Gajra A, Masters GA, Bedor M, Vokes EE, Green MJ. Eicosanoid modulation in advanced lung cancer: cyclooxygenase-2 expression is a positive predictive factor for celecoxib + chemotherapy--Cancer and Leukemia Group B Trial 30203. J Clin Oncol 2008; 26:848-55. [PMID: 18281656 DOI: 10.1200/jco.2007.13.8081] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Increased expression of eicosanoids in cancer has been associated with adverse prognosis. We performed a randomized phase II trial to test the hypothesis that inhibitors of two eicosanoid pathways (cyclooxygenase-2 [COX-2], celecoxib and 5-lipoxygenase [5-LOX], zileuton) added to chemotherapy would improve outcome in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with advanced NSCLC, a performance status of 0 to 2, and no prior therapy were eligible. All patients received carboplatin area under the curve (AUC) 5.5 mg/mL x min day 1 + gemcitabine (1,000 mg/m(2)) days 1 and 8. Patients were randomly assigned to: (a) zileuton 600 mg PO qid, (b) celecoxib 400 mg PO bid, or (c) celecoxib and zileuton at the same doses. Immunohistochemical staining for COX-2 and 5-LOX was performed without knowledge of outcomes. RESULTS One hundred forty patients were entered and 134 were eligible and treated. There was no survival difference between the arms. COX-2 expression was a negative prognostic marker for overall survival (OS; hazard ratio [HR] = 2.51, P = .019 for index >or= 4; HR = 4.16, P = .005 for index = 9) for patients not receiving celecoxib. Patients with increased COX-2 expression (index >or= 4), receiving celecoxib had better survival than did COX-2-expressing patients not receiving drug (HR = .342, P = .005 for OS; HR = .294, P = .002 for failure-free survival). Multivariate analysis confirmed the interaction of COX-2 and celecoxib on survival. 5-LOX expression was neither prognostic nor predictive. CONCLUSION This study failed to demonstrate the value of dual eicosanoid inhibition or benefit from either agent alone in addition to chemotherapy. However, a prospectively defined subset analysis suggests an advantage for celecoxib and chemotherapy for patients with moderate to high COX-2 expression.
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Affiliation(s)
- Martin J Edelman
- University of Maryland Greenebaum Cancer Center, Division of Hematology/Oncology (111H), 22 South Greene Street, Baltimore, MD 21201-1595, USA.
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Rudin CM, Salgia R, Wang X, Hodgson LD, Masters GA, Green M, Vokes EE. Randomized phase II Study of carboplatin and etoposide with or without the bcl-2 antisense oligonucleotide oblimersen for extensive-stage small-cell lung cancer: CALGB 30103. J Clin Oncol 2008; 26:870-6. [PMID: 18281659 DOI: 10.1200/jco.2007.14.3461] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the efficacy and toxicity of carboplatin, etoposide, and the bcl-2 antisense oligonucleotide oblimersen as initial therapy for extensive-stage small-cell lung cancer (ES-SCLC). bcl-2 has been implicated as a key factor in SCLC oncogenesis and chemotherapeutic resistance. PATIENTS AND METHODS A 3:1 randomized phase II study was performed to evaluate carboplatin and etoposide with (arm A) or without oblimersen (arm B) in 56 assessable patients with chemotherapy-naïve ES-SCLC. Outcome measures including toxicity, objective response rate, complete response rate, failure-free survival, overall survival, and 1-year survival rate. RESULTS Oblimersen was associated with slightly more grade 3 to 4 hematologic toxicity (88% v 60%; P = .05). Response rates were 61% (95% CI, 45% to 76%) for arm A and 60% (95% CI, 32% to 84%) for arm B. The percentage of patients alive at 1 year was 24% (95% CI, 12% to 40%) with oblimersen, and 47% (95% CI, 21% to 73%) without oblimersen. Hazard ratios for failure-free survival (1.79; P = .07) and overall survival (2.13; P = .02) suggested worse outcome for patients receiving oblimersen. These results hold when adjusted for other prognostic factors, such as weight loss, in multivariate regression analysis. CONCLUSION Despite extensive data supporting a critical role for Bcl-2 in chemoresistance in SCLC, addition of oblimersen to a standard regimen for this disease did not improve any clinical outcome measure. Emerging data from several groups suggest that this lack of efficacy may be due to insufficient suppression of Bcl-2 in vivo. Additional evaluation of this agent in SCLC is not warranted.
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Affiliation(s)
- Charles M Rudin
- Sidney Kimmel Comprehensive Cancer Center, David H. Koch Cancer Research Building, Suite 544, 1550 Orleans St, Baltimore, MD 21231, USA.
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Cella D, Eton D, Hensing TA, Masters GA, Parasuraman B. Relationship Between Symptom Change, Objective Tumor Measurements, and Performance Status During Chemotherapy for Advanced Lung Cancer. Clin Lung Cancer 2008; 9:51-8. [DOI: 10.3816/clc.2008.n.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Antimicrobial drug resistance is a significant cause of avoidable morbidity and mortality. Inappropriate prescribing of antimicrobials is acknowledged as a key determinant of this phenomenon. Many approaches are advocated for reducing this inappropriate prescribing, including regulatory, professional and educational interventions. Mass media campaigns are often suggested as a useful tool in managing public expectations, but the evidence to support this is weak, as no controlled studies of such campaigns exist. Evaluating such campaigns is problematic, and uncontrolled observations are misleading. We report here the first controlled study of such an intervention in the use of antimicrobials. METHODS Two sequential mass media campaigns, providing information on the appropriate use of antimicrobials, were conducted during early 2004 and 2005 in the North East of England. These messages were articulated in the campaign by the cartoon character 'Moxy Malone'. The campaigns were supported by printed materials, and in parts of this area, with professional education and prescribing support. A retrospective controlled before-after study was conducted, examining the effects on observed prescribing of antimicrobials for the populations covered by these two cycles of mass media campaigns. These populations were controlled with matched populations in the North of England. The primary outcome examined was prescribing rates (items) for all microbial agents for these populations, corrected for population structure (STAR-PU). A repeated measures analysis of variance (ANOVA) was used to analyse factors that had a possible effect on the prescribing of antibacterial drugs. This was supported by a survey of primary care organizations (PCOs) of all interventions undertaken around antimicrobial use in the intervention and comparison populations. RESULTS In this retrospective study, there was incomplete reporting of adjuvant interventions undertaken by the PCOs intervention and comparison areas, so isolating the intervention, and attributing cause and effect is difficult. In this pragmatic evaluation the campaign was found to significantly reduce the volume of antibacterial drugs during the winter months of the intervention years. There were 21.7 fewer items prescribed per 1000 population (P < 0.0005), for the intervention populations over these winter months, equivalent to a 5.8% absolute reduction in prescribing. CONCLUSIONS Mass media campaigns have a role in changing antimicrobial prescribing practice.
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Affiliation(s)
- M F Lambert
- Department of Health Sciences, University of York, York YO10 5DD, UK.
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Masters GA, Li S, Dowlati A, Madajewicz S, Langer C, Schiller J, Johnson D. A Phase II Trial of Carboplatin and Gemcitabine with Exisulind (IND #65,056) in Patients with Advanced Non-small Cell Lung Cancer: An Eastern Cooperative Oncology Group Study (E1501). J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30380-4] [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: 10/22/2022]
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Masters GA, Li S, Dowlati A, Madajewicz S, Langer C, Schiller J, Johnson D. A phase II trial of carboplatin and gemcitabine with exisulind (IND #65,056) in patients with advanced non-small cell lung cancer: an Eastern Cooperative Oncology Group study (E1501). J Thorac Oncol 2006; 1:673-8. [PMID: 17409935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Carboplatin and gemcitabine are one standard regimen for patients with advanced non-small cell lung cancer (NSCLC). The oral proapoptotic agent exisulind is a cyclic guanosine monophosphate phosphodiesterase that increases apoptosis in vitro. We performed a phase II trial of carboplatin and gemcitabine with exisulind in patients with advanced NSCLC. METHODS Gemcitabine (1000 mg/m days 1 and 8) and carboplatin (AUC = 5 day 1) were administered every 21 days, with exisulind orally at 250 mg orally twice daily continuously, starting day 1. The primary objective was to evaluate the 18-month survival. Secondary objectives included response rate, progression-free survival, and toxicities. Eligibility included stage IIIB (pleural effusion) or stage IV NSCLC, no previous chemotherapy, and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-1. RESULTS Of 57 eligible patients treated, 34 patients were male and 23 female, 42 had stage IV, six stage IIIB, and nine had recurrent disease. The median age was 63 years (range, 37-83). Twenty-six patients had an ECOG PS of 0 and 31 had a PS of 1. The majority of grade 3-4 toxicities were hematologic. Grade 3-4 nonhematologic toxicity seen in >5% of patients included nausea/vomiting in 16% and fatigue in 23% of patients. The overall response rate was 19.3%. Median progression-free survival was 4.7 months. Median overall survival was 9.0 months. Eighteen-month overall survival was 30%. CONCLUSION The chemotherapy combination of gemcitabine and carboplatin with the oral proapoptotic agent exisulind is generally well tolerated with principally hematologic toxicity. The statistical endpoint of 17 patients alive at 18 months was met, but given ongoing developments in advanced NSCLC, ECOG will not be pursuing additional trials of exisulind in NSCLC.
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Masters GA, Argiris AE, Hahn EA, Beck JT, Rausch PG, Ye Z, Monberg MJ, Bloss LP, Curiel RE, Obasaju CK. A randomized phase II trial using two different treatment schedules of gemcitabine and carboplatin in patients with advanced non-small-cell lung cancer. J Thorac Oncol 2006; 1:19-24. [PMID: 17409822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Gemcitabine and carboplatin combination therapy is an active and tolerable regimen in the treatment of non-small-cell lung cancer (NSCLC). Twenty-eight- and 21-day regimens without day-15 administration of gemcitabine are common; however, it remains unclear which offers the optimal therapeutic index. METHODS This trial evaluated two schedules of the combination of gemcitabine and carboplatin: gemcitabine (1100 mg/m on days 1 and 8) plus carboplatin (area under the curve = 5 on day 8) every 28 days, or gemcitabine (1000 mg/m on days 1 and 8) plus carboplatin (area under the curve = 5 on day 1) every 21 days. Eligible patients in this trial had stage IIIB (with malignant pleural effusion) or stage IV NSCLC with no prior chemotherapy. The primary objective was to evaluate progression-free survival, with secondary objectives of overall survival, response rate, and toxicity. RESULTS One hundred patients were randomized and enrolled from October of 2000 to January of 2002 into this multi-institutional study (48 for the 28-day regimen and 52 for the 21-day regimen). Baseline demographics were well matched, and a majority of patients (85%) enrolled with stage IV disease. Median progression-free survival and response rates were 3.8 months and 22.9%, respectively, with the 28-day regimen, and 4.9 months and 40.4%, respectively, with the 21-day regimen. Median survival was 8.7 months with the 28-day regimen and 8.0 months for the 21-day regimen. One- and 2-year survival rates were 34.7% and 8.7%, respectively, with the 28-day regimen, and 36.5% and 16.8%, respectively, with the 21-day regimen. Differences in progression-free survival (log-rank statistic, p = 0.5786), response rate (Fisher's exact test, p = 0.0859) and overall survival (log-rank statistic, p = 0.3568) were not statistically significant. Grade 3 to 4 hematologic toxicities occurred with a greater frequency in the 21-day regimen. No grade 3 to 4 nonhematologic toxicity (except nausea/vomiting with the 28-day regimen) was observed in more than 10% of patients in either treatment arm. CONCLUSION Gemcitabine plus carboplatin is active and well tolerated in advanced NSCLC. Both regimens may be considered for further study. Although the 21-day regimen appeared to be associated with preferable outcomes, differences between treatment groups were not statistically significant.
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Masters GA, Argiris AE, Hahn EA, Beck JT, Rausch PG, Ye Z, Monberg MJ, Bloss LP, Curiel RE, Obasaju CK. A Randomized Phase II Trial Using Two Different Treatment Schedules of Gemcitabine and Carboplatin in Patients with Advanced Non–Small-Cell Lung Cancer. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31508-2] [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: 11/24/2022]
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Masters GA. Multidisciplinary Approach to Lung Cancer. Hematol Oncol Clin North Am 2005; 19:xi-xii. [PMID: 15833402 DOI: 10.1016/j.hoc.2005.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gregory A Masters
- Medical Oncology Hematology Consultants, Helen Graham Cancer Center, 4701 Ogletown-Stanton Road, Suite 2200, Newark, DE 19713, USA
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