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Geyer CE, Blum JL, Yothers G, Asmar L, Flynn PJ, Robert NJ, Hopkins JO, O'Shaughnessy JA, Rastogi P, Puhalla SL, Hilton CJ, Dang CT, Gómez HL, Vukelja SJ, Lyss AP, Paul D, Brufsky AM, Colangelo LH, Swain SM, Mamounas EP, Wolmark N. Long-Term Follow-Up of the Anthracyclines in Early Breast Cancer Trials (USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 [NRG Oncology]). J Clin Oncol 2024; 42:1344-1349. [PMID: 38335467 PMCID: PMC11095853 DOI: 10.1200/jco.23.01428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 02/12/2024] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The primary joint efficacy analysis of the Anthracyclines in Early Breast Cancer (ABC) trials reported in 2017 failed to demonstrate nonanthracycline adjuvant therapy was noninferior to anthracycline-based regimens in high-risk, early breast cancer. Full analyses of the studies had proceeded when the prespecified futility boundary was crossed at a planned futility analysis for the ability to demonstrate noninferiority of a nonanthracycline regimen with continued follow-up. These results were presented with 3.3 years of median follow-up. This manuscript reports results of the final analyses of the study efficacy end points conducted with 6.9 years of median follow-up. Long-term analysis of invasive disease-free survival (IDFS), the primary end point of the ABC trials, remains consistent with the original results, as noninferiority of the nonanthracycline regimens could not be declared on the basis of the original criteria. The secondary end point of recurrence-free interval, which excluded deaths not due to breast cancer as events, favored anthracycline-based regimens, and tests for heterogeneity were significant for hormone receptor status (P = .02) favoring anthracycline regimens for the hormone receptor-negative cohorts. There was no difference in overall survival, and review of the type of IDFS events in the groups suggested reductions in cancer recurrences achieved with anthracycline regimens were offset by late leukemias and deaths unrelated to breast cancer.
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Affiliation(s)
- Charles E. Geyer
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joanne L. Blum
- Baylor-Sammons Cancer Center, Texas Oncology, US Oncology Research, Dallas, TX
| | - Greg Yothers
- NRG Oncology SDMC, Department of Biostatistics, and University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Lina Asmar
- USOR, McKesson Specialty Health, The Woodlands, TX
| | - Patrick J. Flynn
- Minnesota Community Oncology Research Consortium (MSORC), Stone Lake, MI
| | | | - Judith O. Hopkins
- Novant Health (Forsyth Medical) Cancer Institute, Southeast Clinical Oncology Research (SCOR) NCORP, Winston Salem, NC
| | | | - Priya Rastogi
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
- UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Shannon L. Puhalla
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Christie J. Hilton
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- Allegheny Health Network, Pittsburgh, PA
| | - Chau T. Dang
- Memorial Sloan Kettering Cancer Center, West Harrison, NY
| | | | | | - Alan P. Lyss
- Heartland Cancer Research NCORP-Missouri Baptist Medical Center, St Louis, MO
| | | | - Adam M. Brufsky
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
- UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Linda H. Colangelo
- NRG Oncology SDMC, Department of Biostatistics, and University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Sandra M. Swain
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, MedStar Health, Washington, DC
| | | | - Norman Wolmark
- NSABP Foundation/NRG Oncology, Pittsburgh, PA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
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2
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George TJ, Yothers G, Rahma OE, Hong TS, Russell MM, You YN, Parker W, Jacobs SA, Lucas PC, Colangelo LH, Gollub MJ, Hall WA, Kachnic LA, Bajaj M, Gross HM, Peterson RA, Dorth JA, Vijayvergia N, Wolmark N. Long-term results from NRG-GI002: A phase II clinical trial platform using total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.7] [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: 01/25/2023] Open
Abstract
7 Background: This NCTN multi-arm randomized phase II modular clinical trial platform utilizes TNT with parallel experimental arms (EAs) in LARC. EAs are not intended for direct comparison, but rather to concurrently randomized control arm (CA) patients. Primary endpoint (EP) and available secondary EPs (from EA1 using veliparib [V], PARPi; and EA2 using pembrolizumab [P], anti-PD-1) have been previously reported. We present long-term outcomes of all pts enrolled (NCT02921256). Methods: Stage II/III pts with MSS LARC (with any ONE of the following: distal location [cT3-4 ≤5cm from anal verge, any N]; bulky [any cT4 or tumor within 3mm of mesorectal fascia]; high risk for metastatic disease [cN2]; or not a sphincter-sparing surgery [SSS] candidate) were randomized to CA (neoadjuvant FOLFOX [x 4mo] → chemoRT [capecitabine with 50.4Gy] → surgery 8-12 wks later). EA1 added V (400mg PO BID) and EA2 added P (200mg IV Q3 wks x 6 doses) each concurrent with chemoRT. Primary EP: 4-point reduction in Neoadjuvant Rectal Cancer (NAR) score with a one-sided α=0.10, 80% power. NAR compared by linear model controlling for clinical T4 at entry (Y/N). Secondary EPs: OS, DFS. p-values are two-sided. Results: From 10/2016-2/2018, 178 pts were randomized (88 CA, 90 EA1). From 8/2018-5/2019, 185 pts were randomized (95 CA, 90 EA2). Baseline characteristics were previously reported. Median follow-up is 3.50 yrs for the 1st comparison. Median follow-up is 3.15 yrs for the 2nd comparison. Updated primary and long-term secondary outcomes are in the table. Conclusions: With longer follow-up, addition of V to TNT provided no significant differences in the NAR score or 3yr outcomes. The addition of P to TNT was associated with a statistically significant improvement in 3yr OS, but not DFS. Correlative molecular analyses are ongoing. Support: U10CA180868, -180822; UG1-189867; U24-196067; AbbVie; Merck. Clinical trial information: NCT02921256 . [Table: see text]
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Affiliation(s)
| | - Greg Yothers
- University of Pittsburgh Department of Biostatistics, Pittsburgh, PA
| | | | - Theodore S. Hong
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Marcia McGory Russell
- David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Y. Nancy You
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Parker
- McGill University Health Centre, Medical Physics Unit, Montreal, QC, Canada
| | | | - Peter C. Lucas
- UMPC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Marc J Gollub
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Madhuri Bajaj
- Illinois CancerCare, P.C. / Hartland NCORP, Peoria, IL
| | - Howard M. Gross
- Dayon NCI Community Oncology Research Program, Englewood, OH
| | | | - Jennifer Anne Dorth
- University Hospitals Seidman Cancer Center, and Case Western Reserve University Comprehensive Cancer Center LAPS, Cleveland, OH
| | | | - Norman Wolmark
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Ganz PA, Hays RD, Spritzer KL, Rogatko A, Ko CY, Colangelo LH, Arora A, Hopkins JO, Evans TL, Yothers G. Health-related quality of life outcomes after neoadjuvant chemoradiotherapy for rectal cancer in NRG Oncology/NSABP R-04. Cancer 2022; 128:3233-3242. [PMID: 35749631 PMCID: PMC9540677 DOI: 10.1002/cncr.34341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
Background There has been limited evaluation of health‐related quality of life (HRQOL) in rectal cancer patients receiving neoadjuvant chemoradiotherapy. HRQOL outcomes in the National Surgical Adjuvant Breast and Bowel Project R‐04 trial are examined in this article. Methods Between 2004 and 2010, R‐04 patients were invited to enroll in the HRQOL substudy, with questionnaires administered before randomization, after completion of chemoradiotherapy, and 1‐year after surgery. HRQOL measures included: Functional Assessment of Cancer Therapy for colorectal cancer (FACT‐C); Short Form‐36v.2 Vitality scale; a treatment‐specific symptom scale; and the FACT neurotoxicity scale. A 5‐year postsurgery assessment was added to the protocol in 2012. Mixed‐effects models examined neoadjuvant therapy treatment effects in the 1‐year sample and models that explored associations of host factors and treatment impact on 5‐year HRQOL. Results A total of 1373 patients completed baseline HRQOL and at least one additional assessment. The average age was 58 years (range, 23–85 years), male (68%), and 59% Stage II. There were no statistically significant differences in HRQOL outcomes by treatment arm, but HRQOL worsened from baseline to postneoadjuvant chemoradiotherapy, with statistically significant effect sizes changes ranging from 0.6 (Vitality) to 0.9 (FACT‐C Trial Outcome Index). Neurotoxicity was greater in the oxaliplatin‐treated groups. Obese/overweight patients had statistically significantly worse FACT‐C Trial Outcome Index scores than did underweight/normal weight groups. At 5 years, younger patients and those with normal baseline weight had statistically significantly better physical function scores and older patients had better mental health outcomes. Conclusions HRQOL did not differ across the four R‐04 treatment arms; however, host factors explained significant variation in posttreatment HRQOL. ClinicalTrials.gov: NCT00058474 (https://ClinicalTrials.gov/ct2/show/NCT00058474). Lay summary This article reports on the health‐related quality of life (HRQOL) outcomes of patients treated with four different chemotherapy regimens combined with radiation in rectal cancer patients before definitive surgical treatment. There were no significant differences in HRQOL by treatment regimen, but all patients experienced decreased vitality (energy) and physical functioning. By 1 year after treatment, most patients had returned to pretreatment vitality and physical functioning, with the exception of increased neurotoxicity. In a subsample of patients assessed at 5 years after surgery, physical function was better in those who at pretreatment were younger, normal weight, and had better performance status. Mental function was better in those who at pretreatment were older and had better performance status.
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Affiliation(s)
- Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, California, USA.,Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ron D Hays
- Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Karen L Spritzer
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - André Rogatko
- Cedars-Sinai Health System, Los Angeles, California, USA
| | - Clifford Y Ko
- Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Linda H Colangelo
- NRG Oncology Statistics and Data Management Center, Pittsburgh, Pennsylvania, USA.,The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amit Arora
- Kaiser Permanente NCI Community Oncology Research Program, Fremont, California, USA
| | - Judith O Hopkins
- Novant Health (Forsyth Medical) Cancer Institute/Southeast Clinical Oncology Research (SCOR) NCORP, Winston-Salem, North Carolina, USA
| | - Terry L Evans
- The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Greg Yothers
- NRG Oncology Statistics and Data Management Center, Pittsburgh, Pennsylvania, USA.,The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rahma OE, Yothers G, Hong TS, Russell MM, You YN, Parker W, Jacobs SA, Colangelo LH, Lucas PC, Gollub MJ, Hall WA, Kachnic LA, Vijayvergia N, O'Rourke MA, Faller BA, Valicenti RK, Schefter TE, Moxley KM, Kainthla R, Stella PJ, Sigurdson E, Wolmark N, George TJ. Use of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: Initial Results From the Pembrolizumab Arm of a Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:1225-1230. [PMID: 34196693 DOI: 10.1001/jamaoncol.2021.1683] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Total neoadjuvant therapy (TNT) is often used to downstage locally advanced rectal cancer (LARC) and decrease locoregional relapse; however, more than one-third of patients develop recurrent metastatic disease. As such, novel combinations are needed. Objective To assess whether the addition of pembrolizumab during and after neoadjuvant chemoradiotherapy can lead to an improvement in the neoadjuvant rectal (NAR) score compared with treatment with FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and chemoradiotherapy alone. Design, Setting, and Participants In this open-label, phase 2, randomized clinical trial (NRG-GI002), patients in academic and private practice settings were enrolled. Patients with stage II/III LARC with distal location (cT3-4 ≤ 5 cm from anal verge, any N), with bulky disease (any cT4 or tumor within 3 mm of mesorectal fascia), at high risk for metastatic disease (cN2), and/or who were not candidates for sphincter-sparing surgery (SSS) were stratified based on clinical tumor and nodal stages. Trial accrual opened on August 1, 2018, and ended on May 31, 2019. This intent-to-treat analysis is based on data as of August 2020. Interventions Patients were randomized (1:1) to neoadjuvant FOLFOX for 4 months and then underwent chemoradiotherapy (capecitabine with 50.4 Gy) with or without intravenous pembrolizumab administered at a dosage of 200 mg every 3 weeks for up to 6 doses before surgery. Main Outcomes and Measures The primary end point was the NAR score. Secondary end points included pathologic complete response (pCR) rate, SSS, disease-free survival, and overall survival. This report focuses on end points available after definitive surgery (NAR score, pCR, SSS, clinical complete response rate, margin involvement, and safety). Results A total of 185 patients (126 [68.1%] male; mean [SD] age, 55.7 [11.1] years) were randomized to the control arm (CA) (n = 95) or the pembrolizumab arm (PA) (n = 90). Of these patients, 137 were evaluable for NAR score (68 CA patients and 69 PA patients). The mean (SD) NAR score was 11.53 (12.43) for the PA patients (95% CI, 8.54-14.51) vs 14.08 (13.82) for the CA patients (95% CI, 10.74-17.43) (P = .26). The pCR rate was 31.9% in the PA vs 29.4% in the CA (P = .75). The clinical complete response rate was 13.9% in the PA vs 13.6% in the CA (P = .95). The percentage of patients who underwent SSS was 59.4% in the PA vs 71.0% in the CA (P = .15). Grade 3 to 4 adverse events were slightly increased in the PA (48.2%) vs the CA (37.3%) during chemoradiotherapy. Two deaths occurred during FOLFOX: sepsis (CA) and pneumonia (PA). No differences in radiotherapy fractions, FOLFOX, or capecitabine doses were found. Conclusions and Relevance Pembrolizumab added to chemoradiotherapy as part of total neoadjuvant therapy was suggested to be safe; however, the NAR score difference does not support further study. Trial Registration ClinicalTrials.gov Identifier: NCT02921256.
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Affiliation(s)
- Osama E Rahma
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Medical Oncology, Dana-Farber Cancer Institute/Alliance, Boston, Massachusetts
| | - Greg Yothers
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theodore S Hong
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - Marcia M Russell
- NRG Oncology, Philadelphia, Pennsylvania.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Y Nancy You
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - William Parker
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Medical Physics, McGill University Health Centre, Montréal, Quebec, Canada
| | | | - Linda H Colangelo
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter C Lucas
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Pathology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William A Hall
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee
| | - Lisa A Kachnic
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Radiation Oncology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, New York.,SWOG Cancer Research Network, San Antonio, Texas
| | - Namrata Vijayvergia
- NRG Oncology, Philadelphia, Pennsylvania.,Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mark A O'Rourke
- NRG Oncology, Philadelphia, Pennsylvania.,National Cancer Institute Community Oncology Research Program, Prisma Health Cancer Institute, Greenville, South Carolina
| | - Bryan A Faller
- Missouri Baptist Medical Center, Heartland Cancer Research, National Cancer Institute Community Oncology Research Program, St Louis
| | | | - Tracey E Schefter
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Radiation Oncology, University of Colorado Cancer Center, Aurora
| | - Katherine M Moxley
- NRG Oncology, Philadelphia, Pennsylvania.,Section of Gynecologic Oncology, University of Oklahoma Stephenson Cancer Center, Oklahoma City
| | - Radhika Kainthla
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Philip J Stella
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Medical Oncology, St Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Elin Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Norman Wolmark
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas J George
- NRG Oncology, Philadelphia, Pennsylvania.,Department of Medicine, University of Florida Health Cancer Center, Gainesville
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5
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Rahma OE, Yothers G, Hong TS, Russell MM, You YN, Parker W, Jacobs SA, Colangelo LH, Lucas PC, Gollub MJ, Hall WA, Kachnic LA, Vijayvergia N, Wolmark N, George TJ. NRG-GI002: A phase II clinical trial platform using total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC)—Pembrolizumab experimental arm (EA) primary results. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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
8 Background: This NCTN multi-arm randomized phase II modular clinical trial platform utilizes TNT with parallel EAs in LARC. EAs are not intended for direct comparison, but rather to test a variety of sensitizers or hypotheses in a consistent and homogenous high-risk pt population with correlative biomarkers. Here we report the primary and available secondary endpoints (EPs). Methods: Stage II/III LARC pts (with ONE or more of the following: distal location [cT3-4 ≤5cm from anal verge, any N]; bulky [any cT4 or tumor within 3mm of mesorectal fascia]; high risk for metastatic disease [cN2]; or not a sphincter-sparing surgery [SSS] candidate) were randomized to neoadjuvant FOLFOX x 4mo → chemoRT (capecitabine with 50.4Gy +/- pembrolizumab 200mg IV Q3 wks x 6 doses) → surgery 8-12 wks following last dose of radiotherapy. Primary EP: Improvement in Neoadjuvant Rectal Cancer (NAR) score for EA v control potentially representing a 3-4% absolute OS improvement. Secondary EPs: Comparisons of OS, DFS, toxicity, pCR, cCR, therapy completion, negative surgical margins, sphincter sparing surgery (SSS), and exploratory assessments of molecular and radiographic predictors of response and distant failure. Binary EPs compared by Fisher’s exact test. Reported p-values are two-sided. Results: From 8/2018-5/2019, 185 pts were randomized to control (n=95) or pembrolizumab (n= 90). Baseline characteristics were relatively well balanced. 137 pts were evaluable for NAR (68 control, 69 pembrolizumab). Mean NAR was 14.08 for control (95% CI: 10.7-17.4) v 11.53 for pembrolizumab (CI: 8.5-14.6) (p=0.26). pCR=29.4% v 31.9% (p=0.75); cCR=13.6% v 13.9% (p=0.95); and SSS=71.0% v 59.4% (p=0.15). The side effects on Arm 3 were consistent with both CRT and pembrolizumab safety profile. Grade 3/4 AEs were slightly increased on the pembrolizumab arm during and after CRT (48.2 v 37.3%). There were 2 deaths during FOLFOX, one on the control arm due to sepsis; the other on the EA due to pneumonia. There were no statistically significant differences in RT (fractions, dose, boost fractions, or boost dose), FOLFOX or capecitabine doses. Conclusions: Pembrolizumab added to chemoRT as part of TNT was safe and without unexpected short-term toxicities but failed to improve the NAR score. The secondary endpoints including PFS and OS have not been reached. Correlative analysis for both T-cell and myeloid cell populations in the tissue and blood in addition to comprehensive cytokine analysis is ongoing. NCT02921256. Support: U10CA180868, -180822; UG1-189867; U24-196067. Clinical trial information: NCT02921256.
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Affiliation(s)
- Osama E. Rahma
- NRG Oncology, and Dana-Farber Cancer Institute/Alliance, Boston, MA
| | - Greg Yothers
- NRG Oncology, and The University of Pittsburgh, Pittsburgh, PA
| | | | - Marcia McGory Russell
- NRG Oncology, and The VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Y. Nancy You
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Parker
- NRG Oncology, and McGill University Health Centre, Montreal, QC, Canada
| | - Samuel A. Jacobs
- NRG Oncology, and The University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Peter C. Lucas
- NRG Oncology, and University of Pittsburgh, Pittsburgh, PA
| | - Marc J Gollub
- NRG Oncology and Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Lisa A. Kachnic
- Columbia University Irving Medical Center/SWOG, New York, NY
| | | | - Norman Wolmark
- NRG Oncology, and The University of Pittsburgh, Pittsburgh, PA
| | - Thomas J. George
- NRG Oncology, and The University of Florida Health Cancer Center, Gainesville, FL
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6
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Penney KL, Banbury BL, Bien S, Harrison TA, Hua X, Phipps AI, Sun W, Song M, Joshi AD, Alberts SR, Allegra CJ, Atkins J, Colangelo LH, George TJ, Goldberg RM, Lucas PC, Nair SG, Shi Q, Sinicrope FA, Wolmark N, Yothers G, Peters U, Newcomb PA, Chan AT. Genetic Variant Associated With Survival of Patients With Stage II-III Colon Cancer. Clin Gastroenterol Hepatol 2020; 18:2717-2723.e3. [PMID: 31811950 PMCID: PMC7269796 DOI: 10.1016/j.cgh.2019.11.046] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/29/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Many genetic variants have been associated with colorectal cancer risk, although few have been associated with survival times of patients. Identification of genetic variants associated with survival times might improve our understanding of disease progression and aid in outcome prediction. We performed a genome-wide association study to identify variants associated with colon cancer survival time. METHODS We performed a post hoc analysis of data from NCCTG N0147 (Alliance), a randomized phase 3 trial of patients with resected stage III colon cancer, and from NSABP C-08 (NRG), a phase 3 trial that compared therapy regimens for patients with resected stage II or III colon cancer. Genotype analyses were performed on DNA from blood samples from 4974 patients. We used Cox proportional hazards regression to evaluate the association of each single nucleotide polymorphism with times of overall survival and disease-free survival, adjusting for age at diagnosis, sex, treatment group, and principal components of genetic ancestry. We performed the analysis for studies N0147 and C-08 separately, and results were combined in a fixed-effects meta-analysis. RESULTS A locus on chromosome 7p15.2 was significantly associated with overall survival time (P ≤ 5x10-08). The most significant variant at this locus, rs76766811 (P = 1.6x10-08), is common among African Americans (minor allele frequency, approximately 18%) but rare in European Americans (minor allele frequency <0.1%). Within strata of self-reported ancestry, this variant was associated with times of overall survival and disease-free survival in only African Americans (hazard ratio for overall survival, 2.82; 95% CI, 1.88-4.23; P = 5.0x10-07 and hazard ratio for disease-free survival, 2.27; 95% CI, 1.62-3.18; P = 1.8x10-06). CONCLUSIONS In an analysis of data from 2 trials of patients with stage II or III colon cancer, we identified rs76766811 as a potential prognostic variant in African American patients. This finding should be confirmed in additional study populations. ClinicalTrials.gov Identifiers: NCT00096278 (NSABP C-08) and NCT00079274 (NCCTG N0147).
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Affiliation(s)
- Kathryn L Penney
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Stephanie Bien
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Xinwei Hua
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Amanda I Phipps
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Wei Sun
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven R Alberts
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Carmen J Allegra
- University of Florida, Gainesville, Florida; NRG Oncology, Pittsburgh, Pennsylvania
| | - James Atkins
- NRG Oncology, Pittsburgh, Pennsylvania; Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, North Carolina
| | - Linda H Colangelo
- NRG Oncology, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas J George
- University of Florida, Gainesville, Florida; NRG Oncology, Pittsburgh, Pennsylvania
| | - Richard M Goldberg
- NRG Oncology, Pittsburgh, Pennsylvania; West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Peter C Lucas
- NRG Oncology, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suresh G Nair
- Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Frank A Sinicrope
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Norman Wolmark
- NRG Oncology, Pittsburgh, Pennsylvania; Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Greg Yothers
- NRG Oncology, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ulrike Peters
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Polly A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Penney K, Banbury BL, Shi Q, Allegra CJ, Alberts SR, Peters U, Yothers G, Sinicrope FA, Sun W, Nair S, Harrison TA, Goldberg RM, Lucas PC, Colangelo LH, Atkins JN, Newcomb PA, Chan AT. Genome-wide association with survival in stage II-III colon cancer clinical trials (NCCTG N0147, Alliance for Clinical Trials in Oncology; NSABP C-08, NRG Oncology). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Sun
- University of Washington, Seattle, WA
| | | | | | | | - Peter C. Lucas
- NSABP/NRG Oncology, and The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Linda H. Colangelo
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | | | - Andrew T. Chan
- Massachusetts General Hospital/Harvard Medical School, Boston, MA
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Blum JL, Flynn PJ, Yothers G, Asmar L, Geyer CE, Jacobs SA, Robert NJ, Hopkins JO, O'Shaughnessy JA, Dang CT, Gómez HL, Fehrenbacher L, Vukelja SJ, Lyss AP, Paul D, Brufsky AM, Jeong JH, Colangelo LH, Swain SM, Mamounas EP, Jones SE, Wolmark N. Anthracyclines in Early Breast Cancer: The ABC Trials-USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 (NRG Oncology). J Clin Oncol 2017; 35:2647-2655. [PMID: 28398846 DOI: 10.1200/jco.2016.71.4147] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Docetaxel and cyclophosphamide (TC) was superior to doxorubicin and cyclophosphamide (AC) in a trial in early breast cancer. However, activity of TC relative to AC regimens with a taxane (TaxAC) is unknown. Methods In a series of three adjuvant trials, women were randomly assigned to TC for six cycles (TC6) or to a standard TaxAC regimen. US Oncology Research (USOR) 06-090 compared TC6 with docetaxel, doxorubicin, and cyclophosphamide (TAC6). National Surgical Adjuvant Breast and Bowel Project (NSABP) B-46-I/USOR 07132 compared TC6, TAC6, or TC6 plus bevacizumab. NSABP B-49 compared TC6 with several standard AC and taxane combination regimens. Before any analysis of individual trials, a joint efficacy analysis of TC versus the TaxAC regimens was planned, with invasive disease-free survival (IDFS) as the primary end point. Patients who received TC6 plus bevacizumab on NSABP B-46-I/USOR 07132 were not included. A hazard ratio (HR) from a stratified Cox model that exceeded 1.18 for TC6 versus TaxAC was predefined as inferiority for TC6. The prespecified interim monitoring plan was to report for futility if the HR was > 1.18 when 334 IDFS events were observed (50% of 668 events required for definitive analysis). Results A total of 2,125 patients were randomly assigned to receive TC6 regimens and 2,117 patients were randomly assigned to receive TaxAC regimens. The median follow-up time was 3.3 years. There were 334 IDFS events, and the HR for TC6 versus TaxAC was 1.202 (95% CI, 0.97 to 1.49), which triggered early reporting for futility. The 4-year IDFS was 88.2% for TC6 and was 90.7% for TaxAC ( P = .04). Tests for treatment interaction by protocol, hormone receptor status, and nodal status were negative. Conclusion The TaxAC regimens improved IDFS in patients with high-risk human epidermal growth factor receptor 2-negative breast cancer compared with the TC6 regimen.
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Affiliation(s)
- Joanne L Blum
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Patrick J Flynn
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Greg Yothers
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Lina Asmar
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Charles E Geyer
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Samuel A Jacobs
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Nicholas J Robert
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Judith O Hopkins
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Joyce A O'Shaughnessy
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Chau T Dang
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Henry Leonidas Gómez
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Louis Fehrenbacher
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Svetislava J Vukelja
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Alan P Lyss
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Devchand Paul
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Adam M Brufsky
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Jong-Hyeon Jeong
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Linda H Colangelo
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Sandra M Swain
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Eleftherios P Mamounas
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Stephen E Jones
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
| | - Norman Wolmark
- Joanne L. Blum, Lina Asmar, Nicholas J. Robert, Joyce A. O'Shaughnessy, Svetislava J. Vukelja, Devchand Paul, and Stephen E. Jones, US Oncology Research; Lina Asmar, McKesson Specialty Health, The Woodlands; Joanne L. Blum and Joyce A. O'Shaughnessy, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas; Svetislava J. Vukelja, Texas Oncology-Tyler, Tyler, TX; Patrick J. Flynn, Charles E. Geyer Jr, Samuel A. Jacobs, Judith O. Hopkins, Louis Fehrenbacher, Alan P. Lyss, Adam M. Brufsky, Sandra M. Swain, Eleftherios P. Mamounas, and Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Greg Yothers, Jong-Hyeon Jeong, and Linda H. Colangelo, NRG Oncology; Greg Yothers, John-Hyeon Jeong, and Linda H. Colangelo, The University of Pittsburgh; Samuel A. Jacobs, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Adam M. Brufsky, Magee-Womens Hospital at University of Pittsburgh Medical Center; Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh; Henry Leonidas Gómez, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Philadelphia, PA; Patrick J. Flynn, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN; Charles E. Geyer Jr, Massey Cancer Center, Virginia Commonwealth University, Richmond; Nicholas J. Robert, Virginia Cancer Specialists, Fairfax, VA; Judith O. Hopkins, The Southeastern Medical Oncology Center, Goldsboro, NC; Chau T. Dang, The Alliance, Boston, MA; Chau T. Dang, Memorial Sloan Kettering Cancer Center, New York, NY; Henry Leonidas Gómez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Louis Fehrenbacher, Kaiser Permanente Oncology Clinical Trials Northern California, Vallejo, CA; Alan P. Liss, Heartland Cancer Research National Cancer Institute Community Oncology Research Program at Missouri Baptist Cancer Center, St Louis, MO; Devchand Paul, Rocky Mountain Cancer Centers, Denver, CO; Sandra M. Swain, MedStar Washington Hospital Center Washington Cancer Institute, and Georgetown University Medical Center, Washington, DC; and Eleftherios P. Mamounas, UF Cancer Center at Orlando Health, Orlando, FL
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Yothers G, George TJ, Petrelli NJ, O'Connell MJ, Beart RW, Allegra CJ, Roh MS, Lopa SH, Colangelo LH, Sharif S, Wolmark N. Neoadjuvant rectal cancer (RC) score to predict survival: Potential surrogate endpoint for early phase trials. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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)
- Greg Yothers
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, and University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA
| | | | | | | | | | | | - Mark S. Roh
- NSABP, and UF Health Cancer Center-Orlando Health, Orlando, FL
| | - Samia H. Lopa
- NSABP Biostatistical Center, and University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA
| | - Linda H. Colangelo
- NSABP Biostatistical Center, and University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA
| | | | - Norman Wolmark
- NSABP, and Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
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O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol 2014; 32:1927-34. [PMID: 24799484 DOI: 10.1200/jco.2013.53.7753] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The optimal chemotherapy regimen administered concurrently with preoperative radiation therapy (RT) for patients with rectal cancer is unknown. National Surgical Adjuvant Breast and Bowel Project trial R-04 compared four chemotherapy regimens administered concomitantly with RT. PATIENTS AND METHODS Patients with clinical stage II or III rectal cancer who were undergoing preoperative RT (45 Gy in 25 fractions over 5 weeks plus a boost of 5.4 Gy to 10.8 Gy in three to six daily fractions) were randomly assigned to one of the following chemotherapy regimens: continuous intravenous infusional fluorouracil (CVI FU; 225 mg/m(2), 5 days per week), with or without intravenous oxaliplatin (50 mg/m(2) once per week for 5 weeks) or oral capecitabine (825 mg/m(2) twice per day, 5 days per week), with or without oxaliplatin (50 mg/m(2) once per week for 5 weeks). Before random assignment, the surgeon indicated whether the patient was eligible for sphincter-sparing surgery based on clinical staging. The surgical end points were complete pathologic response (pCR), sphincter-sparing surgery, and surgical downstaging (conversion to sphincter-sparing surgery). RESULTS From September 2004 to August 2010, 1,608 patients were randomly assigned. No significant differences in the rates of pCR, sphincter-sparing surgery, or surgical downstaging were identified between the CVI FU and capecitabine regimens or between the two regimens with or without oxaliplatin. Patients treated with oxaliplatin experienced significantly more grade 3 or 4 diarrhea (P < .001). CONCLUSION Administering capecitabine with preoperative RT achieved similar rates of pCR, sphincter-sparing surgery, and surgical downstaging compared with CVI FU. Adding oxaliplatin did not improve surgical outcomes but added significant toxicity. The definitive analysis of local tumor control, disease-free survival, and overall survival will be performed when the protocol-specified number of events has occurred.
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Affiliation(s)
- Michael J O'Connell
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Linda H Colangelo
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Robert W Beart
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Nicholas J Petrelli
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Carmen J Allegra
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Saima Sharif
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Henry C Pitot
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Anthony F Shields
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Jerome C Landry
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - David P Ryan
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - David S Parda
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Mohammed Mohiuddin
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Amit Arora
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Lisa S Evans
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Nathan Bahary
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Gamini S Soori
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Janice Eakle
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - John M Robertson
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Dennis F Moore
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Michael R Mullane
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Benjamin T Marchello
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Patrick J Ward
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Timothy F Wozniak
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Mark S Roh
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Greg Yothers
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Norman Wolmark
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
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Pogue-Geile KL, Tanaka N, Gavin P, Yothers G, Colangelo LH, Kim C, Kim SR, Fumagalli D, Taniyama Y, Sharif S, O'Connell MJ, Paik S. DNA mismatch repair deficiency and benefit from adjuvant bevacizumab in NSABP C-08: Molecular profiling results. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.30_suppl.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
55 Background: The purpose of this study was to identify biomarkers that define a subset of patients who received benefit from bevacizumab (bev) in NSABP trial C-08, even though bev did not improve outcomes over standard adjuvant chemotherapy (CT) in the treatment of stage II and III colon cancer. Methods: A randomly selected cohort of C-08 cases (N=500) were profiled for whole genome expression (N=445) and for mutations (N=463) in KRAS, NRAS, PIK3CA, and MET. BRAF mutations and mismatch repair (MMR) status were profiled on the available cases (N=1,764 and 1,993, respectively). Cox proportional hazard models were used to assess prognosis and prediction for the value of bev using overall survival (0S) and time to recurrence (TTR) as end points. Results: The effect of bev was different for MMR deficient (MMR-d) and proficient tumors for OS (interaction p=.035) but not TTR (interaction p=.08). Patients with MMR-d (N=252) tumors showed a significant benefit from the addition of bev to CT for OS (hazard ratio =0.52 (95% CI: 0.29-0.94, p=0.028). KRAS, NRAS, PIK3CA, and MET were not significant for interaction with bev in the discovery cohort. BRAF mutations were associated with MMR status (p<.0001) and the prognostic value of MMR depended on BRAF for TTR (interaction p=.027) but not OS (interaction p=.31). The effect of bev was independent of BRAF (interaction p=.28 TTR and .37 OS). Three-factor interaction tests for bev, MMR, and BRAF were not significant for either endpoint. Gene expression analysis with BRB array tools identified 5 BioCarta pathways (p<0.05) which differentially expressed in 4 statistical tests; 4 of these pathways were directly or indirectly involved in T cell activation and one was involved in the activation of VEGF. Conclusions: Patients in C-08 with MMR-d tumors received benefit from bev treatment but these results need to be validated in a separate study. Gene expression data suggest that T-cells may be differentially expressed based on MMR status. Activation of VEGF has been shown to suppress T-cell development (Ohm et al. Blood. 2003:10;4878). A speculative possibility for the benefit of bev in MMR-d tumors may be due to blocking of VEGF, releasing T cells from VEGF suppression.
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Affiliation(s)
| | - Noriko Tanaka
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Patrick Gavin
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Greg Yothers
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Linda H. Colangelo
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Chungyeul Kim
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Debora Fumagalli
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Yusuke Taniyama
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Saima Sharif
- National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA
| | | | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
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Gavin PG, Colangelo LH, Fumagalli D, Tanaka N, Remillard MY, Yothers G, Kim C, Taniyama Y, Kim SI, Choi HJ, Blackmon NL, Lipchik C, Petrelli NJ, O'Connell MJ, Wolmark N, Paik S, Pogue-Geile KL. Mutation profiling and microsatellite instability in stage II and III colon cancer: an assessment of their prognostic and oxaliplatin predictive value. Clin Cancer Res 2012; 18:6531-41. [PMID: 23045248 DOI: 10.1158/1078-0432.ccr-12-0605] [Citation(s) in RCA: 244] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to examine the prognostic and oxaliplatin predictive value of mismatch repair (MMR) status and common hot spot mutations, which we previously identified in stage II and III colon cancer. EXPERIMENTAL DESIGN Mutations in BRAF, KRAS, NRAS, MET, and PIK3CA were profiled in 2,299 stage II and III colon tumors from National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials C-07 (n = 1,836) and C-08 (n = 463) with Type Plex chemistry and mass spectrometry. C-07 tested the worth of adding oxaliplatin to 5-fluorouracil plus leucovorin, and C-08 tested the worth of adding bevacizumab to FOLFOX. Cox proportional hazard models were used to assess prognostic or oxaliplatin predictive value of mutations for tumor recurrence, overall survival (OS), and survival after recurrence (SAR). RESULTS BRAF mutations were associated with MMR-deficient tumors (P < 0.0001), poor OS [HR, 1.46; 95% confidence interval (CI), 1.20-1.79; P ≤ 0.0002], and poor SAR (HR, 2.31; 95% CI, 1.83-2.95; P < 0.0001). Mutations in KRAS, NRAS, MET, and PIK3CA were not associated with recurrence, OS, or SAR. MMR-deficient tumors were associated with an improved prognosis based on recurrence (HR, 0.48; 95% CI, 0.33-0.70; P < 0.0001). Mutations and MMR status were not predictive for oxaliplatin benefit. CONCLUSIONS This study shows that BRAF mutations profiled from stage II and III colon cancer tumors were associated with poor SAR and validates and explains, at least in part, previous observations associating it with poor OS. Profiling of all of these mutations is warranted for future clinical trials testing new targeted therapies that block relevant signaling pathways. Such clinical trials are under development at NSABP.
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Affiliation(s)
- Patrick G Gavin
- National Surgical Adjuvant Breast and Bowel Project, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15212, USA
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Yothers G, O'Connell MJ, Allegra CJ, Kuebler JP, Colangelo LH, Petrelli NJ, Wolmark N. Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol 2011; 29:3768-74. [PMID: 21859995 PMCID: PMC3188282 DOI: 10.1200/jco.2011.36.4539] [Citation(s) in RCA: 466] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/16/2011] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The National Surgical Adjuvant Breast and Bowel Project (NSABP) C-07 trial demonstrated that the addition of oxaliplatin to fluorouracil plus leucovorin (FULV) improved disease-free survival (DFS) in patients with stage II or III colon cancer. This analysis is the first publication of overall survival (OS) for the NSABP C-07 study. We updated DFS and examined both end points in clinically relevant patient subsets. PATIENTS AND METHODS Other studies have identified patients age 70 or older and those with stage II disease as patient subsets in which oxaliplatin may not be effective. We investigated toxicity as a driver of divergent outcomes in these subsets. RESULTS In all, 2,409 eligible patients with follow-up were randomly assigned to either FULV (FU 500 mg/m(2) by intravenous [IV] bolus weekly for 6 weeks; leucovorin 500 mg/m(2) IV weekly for 6 weeks of each 8-week cycle for three cycles) or FLOX (FULV plus oxaliplatin 85 mg/m(2) IV on days 1, 15, and 29 of each cycle). With 8 years median follow-up, OS was similar between treatment groups (hazard ratio [HR], 0.88; 95% CI, 0.75 to 1.02; P = .08). FLOX remained superior for DFS (HR, 0.82; 95% CI, 0.72 to 0.93; P = .002). The effect of oxaliplatin on OS did not differ by stage of disease (interaction P = .38 for OS; interaction P = 0.37 for DFS) but did vary by age for OS (younger than age 70 v 70+ interaction P = .039). There was a similar trend for DFS (interaction P = .073). Oxaliplatin significantly improved OS in patients younger than age 70 (HR, 0.80; 95% CI, 0.68 to 0.95; P = .013), but no positive effect was evident in older patients. CONCLUSION Overall, the addition of oxaliplatin to FULV has not been proven to extend OS in this trial, but the DFS effect remained strong. Unplanned subset analyses suggest a significant OS effect of oxaliplatin in patients younger than age 70.
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Affiliation(s)
- Greg Yothers
- NSABP Biostatistical Center, One Sterling Plaza, 201 N Craig St, Ste 350, Pittsburgh, PA 15213, USA.
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Allegra CJ, Yothers G, O'Connell MJ, Sharif S, Petrelli NJ, Colangelo LH, Atkins JN, Seay TE, Fehrenbacher L, Goldberg RM, O'Reilly S, Chu L, Azar CA, Lopa S, Wolmark N. Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: results of NSABP protocol C-08. J Clin Oncol 2010; 29:11-6. [PMID: 20940184 DOI: 10.1200/jco.2010.30.0855] [Citation(s) in RCA: 427] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The National Surgical Adjuvant Breast and Bowel Project C-08 trial was designed to investigate the safety and efficacy of adding bevacizumab to modified FOLFOX6 (mFOLFOX6; ie, infusional/bolus fluorouracil, leucovorin, and oxaliplatin) for the adjuvant treatment of patients with stages II to III colon cancer. METHODS Patients received mFOLFOX6 every 2 weeks for 26 weeks alone or modified as FOLFOX6 + bevacizumab (5 mg/kg every 2 weeks for 52 weeks [ie, experimental group]). The primary end point was disease-free survival (DFS). RESULTS Among 2,672 analyzed patients, demographic factors were well balanced by treatment. With a median follow-up of 35.6 months, the addition of bevacizumab to mFOLFOX6 did not result in an overall significant increase in DFS (hazard ratio [HR], 0.89; 95% CI, 0.76 to 1.04; P = .15). The point estimates for 3-year DFS for the overall population were 77.4% and 75.5% for the experimental and control arms, respectively. For patients with stages II and III diseases, these same estimates were 87.4% and 84.7%, respectively, for stage II and 74.2% and 72.4%, respectively, for stage III. Exploratory analyses found that the effect of bevacizumab on DFS was different before and after a 15-month landmark (time-by-treatment interaction P value < .0001). Bevacizumab had a strong effect before the landmark (HR, 0.61; 95% CI, 0.48 to 0.78; P < .001) but no significant effect after (HR, 1.22; 95% CI, 0.98 to 1.52; P = .076). CONCLUSION Bevacizumab for 1 year with mFOLFOX6 does not significantly prolong DFS in stages II and III colon cancer. However, a significant but transient effect during bevacizumab exposure was observed in the experimental arm. We postulate that this observation reflects a biologic effect during bevacizumab exposure. Given the lack of improvement in DFS, the use of bevacizumab cannot be recommended for use in the adjuvant treatment of patients with colon cancer.
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Affiliation(s)
- Carmen J Allegra
- University of Florida, Division of Hematology and Oncology, 1600 SW Archer Ave, Rm N-503, Gainesville, FL 32610, USA.
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Roh MS, Colangelo LH, O'Connell MJ, Deutsch M, Wolmark N. Reply to R. Glynne-Jones et al. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.29.2490] [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)
- Mark S. Roh
- M. D. Anderson Cancer Center Orlando, Orlando, FL
| | - Linda H. Colangelo
- National Surgical Adjuvant Breast and Bowel Project (NSABP) and NSABP Biostatistical Center at the University of Pittsburgh, Pittsburgh, PA
| | | | - Melvin Deutsch
- University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA
| | - Norman Wolmark
- National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA
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Roh MS, Colangelo LH, O'Connell MJ, Yothers G, Deutsch M, Allegra CJ, Kahlenberg MS, Baez-Diaz L, Ursiny CS, Petrelli NJ, Wolmark N. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009; 27:5124-30. [PMID: 19770376 DOI: 10.1200/jco.2009.22.0467] [Citation(s) in RCA: 665] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although chemoradiotherapy plus resection is considered standard treatment for operable rectal carcinoma, the optimal time to administer this therapy is not clear. The NSABP R-03 (National Surgical Adjuvant Breast and Bowel Project R-03) trial compared neoadjuvant versus adjuvant chemoradiotherapy in the treatment of locally advanced rectal carcinoma. PATIENTS AND METHODS Patients with clinical T3 or T4 or node-positive rectal cancer were randomly assigned to preoperative or postoperative chemoradiotherapy. Chemotherapy consisted of fluorouracil and leucovorin with 45 Gy in 25 fractions with a 5.40-Gy boost within the original margins of treatment. In the preoperative group, surgery was performed within 8 weeks after completion of radiotherapy. In the postoperative group, chemotherapy began after recovery from surgery but no later than 4 weeks after surgery. The primary end points were disease-free survival (DFS) and overall survival (OS). RESULTS From August 1993 to June 1999, 267 patients were randomly assigned to NSABP R-03. The intended sample size was 900 patients. Excluding 11 ineligible and two eligible patients without follow-up data, the analysis used data on 123 patients randomly assigned to preoperative and 131 to postoperative chemoradiotherapy. Surviving patients were observed for a median of 8.4 years. The 5-year DFS for preoperative patients was 64.7% v 53.4% for postoperative patients (P = .011). The 5-year OS for preoperative patients was 74.5% v 65.6% for postoperative patients (P = .065). A complete pathologic response was achieved in 15% of preoperative patients. No preoperative patient with a complete pathologic response has had a recurrence. CONCLUSION Preoperative chemoradiotherapy, compared with postoperative chemoradiotherapy, significantly improved DFS and showed a trend toward improved OS.
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Affiliation(s)
- Mark S Roh
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations Cente, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA.
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Allegra CJ, Yothers G, O'Connell MJ, Sharif S, Colangelo LH, Lopa SH, Petrelli NJ, Goldberg RM, Atkins JN, Seay TE, Fehrenbacher L, O'Reilly S, Chu L, Azar CA, Wolmark N. Initial safety report of NSABP C-08: A randomized phase III study of modified FOLFOX6 with or without bevacizumab for the adjuvant treatment of patients with stage II or III colon cancer. J Clin Oncol 2009; 27:3385-90. [PMID: 19414665 DOI: 10.1200/jco.2009.21.9220] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The National Surgical Adjuvant Breast and Bowel Project C-08 trial was designed to investigate the safety and effectiveness of adding bevacizumab to modified infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) 6 regimen for the adjuvant treatment of patients with stage II or III colon cancer. We present safety information in advance of the planned analysis of efficacy. PATIENTS AND METHODS Among 2,710 randomly assigned patients, demographic factors were balanced. Patients received modified FOLFOX6 every 2 weeks x 12 or modified FOLFOX6 plus bevacizumab (5 mg/kg every 2 weeks x 26, experimental group). RESULTS Overall rates of grade 4 or 5 toxicities were nearly identical in the FOLFOX6 and FOLFOX6 plus bevacizumab arms (15.2% and 15.0%, respectively). Six-month mortality rates were 0.96% and 0.90% for the control and experimental groups, respectively. Grade 3+ toxicities that occurred more often in the experimental arm versus control arm included hypertension (12% v 1.8%, respectively), wound complications (abdominal incisional hernia or infusion port dehiscence/inflammation; 1.7% v 0.3%, respectively), pain (11.1% v 6.3%, respectively), and proteinuria (2.7% v 0.8%, respectively). Grade 2+ neuropathy was increased in the experimental arm versus the control arm (grade 2, 33% v 29%, respectively; grade 3, 16% v 14%, respectively; and grade 4, < 1% each). In the experimental arm versus control arm, significantly less thrombocytopenia (1.4% v 3.4%, respectively) and fewer allergic reactions (3.1% v 4.7%, respectively) were observed. Advanced age was associated with a significantly greater rate of grade 4 and 5 toxicities regardless of treatment. CONCLUSION Bevacizumab with modified FOLFOX6 is well tolerated in the surgical adjuvant setting in these patients. No significant increase in GI perforation, hemorrhage, arterial or venous thrombotic events, or death with the addition of bevacizumab to modified FOLFOX6 has been observed. Follow-up for potential delayed adverse effects and efficacy is ongoing.
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Kim GP, Colangelo LH, Paik S, O'Connell MJ, Kirsch IR, Allegra C, Wolmark N. Predictive value of microsatellite instability-high remains controversial. J Clin Oncol 2007; 25:4857; author reply 4857-8. [PMID: 17947740 DOI: 10.1200/jco.2007.13.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Land SR, Kopec JA, Cecchini RS, Ganz PA, Wieand HS, Colangelo LH, Murphy K, Kuebler JP, Seay TE, Needles BM, Bearden JD, Colman LK, Lanier KS, Pajon ER, Cella D, Smith RE, O'Connell MJ, Costantino JP, Wolmark N. Neurotoxicity from oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: NSABP C-07. J Clin Oncol 2007; 25:2205-11. [PMID: 17470850 DOI: 10.1200/jco.2006.08.6652] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The randomized, multicenter, phase III protocol C-07 compared the efficacy of adjuvant bolus fluorouracil and leucovorin (FULV) versus FULV with oxaliplatin (FLOX) in stage II or III colon cancer. Definitive analysis revealed an increase in 4-year disease-free survival from 67.0% to 73.2% in favor of FLOX. This study compares neurotoxicity between the treatments. PATIENTS AND METHODS Neurotoxicity was recorded for all patients using standard adverse event reporting. Patients at select institutions completed a neurotoxicity questionnaire through 18 months of follow-up. RESULTS A total of 2,492 patients enrolled onto C-07 and 400 patients enrolled onto the patient-reported substudy. Mean patient-reported neurotoxicity was higher with oxaliplatin throughout the 18 months of study (P < .0001). During therapy, patients receiving oxaliplatin experienced significantly more hand/foot toxicity (eg, "quite a bit" of cold-induced hand/foot pain 26% FLOX v 2.6% FULV) and overall weakness (eg, moderate weakness in 27.4% FLOX v 16.2% FULV). At 18 months, hand neuropathy had diminished, but patients who received oxaliplatin experienced continued foot discomfort (eg, moderate foot numbness and tingling for 22.1% FLOX v 4.6% FULV). Observer-reported neurotoxicity was low grade and primarily neurosensory rather than neuromotor. Sixty-eight percent in the FLOX group v 8% in the FULV group had neurotoxicity at their first on-treatment assessment. Time to resolution was significantly longer for those receiving oxaliplatin, and continued beyond 2 years for more than 10% in the oxaliplatin group. CONCLUSION Oxaliplatin causes significant neurotoxicity. It is experienced primarily in the hands during therapy and in the feet during follow-up. In a minority of patients the neurotoxicity is long lasting.
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Affiliation(s)
- Stephanie R Land
- National Surgical Adjuvant Breast and Bowel Project Operations Office and Biostatistical Center, Pittsburgh, PA 15213, USA.
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Kuebler JP, Wieand HS, O'Connell MJ, Smith RE, Colangelo LH, Yothers G, Petrelli NJ, Findlay MP, Seay TE, Atkins JN, Zapas JL, Goodwin JW, Fehrenbacher L, Ramanathan RK, Conley BA, Flynn PJ, Soori G, Colman LK, Levine EA, Lanier KS, Wolmark N. Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol 2007; 25:2198-204. [PMID: 17470851 DOI: 10.1200/jco.2006.08.2974] [Citation(s) in RCA: 736] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This phase III clinical trial evaluated the impact on disease-free survival (DFS) of adding oxaliplatin to bolus weekly fluorouracil (FU) combined with leucovorin as surgical adjuvant therapy for stage II and III colon cancer. PATIENTS AND METHODS Patients who had undergone a potentially curative resection were randomly assigned to either FU 500 mg/m2 intravenous (IV) bolus weekly for 6 weeks plus leucovorin 500 mg/m2 IV weekly for 6 weeks during each 8-week cycle for three cycles (FULV), or the same FULV regimen with oxaliplatin 85 mg/m2 IV administered on weeks 1, 3, and 5 of each 8-week cycle for three cycles (FLOX). RESULTS A total of 2,407 patients (96.6%) of the 2,492 patients randomly assigned were eligible. Median follow-up for patients still alive is 42.5 months. The hazard ratio (FLOX v FULV) is 0.80 (95% CI, 0.69 to 0.93), a 20% risk reduction in favor of FLOX (P < .004). The 3- and 4-year disease-free survival (DFS) rates were 71.8% and 67.0% for FULV and 76.1% and 73.2% for FLOX, respectively. Grade 3 neurosensory toxicity was noted in 8.2% of patients receiving FLOX and in 0.7% of those receiving FULV (P < .001). Hospitalization for diarrhea associated with bowel wall thickening occurred in 5.5% of the patients receiving FLOX and in 3.0% of the patients receiving FULV (P < .01). A total of 1.2% of patients died as a result of any cause within 60 days of receiving chemotherapy, with no significant difference between regimens. CONCLUSION The addition of oxaliplatin to weekly FULV significantly improved DFS in patients with stage II and III colon cancer. FLOX can be recommended as an effective option in clinical practice.
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Affiliation(s)
- J Philip Kuebler
- National Surgical Adjuvant Breast and Bowel Project Operations Office and Biostatistical Center, Pittsburgh, PA, USA
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Kim GP, Colangelo LH, Wieand HS, Paik S, Kirsch IR, Wolmark N, Allegra CJ. Prognostic and predictive roles of high-degree microsatellite instability in colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project Collaborative Study. J Clin Oncol 2007; 25:767-72. [PMID: 17228023 DOI: 10.1200/jco.2006.05.8172] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The role of high-degree microsatellite instability (MSI-H) as a marker to predict benefit from adjuvant chemotherapy remains unclear. PATIENTS AND METHODS To help define its impact, we conducted an analysis of National Surgical Adjuvant Breast and Bowel Project (NSABP) patients who were randomly assigned to a surgery-alone group (untreated cohort) and patients assigned to an adjuvant fluorouracil (FU) -treated group (treated cohort). MSI-H and other potential markers were assessed (TGF-BRII, p53, thymidylate synthase, and Ki67). RESULTS In all, 98 (18.1%) of 542 patients exhibited MSI-H, and there was a strong inverse relationship between MSI-H and mutant p53 status (P < .001). The prognostic analyses showed increased recurrence-free survival (RFS) for MSI-H patients versus MSS/MSI-L patients (P = .10), but showed no difference in overall survival (OS; P = .67). There was a potential interaction between MSI-H and mutant p53 in terms of improved RFS (P = .03). In the predictive marker analysis, we observed no interaction between MSI status and treatment for either RFS (P = .68) or OS (P = .62). Hazard ratios (HR) for RFS for MSI-H versus MSS/MSI-L patients were 0.77 (95% CI, 0.40 to 1.48) in the untreated-patients group and 0.60 (95% CI, 0.30 to 1.19) in the treated-patients group. HRs for OS were 0.82 (95% CI, 0.44 to 1.51) and 1.02 (95% CI, 0.56 to 1.85) for the respective groups. There was a trend toward improved RFS in patients with MSI-H and mutant p53. CONCLUSION These results do not support the use of MSI-H as a predictive marker of chemotherapy benefit.
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Affiliation(s)
- George P Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Mayo Clinic, Jacksonville, FL 32224, USA.
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Lembersky BC, Wieand HS, Petrelli NJ, O'Connell MJ, Colangelo LH, Smith RE, Seay TE, Giguere JK, Marshall ME, Jacobs AD, Colman LK, Soran A, Yothers G, Wolmark N. Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06. J Clin Oncol 2006; 24:2059-64. [PMID: 16648506 DOI: 10.1200/jco.2005.04.7498] [Citation(s) in RCA: 255] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The primary aim of this study was to compare the relative efficacy of oral uracil and tegafur (UFT) plus leucovorin (LV) with the efficacy of weekly intravenous fluorouracil (FU) plus LV in prolonging disease-free survival (DFS) and overall survival (OS) after primary surgery for colon carcinoma. PATIENTS AND METHODS Between February 1997 and March 1999, 1,608 patients with stage II and III carcinoma of the colon were randomly assigned to receive either oral UFT+LV or intravenous FU+LV. RESULTS Of the total patients, 47% had stage II colon cancer, and 53% had stage III colon cancer. Median follow-up time was 62.3 months. The estimated hazard ratio (HR) for OS of patients who received UFT+LV versus that of patients who received FU+LV was 1.014 (95% CI, 0.825 to 1.246). The estimated HR for DFS was 1.004 (95% CI, 0.847 to 1.190). Cox proportional hazards model analyses with regard to age (< 60 v > or = 60 years), stage, or number of involved nodes (none v one to three v > or = four nodes) revealed no interaction with OS or DFS. Toxicity was similar in the two groups. In the UFT+LV arm, 38.2% of patients experienced any grade 3 or 4 toxic event compared with 37.8% of patients in the FU+LV arm. Primary quality-of-life end points did not differ between the two regimens, although convenience of care analysis favored UFT+LV. CONCLUSION UFT+LV achieved similar DFS and OS when compared with an intravenous, weekly, bolus FU+LV regimen. The two regimens were equitoxic and generally well tolerated.
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Affiliation(s)
- Barry C Lembersky
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA 15212, USA
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Atkins JN, Jacobs SA, Wieand HS, Smith RE, John WJ, Colangelo LH, Vogel VG, Kuebler JP, Cescon TP, Miller BJ, Geyer CE, Wolmark N. Pemetrexed/Oxaliplatin for First-Line Treatment of Patients with Advanced Colorectal Cancer: A Phase II Trial of the National Surgical Adjuvant Breast and Bowel Project Foundation Research Program. Clin Colorectal Cancer 2005; 5:181-7. [PMID: 16197621 DOI: 10.3816/ccc.2005.n.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pemetrexed and oxaliplatin have clinical activity as single agents in colorectal cancer (response rates, 10%-17%). In this study, these drugs were used in combination as first-line therapy in a group of patients with metastatic colorectal cancer. PATIENTS AND METHODS Fifty-four evaluable patients were to receive pemetrexed (500 mg/m2) with folic acid and vitamin B12 supplementation and oxaliplatin (120 mg/m2) every 21 days for 6 cycles or until disease progression occurred. Patients with stable or responding disease could continue therapy beyond 6 cycles at the discretion of the investigator. Eligibility criteria included a diagnosis of untreated metastatic adenocarcinoma of the colon or rectum, measurable disease, Zubrod performance status <or=2, no adjuvant chemotherapy within 6 months, and >or=12 weeks life expectancy. RESULTS The confirmed clinical response rate (primary endpoint) was 29.6% (95% confidence interval [CI], 18%-48.6%), with 1 complete response and 15 partial responses. Median time to progression was 5.3 months (95% CI, 3.9-6.3 months), and median survival was 12.3 months (95% CI, 8.6-17 months). Grade 3/4 nadir neutropenia occurred in 33.3% of patients, and 3 patients experienced grade 3 febrile neutropenia or infection associated with grade 3/4 neutropenia. Grade 3/4 nadir thrombocytopenia was seen in 11.1% of patients. Only 4% of the patients developed grade 3/4 neurotoxicity. CONCLUSION This regimen of pemetrexed and oxaliplatin has activity in advanced colorectal cancer, and the toxicity profile suggests that escalation of the dose of pemetrexed in this combination may be possible.
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Affiliation(s)
- James N Atkins
- National Surgical Adjuvant Breast and Bowel Project, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15212, USA
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Allegra CJ, Paik S, Colangelo LH, Parr AL, Kirsch I, Kim G, Klein P, Johnston PG, Wolmark N, Wieand HS. Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes' B and C colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study. J Clin Oncol 2003; 21:241-50. [PMID: 12525515 DOI: 10.1200/jco.2003.05.044] [Citation(s) in RCA: 236] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To define the value of thymidylate synthase (TS), Ki-67, and p53 as prognostic markers in patients with stage II and III colon carcinoma. PATIENTS AND METHODS We retrospectively analyzed the prognostic value of TS, Ki-67, and p53 in 706 patients with Dukes' B (291 patients) or Dukes' C (415 patients) colon carcinoma who were treated with either surgery alone (275 patients) or surgery plus fluorouracil (FU)-leucovorin chemotherapy (431 patients) in National Surgical Adjuvant Breast and Bowel Project (NSABP) protocols C01-C04. All three markers were assayed using immunohistochemical techniques. RESULTS Using 5 years of follow-up data, our retrospective analysis demonstrated an association between TS intensity (relapse-free survival [RFS]: risk ratio [RR] = 1.46, P =.01; overall survival [OS]: RR = 1.54, P =.002), Ki-67 (RFS: RR = 0.76, P =.05; OS: RR = 0.62, P =.001), and p53 (RFS: RR = 1.49, P =.01; OS: RR = 1.21, P =.18) for RFS and OS. High TS intensity levels and positive p53 staining were associated with a worse outcome. Tumors containing a high percentage of Ki-67-positive cells enjoyed an improved outcome compared with those patients whose tumors contained relatively few positive cells. An interaction with treatment was not identified for any of the markers. CONCLUSION This retrospective investigation demonstrated that TS, Ki-67, and p53 staining each had significant prognostic value for patients with Dukes' B and C colon carcinoma. However, none of the markers could be used to clearly discern groups of individuals who would be predicted to derive greater or lesser benefit from the use of adjuvant chemotherapy.
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Affiliation(s)
- Carmen J Allegra
- Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-2440, USA.
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Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B. Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease. Blood 1997; 89:1787-92. [PMID: 9057664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Acute chest syndrome (ACS) is an important cause of morbidity and mortality in sickle cell disease (SCD). Previous studies reported conflicting pictures of ACS making therapeutic interventions difficult. The Cooperative Study of Sickle Cell Disease prospectively followed 3,751 patients enrolled from birth to 66 years of age for ACS. Data on presenting signs and symptoms, laboratory findings, and hospital course were collected. There were 1,722 ACS episodes in 939 patients. Young children (age 2 to 4 years) presented with fever and cough, a negative physical exam, and rarely had pain. Adults were often afebrile and complained of shortness of breath, chills, and severe pain. Upper lobe disease was more common in children; multilobe and lower lobe disease affected adults more often. Severe hypoxia occurred in 18% of adults tested and could not be predicted by examination or laboratory findings. Bacteremia was documented in 3.5% of episodes, but was strongly influenced by age (14% of infants and 1.8% of patients > 10 years). ACS was most common in winter with children having the most striking increase. Transfusion was used less frequently, but earlier in children. Young children were hospitalized for 5.4 days versus 9 days for adults. Fifty percent of adults had a pain event in the 2 weeks preceding ACS and children were more likely to have febrile events. The death rate was four times higher in adults than in children. Fatal cases generally developed rapid pulmonary failure and one third were associated with bacteremia. Age has a striking effect on the clinical picture of ACS. In children, ACS was milder and more likely due to infection, whereas in adults ACS was severe, associated with pain and had a higher mortality rate.
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