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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Tutt A, Garber J, Gelber R, Phillips KA, Eisen A, Johannsson O, Rastogi P, Cui K, Im SA, Yerushalmi R, Brufsky A, Taboada M, Rossi G, Yothers G, Singer C, Fein L, Loman N, Cameron D, Campbell C, Geyer C. VP1-2022: Pre-specified event driven analysis of Overall Survival (OS) in the OlympiA phase III trial of adjuvant olaparib (OL) in germline BRCA1/2 mutation (gBRCAm) associated breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rugo HS, O'Shaughnessy J, Boyle F, Toi M, Broom R, Blancas I, Gumus M, Yamashita T, Im YH, Rastogi P, Zagouri F, Song C, Campone M, San Antonio B, Shahir A, Hulstijn M, Brown J, Zimmermann A, Wei R, Johnston S, Reinisch M, Tolaney SM. Adjuvant Abemaciclib Combined with Endocrine Therapy for High Risk Early Breast Cancer: Safety and Patient-Reported Outcomes From the monarchE Study. Ann Oncol 2022; 33:616-627. [PMID: 35337972 DOI: 10.1016/j.annonc.2022.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high risk, early breast cancer demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PRO) are presented. PATIENTS AND METHODS The safety population included all patients who received at least one dose of study treatment (n=5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality-of-life, ET symptoms, fatigue, and side effect burden were assessed. RESULTS The addition of abemaciclib to ET resulted in higher incidence of Grade≥3 AEs (49.7% vs 16.3% with ET alone), predominantly laboratory cytopenias (e.g., neutropenia [19.6%]) without clinical complications. Abemaciclib-treated patients experienced more serious adverse events (SAEs; 13.3% vs 7.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to Grade1/2 AEs (66.8%). AEs were managed with comedications (e.g., antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (Grade1/2: 77%); Grade2/3 events were highest in the first month (20.5%), most short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTE) were higher with abemaciclib+ET (2.5%) vs ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen vs AIs (4.3% vs 1.8%). PROs were similar between arms, including being 'bothered by side effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported "a little bit" or "somewhat". CONCLUSION In patients with high risk EBC, adjuvant abemaciclib+ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.
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Affiliation(s)
- H S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA.
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas TX, USA
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney; University of Sydney, Sydney, Australia
| | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | - R Broom
- Auckland City Hospital, Auckland, New Zealand
| | - I Blancas
- Hospital Universitario Clínico San Cecilio, Granada, Spain; Medicine Department. University of Granada, Spain
| | - M Gumus
- Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | | | - Y-H Im
- Division of Hematology/Medical Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - F Zagouri
- National and Kapodistrian University of Athens, Department of Clinical Therapeutics, School of Medicine, Athens, Greece
| | - C Song
- Fujian Medical University Union Hospital, Fujian, China
| | - M Campone
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes / Saint-Herblain, France
| | | | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | - M Hulstijn
- Eli Lilly and Company, Indianapolis, USA
| | - J Brown
- Eli Lilly and Company, Indianapolis, USA
| | | | - Ran Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Johnston
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Reinisch
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
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Geyer CE, Sikov WM, Huober J, Rugo HS, Wolmark N, O'Shaughnessy J, Maag D, Untch M, Golshan M, Ponce Lorenzo J, Metzger O, Dunbar M, Symmans WF, Rastogi P, Sohn J, Young R, Wright GS, Harkness C, McIntyre K, Yardley D, Loibl S. Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase 3 trial. Ann Oncol 2022; 33:384-394. [PMID: 35093516 DOI: 10.1016/j.annonc.2022.01.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Primary analyses of the phase 3 BrighTNess trial showed addition of carboplatin with/without veliparib to neoadjuvant chemotherapy significantly improved pathological complete response (pCR) rates with manageable acute toxicity in patients with triple-negative breast cancer (TNBC). Here, we report 4.5-year follow-up data from the trial. DESIGN Women with untreated stage II-III TNBC were randomized (2:1:1) to paclitaxel (weekly for 12 doses) plus either: (a) carboplatin (every 3 weeks for four cycles) plus veliparib (twice daily); (b) carboplatin plus veliparib placebo; or (c) carboplatin placebo plus veliparib placebo. All patients then received doxorubicin and cyclophosphamide (AC) every 2‒3 weeks for four cycles. The primary endpoint was pCR. Secondary endpoints included event-free survival (EFS), overall survival (OS), and safety. Since the co-primary endpoint of increased pCR with carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel was not met, secondary analyses are descriptive. RESULTS Of 634 patients, 316 were randomized to carboplatin plus veliparib with paclitaxel, 160 to carboplatin with paclitaxel, and 158 to paclitaxel. With median follow-up of 4.5 years, the hazard ratio [HR] for EFS for carboplatin plus veliparib with paclitaxel versus paclitaxel was 0.63 (95% confidence interval [CI] 0.43‒0.92, P=0.02), but 1.12 (95% CI 0.72‒1.72, P=0.62) for carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel. In post hoc analysis, HR for EFS was 0.57 (95% CI 0.36‒0.91, P=0.02) for carboplatin with paclitaxel versus paclitaxel. OS did not differ significantly between treatment arms, nor did rates of myelodysplastic syndromes, acute myeloid leukemia, or other secondary malignancies. CONCLUSION Improvement in pCR with addition of carboplatin was associated with long-term EFS benefit with a manageable safety profile, and without increasing the risk of second malignancies, while adding veliparib did not impact EFS. These findings support the addition of carboplatin to weekly paclitaxel followed by AC neoadjuvant chemotherapy for early stage TNBC.
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Affiliation(s)
- C E Geyer
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; Houston Methodist Cancer Center, Houston, TX, USA.
| | - W M Sikov
- Women, Infants Hospital of Rhode Island, Providence, RI, USA
| | - J Huober
- Breast Center Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - H S Rugo
- University of California San Francisco Hellen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - N Wolmark
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA; Baylor University Medical Center, Dallas, TX, USA
| | - D Maag
- AbbVie Inc., North Chicago, IL, USA
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Golshan
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - J Ponce Lorenzo
- University General Hospital of Alicante, ISABIAL, Alicante, Spain
| | - O Metzger
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M Dunbar
- AbbVie Inc., North Chicago, IL, USA
| | | | - P Rastogi
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; UPMC Hillman Cancer Center/University of Pittsburgh, Pittsburgh, PA, USA
| | - J Sohn
- Yonsei University College of Medicine, Seoul, Korea
| | - R Young
- Division of Breast Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - G S Wright
- Florida Cancer Specialists and Sarah Cannon Research Institute, New Port Richey, FL, USA
| | - C Harkness
- Hope Women's Cancer Centers, Asheville, NC, USA
| | - K McIntyre
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - D Yardley
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | - S Loibl
- German Breast Group, c/o GBG Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
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O'Shaughnessy J, Rastogi P, Harbeck N, Toi M, Hegg R, Sohn J, Guarneri V, Cortes J, Hamilton E, Wei R, Shahir A, San Antonio B, Nabinger S, Tolaney S, Martin M, Johnston S. VP8-2021: Adjuvant abemaciclib combined with endocrine therapy (ET): Updated results from monarchE. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Krishna M, Parmar K, Kumar S, Singh P, Rastogi P. IgG4-related retroperitoneal fibrosis: a rare cause of obstructive uropathy. Ann R Coll Surg Engl 2021; 104:e105-e108. [PMID: 34825578 DOI: 10.1308/rcsann.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Immunoglobulin G4 (IgG4)-related disease was described in 2003 and is known to affect almost all organ systems. Rarely, this disease can manifest in the retroperitoneum, which can lead to sequalae such as obstructive uropathy. Here we describe a case of IgG4-related retroperitoneal fibrosis leading to obstructive uropathy. The patient was managed with bilateral Double J (DJ) stenting and oral steroids. Following remission of the disease, the DJ stents were removed and the patient remained asymptomatic over the follow-up period. A high index of suspicion is required for diagnosis of this rare disease and timely management can lead to a positive outcome.
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Harbeck N, Rastogi P, Shahir A, Johnston S, O'Shaughnessy J. Letter to the Editor for 'Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study'. Ann Oncol 2021; 33:227-228. [PMID: 34756989 DOI: 10.1016/j.annonc.2021.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- N Harbeck
- Breast Center, LMU University Hospital, Munich, Germany.
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | - S Johnston
- Royal Marsden NHS Foundation Trust, London, UK
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, USA
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Harbeck N, Rastogi P, Martin M, Tolaney SM, Shao ZM, Fasching PA, Huang CS, Jaliffe GG, Tryakin A, Goetz MP, Rugo HS, Senkus E, Testa L, Andersson M, Tamura K, Del Mastro L, Steger GG, Kreipe H, Hegg R, Sohn J, Guarneri V, Cortés J, Hamilton E, André V, Wei R, Barriga S, Sherwood S, Forrester T, Munoz M, Shahir A, San Antonio B, Nabinger SC, Toi M, Johnston SRD, O'Shaughnessy J. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 2021; 32:1571-1581. [PMID: 34656740 DOI: 10.1016/j.annonc.2021.09.015] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adjuvant abemaciclib combined with endocrine therapy (ET) previously demonstrated clinically meaningful improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer at the second interim analysis, however follow-up was limited. Here, we present results of the prespecified primary outcome analysis and an additional follow-up analysis. PATIENTS AND METHODS This global, phase III, open-label trial randomized (1 : 1) 5637 patients to adjuvant ET for ≥5 years ± abemaciclib for 2 years. Cohort 1 enrolled patients with ≥4 positive axillary lymph nodes (ALNs), or 1-3 positive ALNs and either grade 3 disease or tumor ≥5 cm. Cohort 2 enrolled patients with 1-3 positive ALNs and centrally determined high Ki-67 index (≥20%). The primary endpoint was IDFS in the intent-to-treat population (cohorts 1 and 2). Secondary endpoints were IDFS in patients with high Ki-67, DRFS, overall survival, and safety. RESULTS At the primary outcome analysis, with 19 months median follow-up time, abemaciclib + ET resulted in a 29% reduction in the risk of developing an IDFS event [hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.58-0.87; nominal P = 0.0009]. At the additional follow-up analysis, with 27 months median follow-up and 90% of patients off treatment, IDFS (HR = 0.70, 95% CI 0.59-0.82; nominal P < 0.0001) and DRFS (HR = 0.69, 95% CI 0.57-0.83; nominal P < 0.0001) benefit was maintained. The absolute improvements in 3-year IDFS and DRFS rates were 5.4% and 4.2%, respectively. Whereas Ki-67 index was prognostic, abemaciclib benefit was consistent regardless of Ki-67 index. Safety data were consistent with the known abemaciclib risk profile. CONCLUSION Abemaciclib + ET significantly improved IDFS in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer, with an acceptable safety profile. Ki-67 index was prognostic, but abemaciclib benefit was observed regardless of Ki-67 index. Overall, the robust treatment benefit of abemaciclib extended beyond the 2-year treatment period.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of OB & GYN and CCC Munich, LMU University Hospital, Munich, Germany.
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - M Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | - Z M Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - P A Fasching
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C S Huang
- National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - G G Jaliffe
- Grupo Medico Camino S.C., Mexico City, Mexico
| | - A Tryakin
- N.N.Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, San Francisco, USA
| | - E Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - L Testa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
| | | | - K Tamura
- National Cancer Center Hospital, Tokyo, Japan
| | - L Del Mastro
- IRCSS Ospedale Policlinico San Martino, UO Breast Unit, Genoa, Italy; Università di Genova, Department of Internal Medicine and Medical Specialties (DIM), Genoa, Italy
| | - G G Steger
- Medical University of Vienna, Vienna, Austria
| | - H Kreipe
- Medizinische Hochschule Hannover, Hannover, Germany
| | - R Hegg
- Clin. Pesq. e Centro São Paulo, São Paulo, Brazil
| | - J Sohn
- Yonsei Cancer Center, Seoul, Korea
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - J Cortés
- International Breast Cancer Center (IBCC), Madrid & Barcelona, and Vall d'Hebron Institute of Oncology, Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, USA
| | - V André
- Eli Lilly and Company, Indianapolis, USA
| | - R Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Barriga
- Eli Lilly and Company, Indianapolis, USA
| | - S Sherwood
- Eli Lilly and Company, Indianapolis, USA
| | | | - M Munoz
- Eli Lilly and Company, Indianapolis, USA
| | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | | | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, USA
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Dhakad R, Niranjan V, Rastogi P, Pal V. A report of use of baclofen in intractable hiccups. Eur Psychiatry 2021. [PMCID: PMC9479806 DOI: 10.1192/j.eurpsy.2021.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionHiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups lasting longer than one month is termed intractable hiccups. Intractable hiccups can be caused by structural or functional disturbances of the medulla, afferent or efferent nerves to the respiratory muscles or metabolic and endocrine disorders, drugs, general anaesthesia and emotional problems.ObjectivesAuthors present a case report about curing a patient of intractable hiccups using baclofen along with literature review.MethodsA case report along with literature review forms the basis of discussion.ResultsA 30-year female diagnosed with schizophrenia stable on 2mg risperidone for 3 years presented to the outpatient department with complain of intractable hiccups for 6 months. Frequency of hiccups was around 10-12 times per minute and continued throughout the day leading to significant socio-occupational distress. patient had been receiving medical treatment for last 4 months for the same including Metoclopramide, chlorpromazine along with trying breath holding and drinking cold water but symptoms persisted. Her ECG, chest X-ray, complete blood counts were unremarkable, CT scan of brain was normal. Patient was started on baclofen 10mg thrice daily. Within 1-week patient had dramatic response and complete remission was achieved in 2 weeks.ConclusionsBeclofen is effective in hiccups because it is an analogue of GABA, that decreases excitability and inhibits the hiccup reflex, which reduces synaptic transmission. Baclofen is used to treat hiccups, and can be used either as a first-line treatment or if patient does not respond to other medications.DisclosureNo significant relationships.
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Naik AL, Savlania A, Gupta A, Rastogi P, Singh A. Isolated brachial artery aneurysm: a rare presentation of paediatric Behçet's disease. Ann R Coll Surg Engl 2021; 103:e94-e97. [PMID: 33645285 DOI: 10.1308/rcsann.2020.7037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.
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Affiliation(s)
- A L Naik
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Savlania
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Gupta
- Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Rastogi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Johnston S, Harbeck N, Hegg R, Toi M, Martin M, Shao Z, Campone M, Hamilton E, Sohn J, Guarneri V, Cortes J, Neven P, Boyle F, Smith I, Frenzel M, Headley D, Wei R, Cox J, O'Shaughnessy J, Rastogi P. 2MO Abemaciclib in high risk early breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Johnston S, Harbeck N, Hegg R, Toi M, Martin M, Shao Z, Campone M, Hamilton E, Sohn J, Guarneri V, Cortés J, Neven P, Boyle F, Smith I, Headley D, Wei R, Frenzel M, Cox J, O'Shaughnessy J, Rastogi P. LBA5_PR Abemaciclib in high risk early breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Loibl S, Rastogi P, Seiler S, Jackisch C, Lucas P, Denkert C, Poklepovic A, Moreno F, Mamounas E, Nekljudova V, Lin Y, Wolmark N, Geyer C. 248TiP A randomized, double-blind, phase III trial of neoadjuvant chemotherapy (NACT) with atezolizumab/placebo in patients (pts) with triple-negative breast cancer (TNBC) followed by adjuvant continuation of atezolizumab/placebo (GeparDouze). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Reddy A, Savlania A, Naik A, Rastogi P, Gorsi U. Deep venous thrombosis manifestation of common femoral vein leiomyoma. Ann R Coll Surg Engl 2020; 102:e141-e144. [PMID: 32326731 DOI: 10.1308/rcsann.2020.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.
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Affiliation(s)
- A Reddy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Savlania
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Naik
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Rastogi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - U Gorsi
- Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rastogi P, Philipp A, Camboni D, Flörchinger B, Holzamer A, Schopka S, Vasin S, Hilker M, Rupprecht L, Schmid C. Economic Aspects of ECMO-Assisted Resuscitation (ECPR). Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Dilated cardiomyopathy (DCM) is an idiopathic condition that results from impaired ventricular systolic function. Thyroid diseases have been known to cause myriad changes in the structure and function of the heart. Diastolic dysfunction is a common abnormality reported in hypothyroidism. However, hypothyroidism-induced DCM and systolic dysfunction is an uncommon phenomenon, especially as the initial presenting manifestation of hypothyroidism. The current article describes the case of a young female who presented with symptoms of heart failure and was diagnosed as having DCM as echocardiography revealed left ventricular global hypokinesia and severely depressed systolic function. Thyroid profile revealed a grossly elevated thyroid-stimulating hormone (TSH) value of 313 μIU/ml; free thyroxine (fT4) was 0.220 ng/dl. The present case presented with DCM as the initial presentation of hypothyroidism and improved significantly after five months of levothyroxine replacement therapy.
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Affiliation(s)
- P Rastogi
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - A Dua
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - S Attri
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - H Sharma
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
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Loibl S, Jackisch C, Rastogi P, Seiler S, Lucas P, Denkert C, Costantino J, Nekljudova V, Wolmark N, Geyer C. GeparDouze/NSABP B-59: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy with atezolizumab or placebo in patients with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz097.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Geyer CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. Abstract OT3-05-01: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
TNBC is associated with higher percentages of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), and women with a pCR have a favorable prognosis. However, Liedtke (2008) and Loibl (2017) found that women with residual disease have a substantially higher risk of recurrence than women with other subtypes of breast cancer. Additionally, Adams (2017) and Schmid (2017) found that therapeutic blockade of PD-L1 binding by atezolizumab has resulted in relevant anti-tumor efficacy.
Methods:
Design
This is a phase III, double blind, placebo-control trial evaluating neoadjuvant atezolizumab with NAC followed by adjuvant atezolizumab in TNBC. Pts are stratified by region (North America; Europe), tumor size (1.1-3.0cm; >3.0cm), AC/EC schedule (q2w; q3w), and nodal status (positive; negative), then randomized 1:1 to receive atezolizumab/placebo 1200 mg IV every 3 wks concurrently with both sequential regimens of weekly paclitaxel 80 mg/m2 IV for 12 doses with every 3-wk carboplatin AUC of 5 IV for 4 doses followed by AC/EC every 2-3 wks (per investigator discretion) for 4 cycles. Following surgery, pts resume atezolizumab/placebo 1200 mg IV every 3 wks as adjuvant therapy for 6 months. Radiotherapy based on local standards is co-administered with atezolizumab/placebo.
Eligibility criteria
Centrally-confirmed ER-neg, PR-neg, HER2-neg invasive breast cancer by ASCO/CAP guidelines. Primary tumor must be stage T2 or T3 if cN0 or cN1 with negative biopsy or T1c, T2, or T3 if cN1 with positive biopsy or cN2 or cN3. LVEF >55% and no significant cardiac history.
Statistical methods
Co-primary endpoints are event-free survival (EFS) and pCR breast/nodes. Secondary endpoints include pCR breast, overall survival, distant disease-free survival, safety and toxicity. Trial is an academic collaboration between NSABP and GBG with support from Genentech/Roche.
NCT03281954
Support: Genentech/Roche
Citation Format: Geyer, Jr. CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-01.
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Affiliation(s)
- CE Geyer
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - S Loibl
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - P Rastogi
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - S Seiler
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - JP Costantino
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - VN Nekljudova
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - P Cortazar
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - PC Lucas
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - C Denkert
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - EP Mamounas
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - C Jackisch
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - N Wolmark
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
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Mayer E, DeMichele A, Gnant M, Barry W, Pfeiler G, Metzger O, Burstein H, Miller K, Rastogi P, Loibl S, Goulioti T, Zardavas D, Fesl C, Koehler M, Huang-Bartlett C, Huang X, Piccart M, Winer E, Wolff A. Abstract OT3-05-08: PALLAS: PALbociclib CoLlaborative Adjuvant Study: A randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Cell cycle inhibition is a proven target for novel cancer therapeutics. Palbociclib (P) is an orally active inhibitor of CDK4/6, and arrests the cell cycle at the G1-S transition. P in combination with endocrine therapy (ET) has demonstrated efficacy in phase II and III randomized trials for patients with newly diagnosed and recurrent hormone receptor positive/HER2 negative (HR+/HER2-) metastatic breast cancer (MBC), and is approved in these settings. Given confirmed benefits of P and ET for MBC, the PALLAS study was designed to determine if the addition of P to adjuvant ET improves outcomes over ET alone in HR+/HER2- early breast cancer.
Trial Design:
PALLAS is an international open-label phase III trial randomizing (1:1) patients (pts) to 2 years of P (125 mg daily, 21 days on 7 days off in a 28-day cycle) combined with at least 5 years of provider choice ET (AI, tamoxifen, +/- LHRH agonist), versus ET alone. The primary objective of the study is to compare invasive disease-free survival (iDFS) for the combination of P and ET, versus ET alone. Secondary objectives include comparison of iDFS excluding cancer of non-breast origin, DRFS, LRRFS, OS, as well as safety. The principal objective of the translational investigations is to determine the predictive or prognostic utility of defined genomic subgroups with respect to iDFS and OS. Additional objectives include evaluation of cfDNA and tissue biomarkers predictive of benefit or resistance, pharmacogenomics, adherence, and patient-reported QOL. Eligible pts are pre- or post-menopausal women or men with stage II-III, HR+/HER2- breast cancer. Patients may have already initiated ET, but must be randomized within 12 months of diagnosis and 6 months of initiation of adjuvant ET. Trial sample size is 4600 pts and stage IIA pts will be capped at a total accrual of 1000 pts. Interim analyses for safety, futility/efficacy and sample size re-estimation are planned. PALLAS opened in 9/2015 and accrual is ongoing. Contact information: emayer@partners.org
Key words: palbociclib, CDK4/6 inhibition, HR+/HER2- early breast cancer, adjuvant endocrine therapy.
Citation Format: Mayer E, DeMichele A, Gnant M, Barry W, Pfeiler G, Metzger O, Burstein H, Miller K, Rastogi P, Loibl S, Goulioti T, Zardavas D, Fesl C, Koehler M, Huang-Bartlett C, Huang X, Piccart M, Winer E, Wolff A. PALLAS: PALbociclib CoLlaborative Adjuvant Study: A randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-08.
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Affiliation(s)
- E Mayer
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - A DeMichele
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Gnant
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - W Barry
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - G Pfeiler
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - O Metzger
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - H Burstein
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - K Miller
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - P Rastogi
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - S Loibl
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - T Goulioti
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - D Zardavas
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - C Fesl
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Koehler
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - C Huang-Bartlett
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - X Huang
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Piccart
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - E Winer
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - A Wolff
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
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Rastogi P, Toi M, Harbeck N, Bourayou N, Frenzel M, Johnston S. Abstract OT3-05-05: MonarchE: A randomized, open-label, phase 3 study of abemaciclib combined with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone in patients with high risk, node positive, early stage, HR+, HER2- breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Abemaciclib, an oral, selective inhibitor of cyclin-dependent kinases 4 and 6 dosed on a twice daily continuous schedule, has demonstrated clinical efficacy and tolerability in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer when administered as monotherapy (MONARCH 1) and in combination with endocrine therapy (ET) in MONARCH 2 and MONARCH 3. In neoMONARCH, abemaciclib plus anastrozole as neoadjuvant therapy reduced the breast tumor cell proliferation marker Ki67 to a greater extent than anastrozole alone after 2 weeks of treatment. Endocrine monotherapy is the current standard of care in the adjuvant setting. However, a proportion of pts relapse despite this therapy. A population with a higher risk of recurrence (15% at 5 years) may be identified based on the clinical and pathological characteristics of disease. Optimizing adjuvant therapy for these pts is an important need.
Trial Design: MonarchE (NCT03155997) is a multicenter, randomized, open-label Phase 3 trial that will evaluate the potential for abemaciclib to enhance adjuvant ET. Pts will be randomized 1:1 to abemaciclib 150 mg twice daily continuous schedule plus standard of care (SOC) adjuvant ET versus SOC adjuvant ET alone and stratified by prior chemotherapy (neoadjuvant, adjuvant, or none), menopausal status (pre- or post-), and region (N. America/Europe, Asia, or other). Pts may have started ET within 8 weeks prior to randomization. Pts will receive abemaciclib for up to 2 years in combination with ET per physician's choice (such as tamoxifen or an aromatase inhibitor, +/- ovarian suppression). ET alone will be continued as clinically indicated. All randomized pts will be followed for a total of 10 years.
Eligibility Criteria: Eligible pts (male or female) must have early stage resected HR+, HER2- invasive breast cancer with either ≥ 4 positive pathological axillary lymph nodes (pALNs), or 1 to 3 positive pALNs and at least one of the following high risk markers: primary tumor size ≥5 cm, histological grade 3 tumor, or centrally assessed Ki67 index of ≥20% (in a subset of pts). Pts must have completed definitive locoregional therapy (+/- (neo)adjuvant chemotherapy) and be randomized no more than 12 weeks after completion of last non-ET (surgery, chemotherapy, or radiotherapy). Pts must have tumor tissue available for biomarker analysis prior to randomization.
Specific Aims: The primary objective of monarchE is to evaluate invasive disease-free survival (IDFS) per the STEEP System.1 Secondary objectives include evaluation of IDFS in pts with Ki67 index of ≥20%, distant relapse-free survival, overall survival, safety, pharmacokinetics, and pt health outcomes.
Statistical Methods: Assuming an IDFS hazard ratio of .73, the study is powered to approximately 80% to test the superiority of abemaciclib plus standard ET at a 1-sided α=0.025 using a stratified log-rank test.
Target accrual: Approximately 3580 pts
Contact information: 1-877-285-4559
Reference:
1. Hudis et al. J Clin Oncol. 2007;25(15):2127-2132.
Citation Format: Rastogi P, Toi M, Harbeck N, Bourayou N, Frenzel M, Johnston S. MonarchE: A randomized, open-label, phase 3 study of abemaciclib combined with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone in patients with high risk, node positive, early stage, HR+, HER2- breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-05.
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Affiliation(s)
- P Rastogi
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Toi
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - N Harbeck
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - N Bourayou
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Frenzel
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Johnston
- University of Pittsburgh Medical Center, Pittsburgh, PA; Graduate School of Medicine, Kyoto University, Kyoto, Japan; Breast Center, University of Munich (LMU), Munich, Germany; Eli Lilly and Company, Paris, France; Eli Lilly and Company, Indianapolis, IN; The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Manfredi G, Lova P, Di Stasio F, Rastogi P, Krahne R, Comoretto D. Lasing from dot-in-rod nanocrystals in planar polymer microcavities. RSC Adv 2018; 8:13026-13033. [PMID: 35541227 PMCID: PMC9079743 DOI: 10.1039/c8ra01282b] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/01/2018] [Indexed: 11/21/2022] Open
Abstract
Colloidal nanocrystals attract considerable attention in the field of light emitting devices thanks to their high fluorescence quantum yield, low amplified spontaneous emission (ASE) threshold, and spectral tunability via electronic structure engineering and surface functionalization. Combining polymer microcavities with colloidal nanocrystals as gain material promises a solution-based fabrication route to plastic laser cavities as well as applications in the field of smart flexible large area light sources and sensors. Here we demonstrate lasing from polymer microcavities embedding solution processable dot-in-rod (DiR) CdSe/CdS nanocrystals. Two highly reflective polymer dielectric mirrors are prepared by spin-coating of alternated layers of polyacrylic acid and poly(N-vinyl carbazole), with their photonic band gap tailored to the emission of the DiRs. The DiRs are enclosed in the polymer microcavity by drop-cast deposition on one mirror, followed by pressing the mirrors onto each other. We obtain excellent overlap of the ASE band of the DiRs with the photonic band gap of the cavity and observe optically pumped lasing at 640 nm with a threshold of about 50 μJ cm−2. We report on the production of an optically pumped vertical cavity laser made by polymer mirrors embedding inorganic core@shell nanocrystals.![]()
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Affiliation(s)
- G. Manfredi
- Dipartimento di Chimica e Chimica Industriale
- Università Degli Studi di Genova
- Genoa
- Italy
| | - P. Lova
- Dipartimento di Chimica e Chimica Industriale
- Università Degli Studi di Genova
- Genoa
- Italy
| | - F. Di Stasio
- Nanochemistry Department
- Istituto Italiano di Tecnologia
- Genoa
- Italy
| | - P. Rastogi
- Nanochemistry Department
- Istituto Italiano di Tecnologia
- Genoa
- Italy
| | - R. Krahne
- Nanochemistry Department
- Istituto Italiano di Tecnologia
- Genoa
- Italy
| | - D. Comoretto
- Dipartimento di Chimica e Chimica Industriale
- Università Degli Studi di Genova
- Genoa
- Italy
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Tutt A, Kaufman B, Garber J, Gelber R, McFadden E, Goessl C, Viale G, Geyer C, Zardavas D, Arahmani A, Fumagalli D, De Azambuja E, Ponde N, Herbolsheimer P, Wu W, Constantino J, Rastogi P. OlympiA: A randomized phase III trial of olaparib as adjuvant therapy in patients with high-risk HER2-negative breast cancer (BC) and a germline BRCA1/2 mutation (gBRCAm). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mayer E, Demichele A, Pfeiler G, Barry W, Metzger O, Rastogi P, Symmans F, Burstein H, Miller K, Loibl S, Schmatloch S, Goulioti T, Zardavas D, Fesl C, Koehler M, Huang Bartlett C, Huang X, Piccart M, Winer E, Gnant M. PALLAS: PALbociclib CoLlaborative adjuvant study: A randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Lee E, Rastogi P, Hadimani R, Jiles D, Camprodon J. TMS field localization: How anatomy shapes stimulation. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Greenspan SL, Vujevich KT, Brufsky A, Lembersky BC, van Londen GJ, Jankowitz RC, Puhalla SL, Rastogi P, Perera S. Prevention of bone loss with risedronate in breast cancer survivors: a randomized, controlled clinical trial. Osteoporos Int 2015; 26:1857-64. [PMID: 25792492 PMCID: PMC4766869 DOI: 10.1007/s00198-015-3100-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED In postmenopausal women with low bone mass and hormone-receptor-positive breast cancer on an aromatase inhibitor, risedronate maintained skeletal health assessed by bone density and turnover markers. Women with the greatest decreases in bone turnover markers at 12 months had the greatest increases in bone density at 24 months. INTRODUCTION Aromatase inhibitors (AIs), adjuvant endocrine therapy for postmenopausal women with hormone-receptor-positive breast cancer, are associated with bone loss and fractures. Our objectives were to determine if (1) oral bisphosphonate therapy can prevent bone loss in women on an AI and (2) early changes in bone turnover markers (BTM) can predict later changes in bone mineral density (BMD). METHODS We conducted a 2-year double-blind, placebo-controlled, randomized trial in 109 postmenopausal women with low bone mass on an AI (anastrozole, letrozole, or exemestane) for hormone-receptor-positive breast cancer. Participants were randomized to once weekly risedronate 35 mg or placebo, and all received calcium plus vitamin D. The main outcome measures included BMD, BTM [carboxy-terminal collagen crosslinks (CTX) and N-terminal propeptide of type 1 procollagen (P1NP)], and safety. RESULTS Eighty-seven percent completed 24 months. BMD increased more in the active treatment group compared to placebo with an adjusted difference at 24 months of 3.9 ± 0.7 percentage points at the spine and 3.2 ± 0.5 percentage points at the hip (both p < 0.05). The adjusted difference between the active treatment and placebo groups were 0.09 ± 0.04 nmol/LBCE for CTX and 23.3 ± 4.8 μg/mL for P1NP (both p < 0.05). Women with greater 12-month decreases in CTX and P1NP in the active treatment group had a greater 24-month increase in spinal BMD (p < 0.05). The oral therapy was safe and well tolerated. CONCLUSION In postmenopausal women with low bone mass and breast cancer on an AI, the oral bisphosphonate risedronate maintained skeletal health.
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Affiliation(s)
- S L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA.
| | - K T Vujevich
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - A Brufsky
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - B C Lembersky
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - G J van Londen
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - R C Jankowitz
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - S L Puhalla
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - P Rastogi
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - S Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
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Tan AR, Johannes H, Rastogi P, Jacobs SA, Robidoux A, Flynn PJ, Thirlwell MP, Fehrenbacher L, Stella PJ, Goel R, Julian TB, Provencher L, Bury MJ, Bhatt K, Geyer CE, Swain SM, Mamounas EP, Wolmark N. Weekly paclitaxel and concurrent pazopanib following doxorubicin and cyclophosphamide as neoadjuvant therapy for HER-negative locally advanced breast cancer: NSABP Foundation FB-6, a phase II study. Breast Cancer Res Treat 2014; 149:163-9. [DOI: 10.1007/s10549-014-3221-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 11/24/2022]
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Iyer D, Rastogi P, Åneman A, D'Amours S. Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand 2014; 58:1267-75. [PMID: 25307712 DOI: 10.1111/aas.12409] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU). METHODS Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. RESULTS Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality. CONCLUSION IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.
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Affiliation(s)
- D Iyer
- Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia; Trauma Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
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Rastogi P, Iyer D, Aneman A, D'Amours S. Intra-abdominal hypertension and abdominal compartment syndrome: pathophysiological and non-operative management. Minerva Anestesiol 2014; 80:922-932. [PMID: 24299707] [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: 06/02/2023]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are conditions that commonly manifest in critically ill patients. They are associated with a multiplicity of pathophysiological disturbances. This study retrospectively reviewed literature relating to IAH and ACS published in the last two decades to consolidate an understanding of the epidemiology, etiology, pathophysiology, diagnosis and non-operative management of these conditions. Additionally, the authors of this study have recently conducted a large study on intra-abdominal pressures of consecutive catheterised patients admitted to the Intensive Care Unit (N.=403). A preliminary analysis of this study has also been included.
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Affiliation(s)
- P Rastogi
- Royal North Shore Hospital, Sydney, NSW, Australia -
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31
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Rastogi P, Khushalani S, Dhawan S, Goga J, Hemanth N, Kosi R, Sharma RK, Black BS, Jayaram G, Rao V. Understanding clinician perception of common presentations in South Asians seeking mental health treatment and determining barriers and facilitators to treatment. Asian J Psychiatr 2014; 7:15-21. [PMID: 24524704 DOI: 10.1016/j.ajp.2013.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Little is known about the presentation of mental health symptoms among South Asians living in the US. OBJECTIVE To explore mental health symptom presentation in South Asians in the US and to identify facilitators and barriers to treatment. DESIGN Focus group study. PARTICIPANTS Four focus groups were conducted with 7-8 participants in each group. All participants (N = 29) were clinicians who had been involved in the care of South Asian patients with emotional problems and/or mental illness in the US. APPROACH Qualitative content analysis. RESULTS Key themes identified included: generational differences in symptom presentation, stress was the most common symptom for younger South Asians (<40 years of age), while major mental illnesses such as severe depression, psychosis and anxiety disorder were the primary symptoms for older South Asians (>40 years of age). Substance abuse and verbal/physical/sexual abuse were not uncommon but were often not reported spontaneously. Stigma and denial of mental illness were identified as major barriers to treatment. Facilitators for treatment included use of a medical model and conducting systematic but patient-centered evaluations. CONCLUSIONS South Asians living in the US present with a variety of mental health symptoms ranging from stress associated with acculturation to major mental illnesses. Facilitating the evaluation and treatment of South Asians with mental illness requires sensitivity to cultural issues and use of creative solutions to overcome barriers to treatment.
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Affiliation(s)
- Pramit Rastogi
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Johns Hopkins University, School of Medicine, United States.
| | - Sunil Khushalani
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Sheppard Pratt Hospital, University of Maryland, United States
| | - Swaran Dhawan
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Counselors Helping (South) Asian Indians, Inc. (CHAI), United States
| | - Joshana Goga
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Sheppard Pratt Hospital, University of Maryland, United States
| | - Naveena Hemanth
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States
| | - Razia Kosi
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Counselors Helping (South) Asian Indians, Inc. (CHAI), United States
| | - Rashmi K Sharma
- Northwestern University, Feinberg School of Medicine, United States
| | - Betty S Black
- Johns Hopkins University, School of Medicine, United States
| | - Geetha Jayaram
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Johns Hopkins University, School of Medicine, United States
| | - Vani Rao
- Maryland/DC Chapter of the IndoAmerican Psychiatric Association, United States; Johns Hopkins University, School of Medicine, United States
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Lyer D, Rastogi P, Aneman A, D'Amours S. Predictive criteria for the development of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care 2014. [PMCID: PMC4068368 DOI: 10.1186/cc13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cortazar P, Zhang L, Untch M, Mehta K, Constantino J, Wolmark N, Bonnefoi H, Piccart M, Gianni L, Valagussa P, Zujewski JA, Justice R, Loibl S, Swain SM, Bogaerts J, Baselga J, Prowell TM, Rastogi P, Sridhara R, Tang S, Pazdur R, Mamounas E, von Minckwitz G. Abstract P5-17-01: A definition of a high-risk early-breast cancer population based on data from the collaborative trials in neoadjuvant breast cancer (CTNeoBC) meta-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathological complete response (pCR) is a proposed surrogate endpoint for predicting long-term clinical benefit on endpoints such as event-free survival (EFS) or overall survival (OS). The CTNeoBC meta-analysis did not validate the surrogacy of pCR for EFS or OS, and there is no precedent for its use as a regulatory endpoint in oncology. Use of the accelerated approval pathway has been proposed for neoadjuvant therapies that substantially improve pCR as a means to expedite widespread access to highly effective therapies for high-risk, early breast cancer. Potential risks of this approach include approving an agent that ultimately does not demonstrate clinical benefit and, in the interim, exposing curable patients to the toxicity of therapy without certainty of benefit. To mitigate the risks of this pathway, enrollment to neoadjuvant trials intended to support accelerated approval should be restricted to patients presenting with high-risk early-stage breast cancer. The 5-year EFS rate by breast cancer subtype in the CTNeoBC meta-analysis population is presented. Methods: We identified 12 neoadjuvant randomized trials (N = 12,993) with pCR clearly defined and long-term follow-up available for EFS and OS. Trials included AGO 1 (n = 668), ECTO (n = 1355), EORTC 10994/BIG 1-00 (n = 1856), GeparDuo (n = 907), GeparQuattro (n = 1495), GeparTrio (n = 2072), GeparTrio-Pilot (n = 285), NOAH (n = 234), NSABP B18 (n = 760), NSABP B27 (n = 2411), PREPARE (n = 733), and TECHNO (n = 217). The key objective of this analysis was to establish a definition of “high-risk” based on the Kaplan-Meier estimates of the 5-year EFS rate in the different clinical breast cancer subtypes (hormone receptor-positive, HER2-positive and triple-negative) analyzed by tumor stage and tumor grade at presentation. Results: The 5-year EFS rate was less than 65% in all the breast cancer subtypes with stage III disease. For patients with stage II disease, the impact of tumor grade varied by hormone receptor status. Patients with hormone receptor-negative breast cancer, regardless of HER2 status had a poor prognosis that was independent of tumor grade. For patients with hormone receptor-positive tumors, regardless of HER2 status, high grade histology was associated with an increased risk of recurrence.
5-year Event-Free Survival Rate (EFS) 5-year EFS Rate Estimate (95% confidence interval)TNMStage IIStage III Grade IIGrade IIIGrade IIGrade IIIHormone Receptor + HER2-83% (80%, 85%)71% (65%, 77%)63% (58%, 69%)51% (42%, 59%)HER2+ HR+81% (75%, 86%)69% (60%, 76%)50% (41%, 59%)48% (37%, 59%)HER2+ HR-61% (51%, 70%)66% (57%, 73%)58% (46%, 69%)46% (36%, 55%)Triple Negative66% (58%, 72%)72% (67%, 76%)38% (27%, 48%)37% (29%, 45%)
Conclusions: This analysis estimated the 5-year EFS rate in the breast cancer subtypes from the CTNeoBC meta-analysis population. The HER2-positive population in the meta-analysis was at particularly high risk because most of the patients had locally advanced breast cancer and only 39% of these patients received trastuzumab therapy. We propose defining less than 75% 5-year EFS rate as “high-risk” for the purposes of designing neoadjuvant trials that intend to use pCR to support accelerated approval.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-17-01.
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Affiliation(s)
- P Cortazar
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Zhang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Untch
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - K Mehta
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Constantino
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - N Wolmark
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - H Bonnefoi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Piccart
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Gianni
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Valagussa
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - JA Zujewski
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Justice
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Loibl
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - SM Swain
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Bogaerts
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Baselga
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - TM Prowell
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Rastogi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Sridhara
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Tang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Pazdur
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - E Mamounas
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - G von Minckwitz
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
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Fehrenbacher L, Jeong JH, Rastogi P, Geyer CE, Paik S, Ganz PA, Land SR, Costantino JP, Swain SM, Mamounas EP, Wolmark N. OT1-02-07: NSABP B-47: A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women with Node-Positive or High-Risk Node-Negative HER2−Low Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot1-02-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Adjuvant studies utilizing trastuzumab in early HER2+ breast cancer demonstrated a large reduction in recurrence and death. Post-enrollment central testing showed HER2 non-amplified participants derived similar benefit. Among HER2−amplified patients, multiple studies showed no effect on benefit by degree of amplification. Extensive testing including blinded external review confirmed the non-amplified nature of the HER2 normal group. Detailed relevant background and confirmatory studies will be provided. As a result of these findings, NSABP study B-47, sponsored by the NCI, was activated January 2011. The study is NCI central IRB approved, open in the CTSU, and endorsed by SWOG as of April 2011.
Study: Selection of one of the two chemotherapy regimens is by physician choice: The non-anthracycline regimen is TC (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2) administered IV every 3 weeks for 6 cycles; the anthracycline regimen is AC followed by WP (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 administered IV either every 3 weeks or every 2 weeks [per investigator discretion] for 4 cycles followed by paclitaxel 80 mg/m2 IV weekly for 12 doses). Patients will be randomly assigned to receive chemotherapy with or without trastuzumab therapy. For patients receiving the TC chemotherapy regimen, trastuzumab will be given every 3 weeks during and following chemotherapy until 1 year after the first trastuzumab dose (8 mg/kg loading dose; 6 mg/kg for the remaining doses). For patients receiving the AC followed by WP chemotherapy regimen, trastuzumab will begin with the first dose of weekly paclitaxel and will be given weekly for 12 doses (4 mg/kg loading dose; 2 mg/kg for the remaining weekly doses). Following completion of WP, trastuzumab therapy will continue with 6 mg/kg doses given every 3 weeks for a total of 1 year. Patients will also receive adjuvant radiation therapy and endocrine therapy, as clinically indicated.
Detailed menstrual history, concurrent medications, weight changes, and biomarkers (estrogen, stress, inflammation status) will be collected throughout the study. Collection of circulating tumor cells as an ancillary study is planned.
Eligibility: Eligibility includes: node positive or high risk node negative female breast cancer patients; HER2 IHC 1+ or 2+ scores, but non amplified by FISH; normal cardiac, renal, and liver function. Detailed eligibility will be provided.
Statistical: The primary aim is to determine whether the addition of trastuzumab to chemotherapy improves invasive disease-free survival (IDFS). 3260 patients will be enrolled to provide statistical power of 0.9 to detect a 33% reduction in the hazard rate of IDFS using a one-sided alpha level of 0.025. Projected accrual time is approximately 3 years.
Progress: Protocol was activated in January 2011. First patient was entered in February 2011. As of June 16, 2011, 115 of 3260 patients have been enrolled. Supported by NCI U10-12027, -37377, 69651, 69974, and Genentech, Inc.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-02-07.
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Affiliation(s)
- L Fehrenbacher
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - J-H Jeong
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - P Rastogi
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - CE Geyer
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - S Paik
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - PA Ganz
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - SR Land
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - JP Costantino
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - SM Swain
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - EP Mamounas
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - N Wolmark
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
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Abstract
In patients who underwent neurosurgery for excision of acoustic tumors, we used correlation and multivariate logistic regression analysis to study relationships among nine variables thought to have value in predicting hearing preservation. These variables included auditory perceptual, auditory neurophysiologic, and imaging-related characteristics of acoustic tumor dimensions. The univariate correlations showed two general trends. The first trend demonstrated relationships among imaging-related acoustic tumor dimensions (size or porus acousticus widening) with either postoperative hearing or brainstem auditory evoked potential (BAEP) abnormalities (tumor size and postoperative hearing; porus acousticus widening and postoperative hearing; tumor size and preoperative BAEP abnormalities). The second trend reflected interrelationships among preoperative audiometric variables that were not related to postoperative hearing outcome. Logistic regression analysis of eight independent variables on the presence or absence of postoperative hearing found that porus acousticus widening was the best prognostic indicator for hearing outcome. When the porus acousticus was widened, the odds ratio was 11:1 that hearing would be lost postoperatively. Viewed as a whole, the literature on prognostic variables related to hearing preservation has been limited, almost entirely, to univariate relationships. To determine more accurately which preoperative variables have unique prognostic value, more complex multivariate, analysis procedures will be required. Additionally, standardized criteria for assessment and reporting of auditory test results are also needed.
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Bear HD, Tang G, Rastogi P, Geyer CE, Robidoux A, Atkins JN, Baez L, Brufsky A, Mehta RS, Fehrenbacher L, Pajon ER, Senecal FM, Gaur R, Margolese RG, Adams PT, Gross HM, Swain SM, Mamounas EP, Costantino JP, Wolmark N. The effect on pCR of bevacizumab and/or antimetabolites added to standard neoadjuvant chemotherapy: NSABP protocol B-40. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba1005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA1005 Background: The addition of capecitabine (X), gemcitabine (G), and bevacizumab (B) to taxanes have each improved PFS in metastatic breast cancer. The primary aims of this trial were to determine if adding X or G to docetaxel (T) → AC will increase breast pathologic complete response (pCR) rates in operable, HER2-negative breast cancer and if adding B to T-based regimens →AC will increase pCR rates. Secondary aims included assessment of clinical complete response (cCR) rates. Methods: Pts received one of 3 T-based regimens, with or without B, 15mg/kg, q3wks x 4: T 100 mg/m2 day 1; T 75 mg/m2 day 1 and X 825 mg/m2 BID days 1-14; or T 75 mg/m2 day 1 and G 1000 mg/m2 days 1 and 8. Pts then received preoperative AC x 4, with or without B for the initial 2 cycles of AC. Pts randomized to B resumed B for 10 postop doses. The primary endpoint was pCR in the breast. The maximum of the standardized pairwise differences between pCR rate for the T → AC regimen and for the other 2 T-based regimens was used as the test statistic to adjust for multiple comparisons. Fisher’s exact test was used to compare the arms with and without B. Results: The groups were balanced, with 47% clinically node+, 56% poorly differentiated, and 59% HR+. Assessments for pCR were available from 1180 of 1206 randomized patients. pCR for TX and TG were 29.7% and 32% vs. 32.7% for T. Neither TX nor TG increased cCR rates relative to T (58.3% and 60.4% vs. 61.5%). TX and TG increased toxicity. Addition of B increased the pCR rate (28.4 vs. 34.5%, p=0.027) and the cCR rate (55.8 vs. 64.3%, p=0.007). The effect of B was predominantly in the HR+ subset (15.2 vs. 23.3%, p=0.008) with minimal effect in the HR- subset (47.3% vs. 51.3%, p=0.44). Grades 2/3/4 toxicities increased with B were HTN (1/<1/0% vs. 13/9/<1%), HFS (11/7/0% vs. 15/11/0%), and mucositis (10/3/0% vs. 20/5/0%). Conclusions: The addition of B to neoadjuvant chemotherapy improved pCR and cCR rates, but the addition of X or G to T did not improve outcomes. Follow-up for wound healing issues and DFS will help define the role of B in the treatment of early breast cancer. Funded by NCI PHS grants U10-CA-37377, U10-CA-69974, U10-CA-12027, U10-CA-69651, and U10-CA-44066, and F. Hoffmann La-Roche, Ltd., Genentech, USA, and Eli Lilly.
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Affiliation(s)
- H. D. Bear
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - G. Tang
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - P. Rastogi
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - C. E. Geyer
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - A. Robidoux
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - J. N. Atkins
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - L. Baez
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - A. Brufsky
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - R. S. Mehta
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - L. Fehrenbacher
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - E. R. Pajon
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - F. M. Senecal
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - R. Gaur
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - R. G. Margolese
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - P. T. Adams
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - H. M. Gross
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - S. M. Swain
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - E. P. Mamounas
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - J. P. Costantino
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
| | - N. Wolmark
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA; NSABBP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh Medical Center, Magee-Womens Cancer Program, Pittsburgh, PA; National Surgical Adjuvant Breast and Bowel Project and Allegheny General Hospital, Pittsburgh, PA; NSABP; CHUM-Hotel Dieu, Montreal, QC, Canada; SCCC-CCOP, Winston-Salem, NC; San Juan MBCCOP, San Juan, PR; University of California, Irvine School
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Soni A, Brufsky A, Jankowitz RC, Rastogi P, Vogel VG, Puhalla S. Incidence of febrile neutropenia with docetaxel plus cyclophosphamide in a university-based breast oncology clinic. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parulekar W, Chen BE, Elliott C, Shepherd LE, Gelmon KA, Pritchard KI, Whelan TJ, Ligibel JA, Hershman DL, Mayer IA, Hobday TJ, Rastogi P, Lemieux J, Ganz PA, Stambolic V, Goodwin PJ. A phase III randomized trial of metformin versus placebo on recurrence and survival in early-stage breast cancer (BC) (NCIC Clinical Trials Group MA.32). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bear HD, Tang G, Rastogi P, Geyer CE, Robidoux A, Atkins JN, Baez L, Brufsky A, Mehta RS, Fehrenbacher L, Pajon ER, Senecal FM, Gaur R, Margolese RG, Adams PT, Gross HM, Swain SM, Mamounas EP, Costantino JP, Wolmark N. The effect on pCR of bevacizumab and/or antimetabolites added to standard neoadjuvant chemotherapy: NSABP protocol B-40. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba1005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rao V, Goga J, Inscore A, Kosi R, Khushalani S, Rastogi P, Subramaniam G, Jayaram G. Attitudes towards mental illness and help-seeking behaviors among South Asian Americans: Results of a pilot study. Asian J Psychiatr 2011; 4:76. [PMID: 23050922 DOI: 10.1016/j.ajp.2010.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/22/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Vani Rao
- Maryland/DC Chapter, Indo-American Psychiatric Association (IAPA), United States
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Affiliation(s)
- Z A Khan
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
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van Londen GJ, Perera S, Vujevich K, Rastogi P, Lembersky B, Brufsky A, Vogel V, Greenspan SL. The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer. Breast Cancer Res Treat 2010; 125:441-6. [PMID: 21046232 DOI: 10.1007/s10549-010-1223-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/09/2010] [Indexed: 11/29/2022]
Abstract
Aromatase inhibitors (AIs) have become the standard adjuvant therapy of postmenopausal breast cancer survivors. AIs induce a reduction of bioavailable estrogens by inhibiting aromatase, which would be expected to induce alterations in body composition, more extensive than induced by menopause. The objectives are to examine the impact of AIs on (1) DXA-scan derived body composition and (2) gonadal hormone levels. This is a sub-analysis of a 2-year double-blind, placebo-controlled, randomized trial of 82 women with nonmetastatic breast cancer, newly menopausal following chemotherapy, who were randomized to risedronate (35 mg once weekly) versus placebo, and stratified for their usage of AI versus no AI. Outcomes included DXA-scan derived body composition and gonadal hormone levels. As a group, total body mass increased in women over 24 months. Women on AIs gained a significant amount of lean body mass compared to baseline as well as to no-AI users (P < 0.05). Women not on an AI gained total body fat compared to baseline and AI users (P < 0.05). Free testosterone significantly increased and sex hormone binding globulin (SHBG) significantly decreased in women on AIs compared to no AIs at 24 months (P < 0.01) while total estradiol and testosterone levels remained stable. Independent of AI usage, chemotherapy-induced postmenopausal breast cancer patients demonstrated an increase of total body mass. AI users demonstrated maintenance of total body fat, an increase in lean body mass and free testosterone levels, and a decrease in SHBG levels compared to no-AI users. The mechanisms and implications of these changes need to be studied further.
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Affiliation(s)
- G J van Londen
- Medicine, University of Pittsburgh, Kaufmann Medical Bldg, Pittsburgh, PA, 15213, USA.
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Rastogi P, Buyse ME, Tan AR, Jacobs SA, Swain SM, Geyer CE, Wolmark N. A phase II clinical trial of four cycles of doxorubicin and cyclophosphamide followed by weekly paclitaxel given concurrently with pazopanib as neoadjuvant therapy followed by postoperative pazopanib for women with locally advanced breast cancer (LABC): A phase II trial of the NSABP Foundation Research Group (FB-6/VEG110264). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Londen GJ, Perera S, Vujevich K, Rastogi P, Lembersky B, Brufsky A, Vogel V, Greenspan S. Changes in body composition in women with breast cancer on aromatase inhibitors: A two-year trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9528] [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
9528 Background: Aromatase inhibitors (AIs), the preferred adjuvant therapy of postmenopausal breast cancer patients, induce severe hypo-estrogenemia which differentiates them from the Estrogen-Receptor-Agonists-Antagonists (ERAAs). Little is known about the effect of AIs on body composition. We sought to examine the impact of AIs on body composition, and whether any changes correlate with gonadal hormone levels. Methods: We analyzed a two year double-blind trial (Risedronate's Effect on Bone loss in Breast CAncer, REBBeCA). 81 chemotherapy-induced newly postmenopausal nonmetastatic breast cancer patients had been randomized to risedronate 35 mg once weekly or placebo and followed, some of whom were on or started AI during the trial. Measures included body composition by whole body DXA-scan and serum sex hormone levels. Combining the two treatment arms, we estimated and compared body composition changes in those on (AI) and not on AIs (no-AI) using a linear mixed model, and examined correlations with serum hormone levels. Results: By 24 months, 41 women were on an AI. Over 2 years, lean mass increased by 1159g (p=0.0003) in women on an AI and did not change (85g; p=0.7684) in the no-AI group (adjusted difference, AD=1047g; p=0.0004). Percent fat did not change (0.0; p=0.9344) in those on an AI and increased (1.2; p=0.0097) in the no-AI group (AD=1.6; p=0.0433). The change in estradiol was associated with changes in lean mass (correlation r=0.42, p=0.0020) and percent fat (r=-0.48, p=0.0003). Conclusions: The use of AIs is associated with a decrease in fat mass and an increase in lean mass. The changes in estradiol are associated with alterations in body composition. The mechanisms and implications of these changes need to be studied further. [Table: see text]
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Affiliation(s)
- G. J. Van Londen
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - S. Perera
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - K. Vujevich
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - P. Rastogi
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - B. Lembersky
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - A. Brufsky
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - V. Vogel
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
| | - S. Greenspan
- University of Pittsburgh, Pittsburgh, PA; American Cancer Society, Atlanta, GA
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Rastogi P, Buyse M, Swain S, Jacobs S, Robidoux A, Liepman M, Dy P, Geyer C, Wolmark N. Bevacizumab beginning concurrently with a sequential regimen of doxorubicin and cyclophosphamide followed by docetaxel and capecitabine as neoadjuvant therapy followed by postoperative bevacizumab alone for women with HER2-negative locally advanced breast cancer (LABC): A phase II trial of the NSABP Foundation Research Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
584 Background: Bevacizumab with chemotherapy improves outcomes in patients with metastatic breast cancer. The purpose of this trial was to determine the activity and safety profile of bevacizumab with chemotherapy in women with LABC. Methods: Between November 2006 and August 2007, 45 women with HER-2 negative LABC initiated preoperative standard AC x 4 followed by docetaxel 75 mg/m2 IV and capecitabine 825 mg/m2 BID days 1–14 (TX) every 21 days for 4 cycles. Bevacizumab 15 mg/kg IV was given concurrently with chemotherapy every 21 days for a total of 6 preoperative doses. Postoperatively, bevacizumab was resumed for a total of 10 doses. Primary endpoint was pathologic complete response rate (pCR) in the breast. The secondary endpoints include clinical response rates and toxicity. Results: The median age was 50 yrs (range 30–78). 30 patients had stage IIIA (67%), 12 stage IIIB (27%), and 3 stage IIIC (7%) disease. Of these, 10 (22%) had inflammatory breast cancer. 27 patients (60%) had ER-positive disease. A pCR in the breast was documented in 4/44 (9%) patients, which included negative axillary nodes. A complete clinical response was noted in 14/45 (31%). One patient did not have surgery due to progression. Toxicities included hand-foot (grade 2/3–33%/22%), mucositis (grade 2/3–49%/27%), and febrile neutropenia (grade 3–24%). Conclusions: This regimen demonstrated only modest activity with substantial toxicity, and does not appear to warrant further evaluation. This clinical trial is being conducted through the support of Genentech and Roche. [Table: see text]
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Affiliation(s)
- P. Rastogi
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - M. Buyse
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - S. Swain
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - S. Jacobs
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - A. Robidoux
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - M. Liepman
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - P. Dy
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - C. Geyer
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - N. Wolmark
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
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Smith JW, Buyse M, Rastogi P, Geyer C, Jacobs S, Patocskai E, Wolmark N. Epirubicin plus cyclophosphamide followed by docetaxel plus trastuzumab and bevacizumab as neoadjuvant therapy for HER2-positive locally advanced breast cancer (LABC) or as adjuvant therapy for HER2-positive pathologic stage III breast cancer (PS3BC): A phase II trial of the NSABP Foundation Research Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
580 Background: A previous phase II study evaluating the combination of trastuzumab (tras) and bevacizumab (bev) as first-line therapy in HER2 + MBC showed a response rate of 54%. The purpose of this trial is to determine the cardiac safety profile of these agents with docetaxel (T) following epirubicin plus cyclophosphamide (EC) in women with LABC and PS3BC and the activity in those with LABC. Methods: Since June 2007, 75 women with HER-2 + LABC or PS3BC have begun epirubicin 90 mg/m2 IV plus cyclophosphamide 600 mg/m2 IV q3wks x 4 followed by docetaxel 100 mg/m2 IV q3wks x 4. Targeted therapy: Cohort A (neoadjuvant), bev 15 mg/kg IV with Cycle 4 of EC, continued with the first 3 cycles of T. Standard weekly tras with 4 cycles of T. Postop, bev 15 mg/kg IV and tras 6 mg/kg IV q3wks to complete 1 yr of targeted therapy. Cohort B (adjuvant), bev 15 mg/kg q3wks for 4 cycles and weekly tras with T. After chemotherapy, bev and tras q3wks to complete 1 yr of therapy. Primary endpoints were the rate of cardiac events in both cohorts and pCR rate in breast/axillary lymph nodes in Cohort A. Results: Median age was 50 yrs. In Cohort A, 28 (53%) patients (pts) were stage IIIA, 20 (38%) stage IIIB, and 5 (9%) stage IIIC. 13 (25%) had inflammatory BC. A pCR occurred in 19 of the first 36 pts (53%). Toxicity information on the first 73 pts in both cohorts showed that grade 2 LVEF dysfunction has developed in 5 pts and grade 3 LVEF dysfunction in 2, 1 with NYHA Class II and 1 with Class III symptoms. The latter met criteria for a cardiac event. Conclusions: The regimen is active with an acceptable preliminary rate of cardiac toxicity. Updated results will be presented. This trial is conducted with the support of Genentech. [Table: see text]
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Affiliation(s)
- J. W. Smith
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - M. Buyse
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - P. Rastogi
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - C. Geyer
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - S. Jacobs
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - E. Patocskai
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - N. Wolmark
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
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Rao V, Rosenberg P, Bertrand M, Salehinia S, Spiro J, Vaishnavi S, Rastogi P, Noll K, Schretlen DJ, Brandt J, Cornwell E, Makley M, Miles QS. Aggression after traumatic brain injury: prevalence and correlates. J Neuropsychiatry Clin Neurosci 2009; 21:420-9. [PMID: 19996251 PMCID: PMC2918269 DOI: 10.1176/jnp.2009.21.4.420] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.
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Affiliation(s)
- Vani Rao
- Division of Neuropsychiatry & Geriatric Psychiatry, Dept. of Psychiatry, Johns Hopkins University, 5300 Alpha Commons Dr., 4th Floor, #444, Baltimore, MD 21224, USA.
| | - Paul Rosenberg
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Melaine Bertrand
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Saeed Salehinia
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Spiro
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sandeep Vaishnavi
- Division of Neuropsychiatry, Alexian Neurosciences Institute Alexian Brothers Behavioral Health Hospital, Chicago, IL
| | - Pramit Rastogi
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kathy Noll
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - David J Schretlen
- Division of Medical Psychology, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jason Brandt
- Division of Medical Psychology, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Edward Cornwell
- Department of Surgery Howard University College of Medicine, Washington D.C
| | | | - Quincy Samus Miles
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
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Rao V, Spiro J, Vaishnavi S, Rastogi P, Mielke M, Noll K, Cornwell E, Schretlen D, Makley M. Prevalence and types of sleep disturbances acutely after traumatic brain injury. Brain Inj 2008; 22:381-6. [PMID: 18415718 DOI: 10.1080/02699050801935260] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To assess the prevalence of and risk factors for sleep disturbances in the acute post-traumatic brain injury (TBI) period. RESEARCH DESIGN Longitudinal, observational study. METHODS AND PROCEDURES Fifty-four first time closed-head injury patients were recruited and evaluated within 3 months after injury. Pre-injury and post-injury sleep disturbances were compared on the Medical Outcome Scale for Sleep. The subjects were also assessed on anxiety, depression, medical comorbidity and severity of TBI. MAIN OUTCOMES AND RESULTS Subjects were worse on most sleep measures after TBI compared to before TBI. Anxiety disorder secondary to TBI was the most consistent significant risk factor to be associated with worsening sleep status. CONCLUSIONS Anxiety is associated with sleep disturbances after TBI. Further studies need to be done to evaluate if this is a causal relationship.
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Affiliation(s)
- Vani Rao
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Baltimore, MD, USA.
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Rastogi P, Jeong J, Geyer CE, Costantino JP, Romond EH, Ewer MS, Keefe DL, Levine T, Swain SM, Wolmark N. Five year update of cardiac dysfunction on NSABP B-31, a randomized trial of sequential doxorubicin/cyclophosphamide (AC)→paclitaxel (T) vs. AC→T with trastuzumab (H). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba513] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA513 Background: Trastuzumab (H) has been shown to improve survival in HER2 positive, node-positive breast cancer patients when combined with paclitaxel following AC (Romond NEJM 2005:353;1673–1684). Cardiac dysfunction is the major toxicity associated with this regimen. Methods: NSABP B-31 compared doxorubicin and cyclophosphamide (AC) followed by paclitaxel with AC followed by paclitaxel plus 52 weeks of trastuzumab beginning concurrently with paclitaxel in patients with node- positive, HER2-positive breast cancer. Initiation of trastuzumab required normal post-AC left ventricular ejection fraction (LVEF) on MUGA scan. If symptoms suggestive of congestive heart failure (CHF) developed, source documents were blindly reviewed by a panel of cardiologists to determine whether criteria were met for a cardiac event (CE), defined as NYHA class III or IV CHF or possible/probable cardiac death. Among patients with normal post-AC LVEF who began post-AC treatment, 10 of 872 (1.3%) control patients subsequently had confirmed CEs (9 CHFs and 1 cardiac death) compared with 35 of 932 (3.9%) trastuzumab-treated patients (35 CHFs and no cardiac deaths). The difference in cumulative incidence at 5 years was 2.7%. Risk factors for CHF were age 50 (5.2–5.3%), requirement for hypertension medication (7.7%), and post AC-LVEF values of 50–54% (13.0%). Conclusion: Administering trastuzumab with paclitaxel after AC increases incidence of CHF. Risk factors for increased risk of cardiotoxicity should be carefully considered when discussing benefits and risks of this therapy. No significant financial relationships to disclose.
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Affiliation(s)
- P. Rastogi
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - J. Jeong
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - C. E. Geyer
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - J. P. Costantino
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - E. H. Romond
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - M. S. Ewer
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - D. L. Keefe
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - T. Levine
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - S. M. Swain
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - N. Wolmark
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
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Rastogi P, Beckett CS, McHowat J. Prostaglandin production in human coronary artery endothelial cells is modulated differentially by selective phospholipase A(2) inhibitors. Prostaglandins Leukot Essent Fatty Acids 2007; 76:205-12. [PMID: 17374479 DOI: 10.1016/j.plefa.2006.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 11/21/2006] [Accepted: 12/29/2006] [Indexed: 10/23/2022]
Abstract
Atherosclerotic plaque formation is a dynamic process involving repeated injury and inflammation of the endothelium. We have demonstrated previously that thrombin and tryptase stimulation of human coronary artery endothelial cells (HCAEC) leads to increased phospholipase A(2) (PLA(2)) activity and generation of membrane phospholipid derived inflammatory metabolites, including eicosanoids and platelet activating factor. Thus, our hypothesis is that selective PLA(2) inhibitors have therapeutic potential as anti-inflammatory agents. Stimulation of confluent HCAEC monolayers with thrombin or tryptase resulted in a concentration and time-dependent increase in both prostaglandin E(2) (PGE(2)) and prostacyclin (PGI(2)) production. Pretreatment with PX-18 to inhibit secretory PLA(2) or BEL to inhibit calcium-independent PLA(2) prior to thrombin or tryptase stimulation resulted in a significant inhibition of both PGI(2) and PGE(2) release. However, pretreatment with methyl arachidonyl fluorophosphonate (MAFP), a widely used inhibitor of cytosolic PLA(2) isoforms, resulted in a significant potentiation of both thrombin and tryptase stimulated PGI(2) and PGE(2) release as a consequence of increased free arachidonic acid production. We conclude that the use of selective PLA(2) inhibitors may be of therapeutic benefit in the development and progression of atherosclerosis, however, the development of such an agent requires rigorous screening.
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Affiliation(s)
- P Rastogi
- Department of Pathology, School of Medicine, Saint Louis University, 1402 S. Grand Blvd., St. Louis, MO 63104, USA
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