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Hsieh K, Hotca AE, Dickstein DR, Lehrer EJ, Hsieh C, Gupta V, Sindhu KK, Liu JT, Reed SH, Chhabra A, Misiukiewicz K, Roof S, Kahn MN, Kirke D, Urken M, Posner M, Genden E, Bakst RL. Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma. Adv Radiat Oncol 2024; 9:101418. [PMID: 38778826 PMCID: PMC11110036 DOI: 10.1016/j.adro.2023.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/30/2023] [Indexed: 05/25/2024] Open
Abstract
Purpose For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy. Methods and Materials We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival. Results The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention. Conclusions Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.
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Affiliation(s)
- Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Elena Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Celina Hsieh
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jerry T. Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel H. Reed
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott Roof
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed Nazir Kahn
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diana Kirke
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Urken
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Genden
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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Bloom JR, Rodriguez-Russo C, Hsieh K, Dickstein DR, Sheu RD, Jain M, Moshier E, Liu J, Gupta V, Kirke DN, Roof S, Misiukiewicz K, Posner M, Bakst R, Sindhu KK, Sharma S. Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic. Curr Oncol 2024; 31:436-446. [PMID: 38248114 PMCID: PMC10814981 DOI: 10.3390/curroncol31010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.
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Affiliation(s)
- Julie R. Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Mayuri Jain
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY 10029, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Sonam Sharma
- Department of Radiation Oncology, Summit Health, Berkeley Heights, NJ 07922, USA
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3
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Dickstein DR, Lehrer EJ, Bloom JR, Hsieh K, Jones B, Runnels J, Powers A, Barlow J, Chen S, Monrose E, Sindhu K, Factor O, Liu JT, Gupta V, Roof S, Kirke D, Misiukiewicz K, Posner M, Genden E, Bakst RL. Is 80 the New 70? Octogenarians with Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e577-e578. [PMID: 37785756 DOI: 10.1016/j.ijrobp.2023.06.1915] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) As the human papilloma virus (HPV) pandemic evolves and life expectancy increases, the number of older adults with oropharyngeal squamous cell carcinoma (OPSCC) continues to increase. However, there is a paucity of data regarding the fastest growing subset of this population: octogenarians (OGs). We sought to understand differences in treatment tolerability and clinical outcomes between septuagenarians (SGs) and OGs with OPSCC. MATERIALS/METHODS We identified SGs (age 70-79) and OGs (age 80-89) with OPSCC from a cohort of older adults with nonrecurrent, nonmetastatic head and neck squamous cell carcinoma (HNSCC) treated curatively from 2007-2020. We compared demographics, treatment characteristics and toxicities using Fischer's exact test. Time-to-event outcomes, overall survival (OS), locoregional control (LRC), and disease-specific survival (DSS), were evaluated using the Kaplan-Meier method. RESULTS Of 293 patients (age 70-89) with HNSCC, 39% (n = 114) had OPSCC: 93 SGs (median age: 73; interquartile range [IQR]: 71-76), and 21 OGs (median age: 81, IQR: 80-84). The median follow-up for included patients was 2.4 years; 82% were male, 64% white, 48% > 20 pack year smoking history, 37% ECOG 1. Patients had AJCC 8th edition Stage: I (27%); II (33%); III (18%); IV (22%) OPSCC. Treatment consisted of adjuvant radiation (RT) (19%), adjuvant chemoradiation (CRT) (8%), surgery alone (6%), induction/concurrent CRT (27%), concurrent CRT (28%), or RT (12%), with no significant differences in stage or treatment modalities noted between SGs and OGs. Of note, 69% of SGs and 76% of OGs were HPV+. Among 107 patients who received any RT, 24% experienced a treatment interruption (19% of SGs vs. 48% of OGs, p = 0.001) and 2 patients (both HPV- SGs) died on treatment due to unrelated health conditions. Percutaneous endoscopic gastrostomy (PEG) tubes were placed prior to or during treatment in 43% of SGs and 62% of OGs, with OGs more likely to have a PEG placed during treatment (p = 0.025). There was no difference in the prevalence of late (> 6 months) CTCAE grade 2+ dysphagia (36%) or xerostomia (31%) between SGs and OGs. Estimated 3-year LRC, DSS, and OS were not significantly different between SGs (LRC:85%; DSS:87%; OS:76%) and OGs (LRC: 81%; DSS:94%; OS: 55%, p-values: 0.98, 0.42, 0.052, respectively). However, HPV+ disease significantly increased estimated 3-year OS for both SGs (HPV+: 84%; HPV-: 56%, p = 0.0006) and OGs (HPV+: 68%; HPV-: 20%, p = 0.008). CONCLUSION In our cohort, OGs had a higher proportion of HPV+ OPSCC, which was associated with improved OS. This finding may provide insight into the latency of the virus. While there were similar amounts of toxicities among SGs and OGs, OGs more frequently underwent PEG tube placement and experienced more treatment interruptions. Given high rates of HPV+ OPSCC in OGs, our findings suggest that de-escalation strategies should be further investigated to improve tolerability and maximize outcomes for this neglected population.
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Affiliation(s)
- D R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - B Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Runnels
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A Powers
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Barlow
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Chen
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Monrose
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - O Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - V Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Roof
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - D Kirke
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Genden
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Uczkowski D, Sekhri A, Gupta S, Gendler L, Misiukiewicz K, Levin M, Guerin B. Treatment of HER2+ breast cancer: a retrospective of disease prognosis with loss of HER2 amplification on residual disease after neoadjuvant treatment in a community hospital setting. Am J Cancer Res 2023; 13:2564-2571. [PMID: 37424818 PMCID: PMC10326587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) with Anti-Human Epidermal Growth Factor Receptor 2 (Anti-HER2) agents increase rates of pathologic complete response (pCR) in stage II-III, HER2+ breast cancer (BC). Several retrospective studies show HER2 amplification discordance from biopsy to post-NAC residual disease (RD). This phenomenon has unclear prognostic significance. This data was obtained from patients with HER2+ BC treated with NAC between 2018-2021 at our institution. Patients with biopsy and surgical specimens at our institution were analyzed. PCR was defined as ypT0/is N0, and HER2 status on RD was evaluated. 2018 HER2 ASCO/CAP definitions were used. In total, 71 patients were identified. 34/71 patients had pCR and were not included in further analysis. 37/71 patients had RD and HER2 was analyzed. 17/37 had HER2 loss and 20/37 remained HER2 positive. Mean follow-up time for HER2 loss was 43 months and 27 months for patients remaining HER2 positive, but neither group met 5-year Overall Survival as follow-up is ongoing. Recurrence Free Survival (RFS) was 35 months for HER2+ and 43 months for HER2 loss (P = 0.007). However, short follow-up time since diagnosis likely contributed to the underrepresentation of the true RFS of both groups. Therefore, at our institution, retained HER2 positivity on RD after NAC was associated with a statistically worse RFS. Although limited by sample size and follow-up time, further prospective investigation into the significance of HER2 discordance on RD assessed by 2018 definitions could clarify true RFS and if next-generation tumor profiling on RD will yield changes in tailored management.
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Affiliation(s)
- Dariusz Uczkowski
- Department of Internal Medicine, Overlook Medical CenterSummit, New Jersey, USA
| | - Arunabh Sekhri
- Department of Oncology, RWJ Barnabas Health, Jersey City Medical CenterJersey, New Jersey, USA
| | - Shilpi Gupta
- Department of Oncology, Morristown Medical CenterMorristown, New Jersey, USA
| | - Leah Gendler
- Department of Oncology, Morristown Medical CenterMorristown, New Jersey, USA
| | | | - Miles Levin
- Department of Internal Medicine, Overlook Medical CenterSummit, New Jersey, USA
| | - Bonni Guerin
- Department of Internal Medicine, Overlook Medical CenterSummit, New Jersey, USA
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Uczkowski D, Sekhri A, Gupta S, Gendler L, Misiukiewicz K, Levin M, Guerin B. CLO23-032: Treatment of HER2+ Breast Cancer: A Retrospective of Disease Prognosis With Loss of HER2 Amplification on Residual Disease After Neoadjuvant Treatment in a Community Hospital Setting. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7126] [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: 04/03/2023]
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Dickstein DR, Lehrer EJ, Hsieh K, Hotca A, Jones BM, Powers A, Sharma S, Liu J, Gupta V, Mell L, Husain Z, Kirke D, Misiukiewicz K, Posner M, Genden E, Bakst RL. Management of Older Adults with Locally Advanced Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14112809. [PMID: 35681789 PMCID: PMC9179912 DOI: 10.3390/cancers14112809] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Approximately one third of patients with head and neck cancer are older adults. The number of older adults with head and neck cancer continues to rise especially as life expectancy increases. However, this population remains significantly underrepresented in clinical trials. Due to this, there is no clear consensus regarding the optimal treatment for older adults with head and neck cancer. In general, older adults are a complex cohort due to variations in functional and performance status, medical comorbidities, and medication management. Treatment for head and neck cancer involves surgery, radiation therapy, systemic therapy, or a combination. These treatments are highly demanding. Additionally, they are associated with toxicity which can be especially difficult for older adults to tolerate. This may lead to treatment interruptions and compromised outcomes. In order to understand the optimal treatment for older adults with head and neck cancer, novel predictive scores are being developed. Additionally, ongoing clinical trials are investigating less intensive treatments for older adults. This review provides an overview of current clinical data, treatment considerations, and future areas of investigation for older adults with head and neck cancer. Abstract Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity on optimal management. Older adults are a complex patient population, often requiring increased support due to issues relating to functional and performance status, medical comorbidities, and medication management. Furthermore, in older adults with HNSCC, many of these conditions are independently associated with increased toxicity and worse outcomes. Toxicity in the older adult remains difficult to predict and to understand, and as treatment decisions are based on treatment tolerability, it is essential to understand the toxicities and how to minimize them. Novel predictive scores are being developed specifically for older adults with HNSCC to understand toxicity and to assist in personalized treatment decisions. There are clinical trials presently underway that are investigating shortened radiation courses and novel, less toxic systemic treatments in this population. In the forthcoming sections, we provide a detailed overview of the clinical data, treatment paradigms, and considerations in this population. This review provides a comprehensive overview of existing clinical data and clinical considerations in the older adult head and neck cancer population. Additionally, we provide a detailed overview of pertinent current and ongoing clinical trials, as well as future areas for investigation.
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Affiliation(s)
- Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Alexandra Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Brianna M. Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Ann Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Loren Mell
- Department of Radiation Oncology, University of San Diego, La Jolla, CA 92110, USA;
| | - Zain Husain
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Diana Kirke
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Krzysztof Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (K.M.); (M.P.)
| | - Marshall Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (K.M.); (M.P.)
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
- Correspondence:
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7
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Nehlsen AD, Lehrer EJ, Dickstein DR, Posner MR, Misiukiewicz K, Liu J, Gupta V, Bakst RL, Sharma S. Functional Larynx Preservation in Patients With Locally Advanced Squamous Cell Carcinoma of the Larynx and Hypopharynx Treated With Induction Chemotherapy vs. Concurrent Chemoradiation Alone. Cureus 2021; 13:e16310. [PMID: 34405069 PMCID: PMC8354511 DOI: 10.7759/cureus.16310] [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] [Accepted: 07/11/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Chemoradiation therapy (CRT) has been established as a standard treatment for locally advanced hypopharynx/larynx squamous cell carcinoma (SCC) but the role of induction chemotherapy (IC) remains unclear. The primary outcome of this study is to determine whether functional larynx-preservation survival (FLPS) is improved with the addition of IC in these patients. Secondary outcomes were overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and laryngectomy rates. Methods Records for patients with AJCC 8th edition clinical stage III-IVB laryngeal and hypopharyngeal SCC treated with CRT +/- IC from 2005-2019 were reviewed. FLPS was defined as time until death, progression, laryngectomy, or non-functional larynx. Kaplan-Meier curves were generated for FLPS, OS, PFS, and DMFS. Outcomes were compared using the stratified log-rank test. Laryngectomy rates were compared using Fisher’s exact test. Results We included 52 patients with laryngeal and 38 with hypopharyngeal SCC (n=90); 19 patients with laryngeal SCC and 19 with hypopharyngeal SCC received IC (median three cycles). There were no differences in the three-year FLPS (61% vs 67.8%; p=0.88), OS (73.9% vs 86.2%; p=0.42), PFS (53.6% vs 62.6%; p=0.44), or DMFS (65.2% vs 71.5%, p= 0.85) between patients who did and did not receive IC all patients. Laryngectomy rates did not differ with and without IC (18.4 % vs 7.7%; p=0.19). Conclusion In this study of advanced laryngeal and hypopharyngeal SCC, IC did not improve three-year FLPS, OS, PFS, or laryngectomy rates compared to CRT alone. A large prospective series would provide a more robust understanding of the role of IC in this group of patients.
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Affiliation(s)
| | - Eric J Lehrer
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Daniel R Dickstein
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marshall R Posner
- Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jerry Liu
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Sonam Sharma
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
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Takahashi M, Hwang M, Misiukiewicz K, Bakst RL, Miles BA, Gupta V, Bonomi MR, Sharma S, Botzler J, Genden EM, Moshier E, Selkridge I, Posner MR. Quality of life analysis of HPV-positive oropharyngeal cancer patients in a randomized trial of reduced-dose (rdCRT) versus standard (sdCRT) chemoradiotherapy: Five-year follow-up. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6062] [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
6062 Background: Human papillomavirus-positive oropharyngeal cancer (HPV OPC) portends a more favorable prognosis compared to HPV-negative cases. To prevent overtreatment, long-term morbidity and deterioration in functionality and quality of life (QoL), multiple studies have focused on de-intensification techniques for HPV OPC treatment. To this end, we prospectively assessed differences in patient reported QoL in locally advanced HPV OPC patients receiving rdCRTversus sdCRT)in a randomized trial using a sequential therapy plan. Methods: Patients were enrolled between December 2012 and February 2016; received 3 cycles of induction docetaxel, cisplatin, and 5-FU; and were randomized to sdCRT (70 Gy) or rdCRT (56 Gy) with weekly carboplatin. Patients were followed for Progression Free Survival (PFS), Overall Survival (OS), and changes in QoL as assessed by the MD Anderson Dysphagia Inventory (MDADI), MD Anderson Symptom Inventory (MDASI Head and Neck), Xerostomia Questionnaire (XQ), and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) with the head and neck module (EORTC HN). A mixed model ANOVA was used to estimate changes from baseline QoL to that at each follow-up timepoint and to compare the difference in QoL changes between the treatment arms. Results: We randomized 20 HPV+ locally advanced (LA) patients (median age: 56.5 yrs) to rdCRT (12 subjects) or sdCRT (8 subjects). 70% had high risk features. At a median follow-up of 81.5 mos, PFS and OS were 87.5% and 83.3% for sdCRT and rdCRT, respectively with a median OS of 76 mos in both arms. One patient in the sdCRT arm developed an HPV negative retromolar trigone squamous cell cancer in the radiation field 7 yrs after therapy. Baseline QoL was identical in the 15 patients who completed the QoL modules. Patients receiving rdCRT hadsignificantly lower declines in QoL scores at 3-6 month follow-up. At 5 yrs, differences in QoL changes all favored the rdCRT arm (Table) and two QoL scales reached statistical significance (P<0.05). Conclusions: In HPV OPC patients, rdCRT resulted in comparable long-term survival and greater improvement in specific domains of QoL when compared to sdCRT. Our results support the need for a larger, long-term Phase 3 study in LA HPVOPC to assess these two treatments with respect to survival, QoL, and safety. Clinical trial information: NCT02945631. [Table: see text]
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Affiliation(s)
- Mai Takahashi
- Harvard University T H Chan School of Public Health, Boston, MA
| | | | | | - Richard Lorne Bakst
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Brett A. Miles
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
| | | | | | | | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Posner MR, Misiukiewicz K, Miles BA, Sharma S, Gupta V, Genden EM, Botzler J, Selkridge I, Moshier E, Virani V, Bakst RL. Survival (OS) and progression-free survival (PFS) results after induction chemotherapy (IC) followed by de-escalated chemoradiotherapy (RDCRT) for locally advanced (LA) HPV positive oropharynx cancer (HPVOPC. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
6058 Background: HPVOPC has a significantly better prognosis and survival than HPV negative cancer resulting in overtreatment with significant acute and late toxicities and mortality. Radiation therapy is the single greatest determinant of toxicity. Studies to support reduction of radiation dose are a high priority. IC improves local regional control, reduces distant metastases, and may support radiotherapy de-escalation. Patients with T4, ECE, and N2c disease have poorer local regional control (LRC) and a higher rate of distant metastases (DM) and may be suitable for this option. Methods: Data was combined for the experimental arm of a previously reported Phase 3 trial (12 subjects, NCT01706939) and a continuation Phase 2 trial (20 subjects, NCT02945631). After informed consent subjects who were PCR+ HPVOPC, smoked < 20 py, and were LA or functionally unresectable were treated with Taxotere, cisplatin and reduced 5-fluorouracil (mTPF) for 3 cycles and then assessed for response. Responders were treated with 5600 cGy and weekly carboplatin, and then followed for LRC, DM, PFS, OAS and toxicity. Data was analyzed as of 2/1/21. 85% LRC at 3 years was considered non inferior to standard of care chemoradiotherapy. An acceptable end point was predetermined to be 80% PFS and 85% LRC at 3 years in this LA population. Results: 32 subjects were entered and included in the analysis, all responded to IC and had RDCRT. 2 patients with non-HPV16 subtypes were initially entered, treated with IC, responded, and then were taken off study and excluded from the analysis due to non-HPV 16 subtype. They were treated with 7000 cGy and are alive and well. Poor risk factors (ECE, T4, N2c, Non-HPV16 subtype) were present in 72% of 32 subjects; 22 (69%) never smoked. At data cutoff with a median follow up of 50m (21-95m), 28/32 (87.5%) have LRC, 1/32 DM (3.1%), OS is 28/32 (87.5%) and PFS is 27/32 (84.4%). All 5 patients who recurred did so in the first 12m (median 8m); all had 1 or more poor risk factors and 1 is alive with disease 42m post recurrence. 2 year LRC, PFS and OS are 87.4% [95% CI: 69.8%, 95.1%], 84.4% [95% CI: 66.5%, 93.2%] and 90.6% [95% CI: 73.7%, 96.9%] respectively. There was no therapy-related mortality, generally rapid recovery from CRT and minimal long term consequences (to be reported). Conclusions: Induction with mTPF followed by RDCRT resulted in excellent LRC, PFS and OS in patients with LA HPV OPC and significant risk factors. These results compare favorably to standard of care and other dose de-escalation trials in high and low risk categories. This treatment paradigm is highly effective in a LA, high risk HPVOPC patients and is a reasonable treatment option to be compared to other de-escalation treatment plans in Phase 3 trials for this higher risk population. Clinical trial information: NCT02945631, NCT01706939.
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Affiliation(s)
- Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Brett A. Miles
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
| | | | | | | | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Richard Lorne Bakst
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
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10
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Smith AW, Gallitto M, Lehrer EJ, Wasserman I, Gupta V, Sharma S, Liu JT, Posner M, Misiukiewicz K, Westra WH, Genden EM, Haidar Y, Yao M, Teng MS, Miles BA, Bakst RL. Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era. Head Neck 2021; 43:1409-1414. [PMID: 33474814 DOI: 10.1002/hed.26607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/15/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The optimal extent of surgery and/or radiation to the contralateral lymph node region is unknown in early-stage human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). METHODS To investigate the pathologic incidence of and risk factors for contralateral nodal disease (CND) in cT1-T2 HPV-related OPSCC treated with transoral robotic surgery (TORS) and bilateral neck dissection (BND), the records of 120 patients were reviewed. RESULTS Eleven patients displayed pathologic contralateral nodal disease (pCND), including 7.1% of tonsil and 10.9% of base of tongue (BOT) cases. Medial hemistructure involvement and cN2 disease were significantly associated with pCND. Zero cN0 patients had pCND, and on multivariate analysis only cN classification remained significantly associated with pCND. Four percent of BOT patients and 2% of tonsil patients with a well-lateralized primary and cN0/N1 neck demonstrated pCND. CONCLUSIONS HPV-related OPSCC that are cN0-N1 have exceedingly low rates of pCND. Well-lateralized HPV-related BOT primaries with limited clinical nodal disease may be candidates for ipsilateral only treatment.
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Affiliation(s)
- Andrew W Smith
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Matthew Gallitto
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Isaac Wasserman
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
| | - Marshall Posner
- Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof Misiukiewicz
- Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yarah Haidar
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita S Teng
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Health System, New York, New York, USA
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11
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Dickstein DR, Egerman M, Monrose E, Varma A, Ozbek U, Sharma S, Liu JT, Gupta V, Posner MR, Misiukiewicz K, Miles BA, Genden E, Bakst RL. Treatment tolerability and outcomes in elderly patients with head and neck cancer. Head Neck 2020; 43:858-873. [PMID: 33615611 DOI: 10.1002/hed.26548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The number of elderly patients with head and neck squamous cell carcinoma (HNSCC) continues to grow. Management of this cohort remains poorly defined. We investigated treatment tolerability and clinical outcomes in this underrepresented population. METHODS We identified patients aged ≥70 with nonrecurrent, nonmetastatic HNSCC treated curatively from 2007-2018 and analyzed clinical covariates. RESULTS Two hundred and twenty patients with a median age of 75 (interquartile range:72-80) were identified. Age and comorbidities were not correlated with toxicity (P ≥ .05). Patients who experienced a treatment interruption had significantly greater weight loss (P = .042) and worse overall survival (OS) (P < .001), but not worse disease-specific survival (P = .45), or locoregional control (P = .21). CONCLUSIONS Treatment interruptions were associated with weight loss and worse OS, but not disease related outcomes, suggesting an interruption in the elderly may be a surrogate for another issue. In sum, our data should guide clinical trial design to benefit this growing, neglected cohort.
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Affiliation(s)
- Daniel R Dickstein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc Egerman
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erica Monrose
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Achintya Varma
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Umut Ozbek
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall R Posner
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Schlussel Markovic E, Marqueen KE, Sindhu KK, Lehrer EJ, Liu J, Miles B, Genden E, Sharma S, Gupta V, Westra W, Iloreta A, Posner M, Misiukiewicz K, Bakst RL. The prognostic significance of human papilloma virus in sinonasal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:1070-1078. [PMID: 33364396 PMCID: PMC7752049 DOI: 10.1002/lio2.468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/01/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human papilloma virus (HPV) has been implicated in the pathology of oropharyngeal head and neck cancers, but its role in sinonasal squamous cell carcinoma (SNSCC) has not been well established. METHODS Thirty-two patients with SNSCC diagnosed between 2011 and 2018 were identified and stratified by HPV status and viral serotype, as determined by PCR. Endpoints including recurrence, metastases and survival were analyzed using the Kaplan-Meier method. RESULTS Seventeen (53%) patients were HPV-positive and 15 (47%) were HPV-negative. The median follow-up time of living patients was 30.7 months (range 4-123 months). Survival did not differ by HPV status, but HPV+ tumors were more likely to locally recur and metastasize. When stratifying by treatment type, the lowest rate of recurrence occurred in patients receiving surgery and chemoradiation. CONCLUSION A significant proportion of sinonasal tumors appear to be associated with HPV. Testing for HPV might be justified in all cases of sinonasal cancers. Further investigation is warranted to better understand the role of HPV in SNSCC.
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Affiliation(s)
| | - Kathryn E. Marqueen
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kunal K. Sindhu
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eric J. Lehrer
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jerry Liu
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Brett Miles
- Department of OtolaryngologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eric Genden
- Department of OtolaryngologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sonam Sharma
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Vishal Gupta
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - William Westra
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alfred Iloreta
- Department of OtolaryngologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marshall Posner
- Department of Medicine, Division of Hematology/OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Krzysztof Misiukiewicz
- Department of Medicine, Division of Hematology/OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Richard L. Bakst
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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13
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Nehlsen A, Lehrer E, Dickstein D, Posner M, Misiukiewicz K, Liu J, Gupta V, Bakst R, Sharma S. Comparison of Functional Larynx Preservation in Patients with Locally Advanced Squamous Cell Carcinoma of the Larynx and Hypopharynx Treated with Induction Chemotherapy vs Concurrent Chemoradiation Alone. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.382] [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: 11/15/2022]
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14
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Dickstein DR, Egerman MA, Bui AH, Doucette JT, Sharma S, Liu J, Gupta V, Miles BA, Genden E, Westra WH, Misiukiewicz K, Posner MR, Bakst RL. A new face of the HPV epidemic: Oropharyngeal cancer in the elderly. Oral Oncol 2020; 109:104687. [PMID: 32882642 PMCID: PMC9556263 DOI: 10.1016/j.oraloncology.2020.104687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/25/2020] [Accepted: 04/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES As the human papillomavirus (HPV) epidemic continues to grow, the number of elderly patients with oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing. Despite this observation, this cohort remains understudied. We aimed to understand HPV prevalence and characteristics within this cohort as well as its impact on disease control in elderly patients. METHODS AND MATERIALS We identified patients aged ≥70 with newly diagnosed, non-metastatic, OPSCC treated with curative intent at our institution from 2007 to 2018. Logistic regression and survival analyses were used for outcome-specific endpoints. RESULTS In total, 88 patients were identified with a median age of 73 (interquartile range [IQR]: 71-78) and a median Charlson Comorbidity Index of 6 (IQR: 5-7). Eighty-two percent were ECOG 0 or 1 performance. Of note, 70% of the cohort had HPV+ tumors. Fifty-one percent of patients were AJCC 8th edition stage I/II and 49% were stage III/IV. Median follow-up time was 2.5 years (IQR: 0.9-4.7). Eight percent had surgery alone, 27% underwent adjuvant RT, and 64% received definitive RT. Sixty-four percent received concurrent chemotherapy. By both univariate and multivariable analyses, HPV+ status was significantly associated with improved locoregional control (LRC), overall survival (OS), and disease specific survival (DSS). CONCLUSIONS In our cohort of elderly patients with OPSCC, the majority was HPV+, which was associated with improved clinical outcomes. There are many challenges when managing elderly patients with OPSCC, but as the population ages and the HPV epidemic evolves, these patients should be considered for elderly specific clinical trials.
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Affiliation(s)
- Daniel R Dickstein
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Marc A Egerman
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Anthony H Bui
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - John T Doucette
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, United States
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, United States
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, United States
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, United States
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 5 East 98(th) Street, New York, NY 10029, United States
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 5 East 98(th) Street, New York, NY 10029, United States
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Annenberg Building 15-01 Box 1194, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY 10029, United States
| | - Marshall R Posner
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY 10029, United States
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, United States.
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15
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Su W, Rajeev-Kumar G, Kang M, Posner M, Liu JT, Westra W, Miles BA, Gupta V, Sharma S, Misiukiewicz K, Genden E, Bakst RL. Long-term outcomes in patients with recurrent human papillomavirus-positive oropharyngeal cancer after upfront transoral robotic surgery. Head Neck 2020; 42:3490-3496. [PMID: 32776411 DOI: 10.1002/hed.26396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Clinical course following failure of human papillomavirus (HPV)-positive oropharyngeal cancers (HPV + OPC) is poorly understood. This study aims to characterize disease course following failure after transoral robotic surgery (TORS). METHODS We identified patients with HPV + OPC-treated upfront with TORS at our institution from 2007 to 2017. HPV status was confirmed with immunohistochemistry or HPV DNA polymerase chain reaction. Patient characteristics, treatment modalities, and post-recurrence outcomes were analyzed for the recurrent cohort. RESULTS Of the 317 HPV + OPC patients, 28 (8.8%) experienced recurrence, all of HPV 16/18 subtypes. Median post-recurrence survival was 19.8 months (range 2.3-195.8 months) in the 12 locoregional and 16 months (range 2.4-79.5 months) in the 14 distant failures. Sixteen are alive with a median of 39.8 months (range 5.5-209.4 months) after retreatment. CONCLUSION This is one of the largest series evaluating survival following TORS failure in HPV + OPC. Despite failure, long-term survival and durable remission are possible with single-modal or multiple-modal salvage treatment.
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Affiliation(s)
- William Su
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Greeshma Rajeev-Kumar
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martin Kang
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall Posner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Westra
- Department of Anatomic and Clinical Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof Misiukiewicz
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Miles B, Posner M, Teng M, Yao M, Chai R, Misiukiewicz K, Gupta V, Bakst R, Sharma S, Zhang D, Ye F, Westra W, Kim-Schulze S, Sobotka S, Sikora A, Som P, Genden E. De-Escalated Adjuvant Therapy after Transoral Robotic Surgery for HPV related Oropharyngeal Carcinoma: The SiRS Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.341] [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: 11/15/2022]
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17
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Dickstein D, Egerman M, Doucette J, Sharma S, Liu J, Gupta V, Miles B, Posner M, Westra W, Misiukiewicz K, Genden E, Bakst R. The Rise of HPV in the Elderly: A Changing Landscape of Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.201] [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: 11/30/2022]
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18
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Villavisanis D, Dickstein D, Sindhu K, Rutland J, Misiukiewicz K, Posner M, Liu J, Gupta V, Sharma S, Teng M, Genden E, Miles B, Bakst R. Oral Tongue Squamous Cell Carcinoma in Young, Non-Smoking, and Non-Drinking Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.139] [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: 10/24/2022]
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Ferris RL, Saba NF, Gitlitz BJ, Haddad R, Sukari A, Neupane P, Morris JC, Misiukiewicz K, Bauman JE, Fenton M, Jimeno A, Adkins DR, Schneider CJ, Sacco AG, Shirai K, Bowles DW, Gibson M, Nwizu T, Gottardo R, Manjarrez KL, Dietsch GN, Bryan JK, Hershberg RM, Cohen EEW. Effect of Adding Motolimod to Standard Combination Chemotherapy and Cetuximab Treatment of Patients With Squamous Cell Carcinoma of the Head and Neck: The Active8 Randomized Clinical Trial. JAMA Oncol 2019; 4:1583-1588. [PMID: 29931076 DOI: 10.1001/jamaoncol.2018.1888] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Immunotherapy for recurrent and/or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) is promising. The toll-like receptor 8 (TLR8) agonist motolimod may stimulate innate and adaptive immunity. Objective To determine whether motolimod improves outcomes for R/M SCCHN when combined with standard therapy. Design, Setting, and Participants The Active8 study was a multicenter, randomized, double-blind, placebo-controlled clinical trial enrolling adult patients (age ≥18 years) with histologically confirmed R/M SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx between October 2013 and August 2015. Follow-up ended September 2016. Analysis for the present report was conducted between June 2016 and December 2017. Interventions Combination treatment with platinum (carboplatin or cisplatin), fluorouracil, cetuximab (the EXTREME regimen), and either placebo or motolimod, each administered intravenously every 3 weeks. Patients received a maximum of 6 chemotherapy cycles, after which patients received weekly cetuximab with either placebo or motolimod every 4 weeks. Main Outcomes and Measures Progression-free survival (PFS) as determined by independent central review using immune-related RECIST (Response Evaluation Criteria in Solid Tumors). Key secondary end points included overall survival (OS) and safety. Results Of 195 patients enrolled, 85% were men (n = 166); 82% were white (n = 159); median age was 58 years (range 23-81 years). Median PFS was 6.1 vs 5.9 months (hazard ratio [HR], 0.99; 1-sided 90% CI, 0.00-1.22; P = .47), and median OS was 13.5 vs 11.3 months (HR, 0.95; 1-sided 90% CI, 0.00-1.22; P = .40) for motolimod vs placebo. Increased incidence of injection site reactions, pyrexia, chills, anemia, and acneiform rash were noted with motolimod. Of 83 cases oropharyngeal cancer, 52 (63%) were human papillomavirus (HPV) positive. In a prespecified subgroup analysis of HPV-positive participants, motolimod vs placebo resulted in significantly longer PFS (7.8 vs 5.9 months; HR, 0.58; 1-sided 90% CI, 0.00-0.90; P = .046) and OS (15.2 vs 12.6 months; HR, 0.41; 1-sided 90% CI, 0.00-0.77; P = .03). In an exploratory analysis, patients with injection site reactions had longer PFS and OS (median PFS, 7.1 vs 5.9 months; HR, 0.69; 1-sided 90% CI, 0.00-0.93; P = .06; and median OS, 18.7 vs 12.6; HR, 0.56; 1-sided 90% CI, 0.00-0.81; P = .02). Conclusions and Relevance Adding motolimod to the EXTREME regimen was well tolerated but did not improve PFS or OS in the intent-to-treat population. Significant benefit was observed in HPV-positive patients and those with injection site reactions, suggesting that TLR8 stimulation may benefit subset- and biomarker-selected patients. Trial Registration ClinicalTrials.gov identifier: NCT01836029.
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Affiliation(s)
- Robert L Ferris
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Barbara J Gitlitz
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | | | | | - John C Morris
- University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | | | - Julie E Bauman
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Moon Fenton
- West Cancer Center, University of Tennessee, Memphis
| | | | | | | | | | | | | | - Michael Gibson
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla
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Dickstein D, Gallitto M, Egerman M, Powers A, Gupta V, Sharma S, Miles B, Posner M, Misiukiewicz K, Bakst R. Treatment Tolerability and Outcomes in Advanced-Age Oropharyngeal Cancer Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1518] [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: 10/26/2022]
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21
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Bangi E, Ang C, Smibert P, Uzilov AV, Teague AG, Antipin Y, Chen R, Hecht C, Gruszczynski N, Yon WJ, Malyshev D, Laspina D, Selkridge I, Rainey H, Moe AS, Lau CY, Taik P, Wilck E, Bhardwaj A, Sung M, Kim S, Yum K, Sebra R, Donovan M, Misiukiewicz K, Schadt EE, Posner MR, Cagan RL. A personalized platform identifies trametinib plus zoledronate for a patient with KRAS-mutant metastatic colorectal cancer. Sci Adv 2019; 5:eaav6528. [PMID: 31131321 PMCID: PMC6531007 DOI: 10.1126/sciadv.aav6528] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/12/2019] [Indexed: 05/03/2023]
Abstract
Colorectal cancer remains a leading source of cancer mortality worldwide. Initial response is often followed by emergent resistance that is poorly responsive to targeted therapies, reflecting currently undruggable cancer drivers such as KRAS and overall genomic complexity. Here, we report a novel approach to developing a personalized therapy for a patient with treatment-resistant metastatic KRAS-mutant colorectal cancer. An extensive genomic analysis of the tumor's genomic landscape identified nine key drivers. A transgenic model that altered orthologs of these nine genes in the Drosophila hindgut was developed; a robotics-based screen using this platform identified trametinib plus zoledronate as a candidate treatment combination. Treating the patient led to a significant response: Target and nontarget lesions displayed a strong partial response and remained stable for 11 months. By addressing a disease's genomic complexity, this personalized approach may provide an alternative treatment option for recalcitrant disease such as KRAS-mutant colorectal cancer.
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Affiliation(s)
- Erdem Bangi
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Celina Ang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Peter Smibert
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Andrew V. Uzilov
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Alexander G. Teague
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yevgeniy Antipin
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Rong Chen
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Chana Hecht
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nelson Gruszczynski
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Wesley J. Yon
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Denis Malyshev
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Denise Laspina
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Isaiah Selkridge
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hope Rainey
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aye S. Moe
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Chun Yee Lau
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Patricia Taik
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Eric Wilck
- Department of Radiology, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Aarti Bhardwaj
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Max Sung
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara Kim
- Department of Pharmacy, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Kendra Yum
- Department of Pharmacy, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Michael Donovan
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Eric E. Schadt
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- SEMA4, a Mount Sinai Venture, 333 Ludlow Street, South Tower, 3rd floor, Stamford, CT 06902, USA
| | - Marshall R. Posner
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ross L. Cagan
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Corresponding author.
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Factor O, Su W, Lazarev S, Miles B, Genden E, Sharma S, Gupta V, Misiukiewicz K, Bakst RL. Rapid in-field failures following adjuvant radiation for buccal squamous cell carcinoma. Laryngoscope 2019; 130:413-417. [PMID: 31021426 DOI: 10.1002/lary.27996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/10/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma originating in the buccal mucosa and retromolar trigone (RMT) have historically poor outcomes. Difficulties in discriminating tumor origin often result in these subsites being combined in surgical and pathological reports. We aimed to determine if making this anatomical distinction has implications for treatment design and clinical outcomes. STUDY DESIGN Retrospective case series. METHODS We identified 27 tumors from either the buccal mucosa patients or RMT patients who underwent surgery followed by radiation. For patients who developed a local failure, we fused the pretreatment imaging, simulation computed tomography, and follow-up imaging to determine the location of failures relative to the radiation field. We calculated the 2-year locoregional control and 2-year disease-free survival. RESULTS The median time from surgery to radiation was 50 days (range, 32-133 days). The 2-year locoregional control for buccal mucosa versus RMT, respectively, were 35.9% versus 68.4% (P = .252). The 2-year disease-free survival rates were 32.7% versus 68.4%, respectively (P = .196). The median times to failure were 12.00 months (range, 4.9-115.0 months) versus 18.5 months (range, 4.5-61.0 months), respectively. All buccal mucosa failures occurred within the high-dose planning target volume, with a median dose of 60 Gy within the failure region. Following locoregional failure, 10 of the 12 patients have died, with a median time from local failure to death of 3.6 months (range, 1-17.6 months). CONCLUSIONS Squamous cell carcinomas of the buccal mucosa appear to have a poor prognosis characterized by rapid in-field failure. Therefore, differentiating tumor origin may be important for prognostication and treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 130:413-417, 2020.
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Affiliation(s)
- Oren Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - William Su
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Krzysztof Misiukiewicz
- Department of Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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23
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Gallitto M, Sindhu K, Wasserman I, De B, Gupta V, Miles BA, Genden EM, Posner M, Misiukiewicz K, Bakst RL. Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit? Head Neck 2019; 41:3009-3022. [DOI: 10.1002/hed.25779] [Citation(s) in RCA: 7] [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] [Received: 11/14/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew Gallitto
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Kunal Sindhu
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Isaac Wasserman
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brian De
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Vishal Gupta
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brett A. Miles
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Eric M. Genden
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Marshall Posner
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Richard L. Bakst
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
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Hicks DF, Bakst R, Doucette J, Kann BH, Miles B, Genden E, Misiukiewicz K, Posner M, Gupta V. Impact of obesity on outcomes for patients with head and neck cancer. Oral Oncol 2018; 83:11-17. [DOI: 10.1016/j.oraloncology.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/31/2018] [Indexed: 12/17/2022]
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Misiukiewicz K, Gupta V, Posner M. The Italian Collaborative Group sets a standard for the treatment of locally advanced head and neck cancer. Ann Oncol 2018; 28:2051-2054. [PMID: 28911089 DOI: 10.1093/annonc/mdx394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Misiukiewicz
- Tisch Cancer Institute, One Gustave L Levy Place, New York
| | - V Gupta
- Department of Radiation Oncology, Mount Sinai Hospital, New York, USA
| | - M Posner
- Tisch Cancer Institute, One Gustave L Levy Place, New York
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Kyi C, Roudko V, Sabado R, Saenger Y, Loging W, Mandeli J, Thin TH, Lehrer D, Donovan M, Posner M, Misiukiewicz K, Greenbaum B, Salazar A, Friedlander P, Bhardwaj N. Therapeutic Immune Modulation against Solid Cancers with Intratumoral Poly-ICLC: A Pilot Trial. Clin Cancer Res 2018; 24:4937-4948. [PMID: 29950349 DOI: 10.1158/1078-0432.ccr-17-1866] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/12/2017] [Accepted: 06/21/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Polyinosinic-polycytidylic acid-poly-l-lysine carboxymethylcellulose (poly-ICLC), a synthetic double-stranded RNA complex, is a ligand for toll-like receptor-3 and MDA-5 that can activate immune cells, such as dendritic cells, and trigger natural killer cells to kill tumor cells.Patients and Methods: In this pilot study, eligible patients included those with recurrent metastatic disease in whom prior systemic therapy (head and neck squamous cell cancer and melanoma) failed. Patients received 2 treatment cycles, each cycle consisting of 1 mg poly-ICLC 3× weekly intratumorally (IT) for 2 weeks followed by intramuscular (IM) boosters biweekly for 7 weeks, with a 1-week rest period. Immune response was evaluated by immunohistochemistry (IHC) and RNA sequencing (RNA-seq) in tumor and blood.Results: Two patients completed 2 cycles of IT treatments, and 1 achieved clinical benefit (stable disease, progression-free survival 6 months), whereas the remainder had progressive disease. Poly-ICLC was well tolerated, with principal side effects of fatigue and inflammation at injection site (<grade 2). In the patient with clinical benefit, IHC analysis of tumor showed increased CD4, CD8, PD1, and PD-L1 levels compared with patients with progressive disease. RNA-seq analysis of the same patient's tumor and peripheral blood mononuclear cells showed dramatic changes in response to poly-ICLC treatment, including upregulation of genes associated with chemokine activity, T-cell activation, and antigen presentation.Conclusions: Poly-ICLC was well tolerated in patients with solid cancer and generated local and systemic immune responses, as evident in the patient achieving clinical benefit. These results warrant further investigation and are currently being explored in a multicenter phase II clinical trial (NCT02423863). Clin Cancer Res; 24(20); 4937-48. ©2018 AACR.
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Affiliation(s)
- Chrisann Kyi
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vladimir Roudko
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Sabado
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - William Loging
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Mandeli
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tin Htwe Thin
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah Lehrer
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Donovan
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall Posner
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Benjamin Greenbaum
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Philip Friedlander
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nina Bhardwaj
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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Hwang M, Bonomi MR, Misiukiewicz K, Selkridge I, Roy E, Surgeon JT, Genden EM, Gupta V, Bakst RL, Posner MR. Quality of life (QoL) analysis in HPV positive oropharynx cancer (HPVOPC) patients in a randomized deintensification trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18068] [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)
| | | | | | | | | | | | | | | | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Margalit D, Haddad R, Tishler R, Chau N, Schoenfeld J, Bakst R, Misiukiewicz K, Goguen L, Annino D, Mchugh P, Bacay A, Groden P, Catalano P, Rabinowits G. Final Safety Results of a Phase 1 Clinical Trial of Afatinib in Combination With Docetaxel and Postoperative Radiation Therapy for High-Risk Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.052] [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: 10/17/2022]
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Lazarev S, Ghiassi-Nejad Z, Gupta V, Miles B, Scarborough B, Misiukiewicz K, Reckson B, Sheu R, Bakst R. Discontinuation of Curative Head and Neck Irradiation: Etiologies and Outcomes. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.209] [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: 10/17/2022]
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Margalit D, Haddad R, Tishler R, Chau N, Schoenfeld J, Bakst R, Misiukiewicz K, Goguen L, Annino D, Mchugh P, Bacay A, Rath L, Groden P, Catalano P, Rabinowits G. Safety Results of a Multi-Institutional Phase 1 Clinical Trial of Afatinib in Combination with Docetaxel and Postoperative Radiation Therapy for High-Risk Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.115] [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: 11/26/2022]
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Su W, Miles B, Genden E, Misiukiewicz K, Posner M, Som P, Kostakoglu L, Gupta V, Bakst R. Recurrence Patterns in HPV-Positive Oropharyngeal Cancers and Implications for Long-Term Surveillance Imaging. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1494] [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: 11/26/2022]
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Lazarev S, Ghiassi-Nejad Z, Gupta V, Misiukiewicz K, Miles B, Sheu R, Bakst R. Clinical Outcomes After Premature Discontinuation of Curative Head and Neck Irradiation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1439] [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: 10/18/2022]
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Bakst R, Dave E, Gupta V, Miles B, Su W, Misiukiewicz K. Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma in the Elderly. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1370] [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: 10/18/2022]
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Konuthula N, Iloreta AM, Miles B, Rhome R, Ozbek U, Genden EM, Posner M, Misiukiewicz K, Govindaraj S, Shrivastava R, Gupta V, Bakst RL. Prognostic significance of Kadish staging in esthesioneuroblastoma: An analysis of the National Cancer Database. Head Neck 2017; 39:1962-1968. [PMID: 28815831 DOI: 10.1002/hed.24770] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/27/2016] [Accepted: 02/10/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Given the rarity of esthesioneuroblastoma, it is difficult to validate a staging system. The purpose of this study was to investigate the utility of the Kadish staging system in esthesioneuroblastoma using the National Cancer Database (NCDB). METHODS One thousand one hundred sixty-seven patients with esthesioneuroblastoma were identified from the NCDB. RESULTS Five-year survival was 80.0% for Kadish A, 87.7% for Kadish B, 77.0% for Kadish C, and 49.5% for Kadish D. Kadish B had higher survival than Kadish A. More Kadish B patients received surgery with adjuvant therapy than Kadish A patients (41.6% vs 32.5%; P = .0038) and also had more positive margins (21.6% vs 11.3%; P = .03). There was no difference in age distribution, sex, race, or neck dissection status between the 2 groups. CONCLUSION Kadish B had greater survival than Kadish A, but the treatment characteristics could not account for this difference. The utility of early-stage Kadish staging is uncertain and requires further study.
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Affiliation(s)
- Neeraja Konuthula
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Medical Center, New York, New York
| | - Alfred M Iloreta
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Medical Center, New York, New York
| | - Brett Miles
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Medical Center, New York, New York
| | - Ryan Rhome
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York
| | - Umut Ozbek
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Medical Center, New York, New York
| | - Marshall Posner
- Department of Medicine, Hematology and Medical Oncology, Mount Sinai Medical Center, New York, New York
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical Oncology, Mount Sinai Medical Center, New York, New York
| | - Satish Govindaraj
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Medical Center, New York, New York
| | - Raj Shrivastava
- Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
| | - Vishal Gupta
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York
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Camille N, Rozehnal J, Roy E, Uczkowski D, Olson A, Genden E, Teng M, Bakst R, Gupta V, Posner M, Misiukiewicz K. A phase I study of cabazitaxel in combination with platinum and 5-fluorouracil (PF) in locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). Oral Oncol 2017; 71:99-104. [DOI: 10.1016/j.oraloncology.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/16/2022]
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Dave E, Ozbek U, Gupta V, Genden E, Miles B, Teng M, Posner M, Misiukiewicz K, Bakst RL. The prognostic impact of human papillomavirus status following treatment failure in oropharyngeal cancer. PLoS One 2017; 12:e0181108. [PMID: 28732044 PMCID: PMC5521776 DOI: 10.1371/journal.pone.0181108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the human papillomavirus conferring a better prognosis in the primary treatment setting, the prognostic impact of viral status after treatment failure in oropharyngeal squamous cell carcinoma patients is poorly understood. METHODS We retrospectively identified 33 oropharyngeal squamous cell carcinoma (OPC) patients with local and/or distant disease recurrence post-treatment, and looked at metastatic patterns, time to failure and survival patterns by HPV status. RESULTS Median overall survival following local failure was not significantly different by HPV status (17 months for HPV+ vs. 14 months for HPV-, p = 0.23). However, following distant failures, HPV+ patients lived significantly longer than HPV- patients (median 42 months vs. 11 months, p = 0.004). HPV- patients were more likely to have locoregional failures as compared to HPV+ patients (p = 0.005), but the difference in distant failure between both groups was not significant (p = 0.09). HPV+ patients were more likely to develop metastases to sites other than the lung and bones. CONCLUSION HPV positivity predicts a favorable prognosis with the potential for long-term survival following distant, not locoregional, failures. These results have important implications for the aggressiveness of treatment and type of surveillance imaging performed.
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Affiliation(s)
- Eesha Dave
- Department of Medical Education, Icahn School of Medicine, New York, New York, United States of America
| | - Umut Ozbek
- Department of Population Science and Policy, Mount Sinai Hospital, New York, New York, United States of America
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Marita Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Marshall Posner
- Department of Hematology-Oncology-Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Krzysztof Misiukiewicz
- Department of Hematology-Oncology-Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Bossert A, Shevach J, Bakst R, Liu J, Misiukiewicz K, Beyda J, Miles B, Genden E, Posner MR, Gupta V. (S024) Extracapsular Extension Is Associated With Worse Distant Control and Progression-Free Survival in Patients With Lymph Node-Positive Human Papillomavirus-Related Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.060] [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: 10/19/2022]
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Rainey H, Roy E, Selkridge I, Misiukiewicz K, Gupta V, Bakst RL, Zhang DY, Kotz T, Som P, Anderson KS, Miles BA, Genden E, Teng M, Bonomi M, Sikora AG, Demicco E, Jia R, Posner MR. Standard of care vs reduced-dose chemoradiation after induction chemotherapy in HPV+ oropharyngeal carcinoma patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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
6069 Background: Locally advanced Human Papillomavirus (HPV) + oropharyngeal carcinoma (OPC) has a significantly better response, locoregional control and survival compared to non HPVOPC. Standard-dose chemoradiotherapy (sdCRT) results in significant side effects, leading to acute and life-threatening late morbidity. We studied whether reduced dose chemoradiation (rdCRT) after induction chemotherapy (IC) resulted in equivalent progression-free survival (PFS) compared to sdCRT + IC with decreased late morbidity. Methods: Patients with locally advanced OPC and < 20 pack years (py) smoking history were tested for p16 and then HPV by type-specific PCR. After 3 cycles of docetaxel, cisplatin and fluorouracil (TPF) IC all HPV+/p16+ subjects underwent clinical and radiographic evaluation. Clinical responders were randomized to either sdCRT (70Gy) or rdCRT (56Gy) with weekly carboplatin (AUC 1.5) at a 1:2 ratio. The primary endpoint was 2 year PFS; the secondary endpoint was 2 year overall survival (OS). Toxicity, late morbidity and swallowing were monitored. Results: 23 patients were enrolled and 20 randomized, 8 to sdCRT and 12 to rdCRT; 2 were HPV- and 1 refused further therapy after IC and were not randomized. Median age was 56.5 yrs (range 36-78); 30% were African-American, 10% were Hispanic, 5% were female; 16 were HPV 16+ and 4 were other high risk (HR) variants; 60% never smoked, 25% were < 10 py, and 15% were 10-20 py; 70% had high risk features: T4, N2c, or N3. Clinical response to TPF was 100%; 70% had a clinical complete response. As of February 1, patients have been followed for a median of 37.5 months (range 21.7 – 49.5). 2 year PFS/OS for sdCRT and rdCRT are 87.5% vs 83.3% (log-rank test p = 0.85), respectively. All 3 failures were local or regional and 2 of 3 occurred in non HPV16 HR variants. Conclusions: HPV+ OPC patients who received rdCRT after TPF IC had similar PFS/OS compared to those receiving sdCRT. These results uphold the potential clinical benefit of radiation dose reduction as a treatment option with comparable survival to the standard radiation dose. A Phase III trial comparing IC plus rdCRT to sdCRT alone or with IC is warranted in this population. Non-HPV16 HR variants may have a worse outcome. Clinical trial information: NCT01706939.
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Affiliation(s)
- Hope Rainey
- Mount Sinai School of Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | - Brett A. Miles
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
| | | | | | - Marcelo Bonomi
- Wake Forest Baptist School of Medicine, Winston-Salem, NC
| | | | | | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Ramer I, Varier I, Zhang D, Demicco EG, Posner MR, Misiukiewicz K, Genden EM, Miles BA, Teng MS, Sikora AG. Racial disparities in incidence of human papillomavirus-associated oropharyngeal cancer in an urban population. Cancer Epidemiol 2016; 44:91-95. [DOI: 10.1016/j.canep.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/03/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
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Konuthula N, Iloreta A, Rhome R, Posner M, Misiukiewicz K, Gupta V, Bakst R. Definitive Radiation in the Treatment of Locally Advanced Esthesioneuroblastoma: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Cohen E, Saba N, Gitlitz B, Haddad R, Sukari A, Neupane P, Morris J, Misiukiewicz K, Manjarrez K, Dietsch G, Bryan J, Hershberg R, Ferris R. immunotherapy of cancer Active8: A randomized, double-blind, placebo-controlled study of chemotherapy plus cetuximab in combination with motolimod immunotherapy in patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sayan M, Vempati P, Miles B, Teng M, Genden E, Demicco EG, Misiukiewicz K, Posner M, Gupta V, Bakst RL. Adjuvant Therapy for Salivary Gland Carcinomas. Anticancer Res 2016; 36:4165-4170. [PMID: 27466526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Abstract
AIM We compared the clinical outcomes and toxicity profile among a retrospective cohort of patients with primary major salivary gland carcinomas (SGCs) treated with surgery followed by adjuvant radiation therapy (S+RT) versus surgery and adjuvant chemoradiotherapy (S+CRT). PATIENTS AND METHODS Twenty patients (71%) underwent S+RT and eight (29%) S+CRT at our Institution between 2006 and 2015. Microscopic positive margins were present in 54% of the patients. RESULTS The 3-year overall survival (OS) was 100% with S+RT and 87.5% with S+CRT (p=0.141) and locoregional control (LRC) was 95% with S+RT and 87.5% with S+CRT (p=0.383). There were no significant differences in the rate of acute (p=0.801) and late (p=0.714) toxicities. CONCLUSION While we await randomized data, adjuvant CRT may be considered as a viable therapeutic option for patients at high-risk of local or regional recurrence, especially in those with a positive microscopic margin where further surgery may result in functional cranial neuropathies.
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Affiliation(s)
- Mutlay Sayan
- University of Vermont, College of Medicine, Burlington, VT, U.S.A
| | - Prashant Vempati
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Marita Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Elizabeth G Demicco
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Krzysztof Misiukiewicz
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Marshall Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, U.S.A.
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43
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Rozehnal JM, Ang C, Donovan M, Bangi E, Yeykal C, Cagan RL, Antipin Y, Uzilov AV, Posner MR, Misiukiewicz K. Clinical outcomes in genetically targeted cancer treatment. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23127] [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)
| | - Celina Ang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ross L. Cagan
- Department of Developmental and Regenerative Biology, Icahn School of Medicine, New York, NY
| | | | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Kyi C, Sabado RL, Saenger YM, Posner MR, Donovan M, Loging W, Sacris E, Mandeli JP, Htwe Thin T, Misiukiewicz K, Maki RG, Salazar AM, Friedlander PA, Bhardwaj N. In situ, therapeutic vaccination against refractory solid cancers with intratumoral Poly-ICLC: A phase I study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3086] [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)
- Chrisann Kyi
- Tisch Cancer Center, Mount Sinai School of Medicine, New York, NY
| | | | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Tin Htwe Thin
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Nina Bhardwaj
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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45
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Rozehnal JM, Posner MR, Ang C, Bangi E, Yeykal C, Cagan RL, Dang RP, Donovan M, Uzilov AV, Antipin Y, Schadt EE, Misiukiewicz K. Transgenic drosophila as a drug-screening platform in colorectal cancer and medullary thyroid cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23164] [Citation(s) in RCA: 2] [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)
| | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Ang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ross L. Cagan
- Department of Developmental and Regenerative Biology, Icahn School of Medicine, New York, NY
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46
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Dave E, Ozbek U, Gupta V, Genden E, Miles B, Teng M, Demicco E, Posner M, Misiukiewicz K, Bakst R. Patterns of Failure in Human Papillomavirus (HPV)-Positive Versus HPV-Negative Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.240] [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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47
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Smith W, Bakst R, Genden E, Yao M, Demicco E, Misiukiewicz K, Posner M, Gupta V. Contralateral Neck-Sparing Radiation Therapy in Select Patients With Locally Advanced Oropharyngeal Cancer After Primary Surgery With Neck Dissection. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soulières D, Aguilar JL, Chen E, Misiukiewicz K, Ernst S, Lee HJ, Bryant K, He S, Obasaju CK, Chang SC, Chin S, Adkins D. Cetuximab plus platinum-based chemotherapy in head and neck squamous cell carcinoma: a randomized, double-blind safety study comparing cetuximab produced from two manufacturing processes using the EXTREME study regimen. BMC Cancer 2016; 16:19. [PMID: 26768732 PMCID: PMC4714495 DOI: 10.1186/s12885-016-2064-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cetuximab, in combination with platinum chemotherapy plus 5-fluoruracil (5-FU), is approved for the first-line treatment of recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN). Cetuximab manufactured by ImClone (US commercial cetuximab) potentially results in higher systemic exposures than cetuximab manufactured by Boehringer Ingelheim (BI-manufactured cetuximab). This prospective, randomized, double-blind study compared the safety profiles of the two cetuximab formulations. METHODS Patients with previously untreated locoregionally recurrent and/or metastatic SCCHN were randomly assigned to receive the same dose of US commercial cetuximab (Arm A) or BI-manufactured cetuximab (Arm B), each in combination with cisplatin or carboplatin plus 5-FU. The primary outcome was all-grade, all-cause treatment-emergent adverse events (TEAEs). RESULTS The majority of patients experienced ≥ 1 TEAE, regardless of causality (Arm A: 75/77 patients, 97.4%; Arm B: 68/71 patients, 95.8%). TEAEs with the highest incidence included nausea, fatigue, and hypomagnesemia in both arms. The absolute risk difference between the two arms for patients experiencing at least one adverse event (AE) was 0.029 (p = 0.281, 95% confidence interval [CI]: -0.024, 0.082) for AEs regardless of causality and 0.005 (p = 0.915, 95% CI: -0.092, 0.103) for AEs possibly related to study drug. There were no significant differences between the two arms in the incidence of acneiform rash, cardiac events, infusion reactions, or hypomagnesemia. Overall survival, progression-free survival, and overall response rates were similar in the two arms. CONCLUSIONS There were no clinically meaningful differences in safety between US commercial cetuximab and BI-manufactured cetuximab in combination with platinum-based therapy with 5-FU in patients with locoregionally recurrent and/or metastatic SCCHN. The use of US commercial cetuximab in this combination chemotherapy regimen did not result in any unexpected safety signals. The efficacy results of this study are consistent with the efficacy results of the cetuximab arm of the EXTREME study. TRIAL REGISTRATION ClinicalTrials.gov NCT01081041 ; date of registration: March 3, 2010).
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Affiliation(s)
- Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | - Eric Chen
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - Scott Ernst
- London Regional Cancer Center, London, Ontario, Canada
| | | | | | - Shuang He
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Steve Chin
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Douglas Adkins
- Washington University School of Medicine, 660 S. Euclid, Box 8056, St. Louis, MO, 63110, USA.
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McFarland DC, Dang RP, Miles BA, Misiukiewicz K. Four Difficult Thyroid Cancer Cases: Incorporating Medical Therapies. Semin Oncol 2015; 42:e83-98. [PMID: 26615140 DOI: 10.1053/j.seminoncol.2015.09.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel C McFarland
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Rajan P Dang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Division of Head and Neck Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Krzysztof Misiukiewicz
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Misiukiewicz K, Dang RP, Parides M, Camille N, Uczkowski H, Sarlis NJ, Posner M. Endothelial growth factor receptor inhibitors in recurrent metastatic cancer of the head and neck. Head Neck 2015; 38 Suppl 1:E2221-8. [PMID: 25900280 DOI: 10.1002/hed.24083] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/25/2022] Open
Abstract
Targeted therapy has become an important new class of therapeutic agents used in squamous cell carcinoma of the head and neck (SCCHN). Among them epidermal growth factor receptor (EGFR) inhibitors have been studied the most. Today, two classes of EGFR inhibitors are routinely used in the clinic; anti-EGFR monoclonal antibodies and small-molecule inhibitors of the EGFR tyrosine kinase activity. These agents have been used clinically in the recurrent metastatic (R/M) settings but only cetuximab has reached a regulatory approval. Current research is focused on innovative compound design, predictive biomarker discovery, and combination strategies in order to overcome resistance. Efforts should also be focused on endpoints other than overall survival, which is the current gold standard, such as surrogate endpoints. This article summarizes the clinical evidence of the anticancer activity of EGFR inhibitors in patients with R/M SCCHN, and analyzes the current, controversial clinical issues with respect to their interpretation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2221-E2228, 2016.
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Affiliation(s)
- Krzysztof Misiukiewicz
- Department of Medical Oncology, Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rajan P Dang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Parides
- Department of Medical Oncology, Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nadia Camille
- Department of Medical Oncology, Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Nicholas J Sarlis
- Department of Clinical & Exper. Medicine & Pharmacology Masters Program, University of Messina, Messina, Italy
| | - Marshall Posner
- Department of Medical Oncology, Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, New York, New York
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