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Kopelman ZA, Tian C, Tumas J, Phippen NT, Tarney CM, Hope ER, Winkler SS, Jokajtys S, Kucera CW, Chan JK, Richardson MT, Kapp DS, Hamilton CA, Leath CA, Jones NL, Rocconi RP, Farley JH, Secord AA, Cosgrove CM, Powell MA, Klopp A, Walker JL, Fleming GF, Bateman NW, Conrads TP, Maxwell GL, Darcy KM. Disease progression, survival, and molecular disparities in Black and White patients with endometrioid endometrial carcinoma in real-world registries and GOG/NRG oncology randomized phase III clinical trials. Gynecol Oncol 2024; 183:103-114. [PMID: 38593674 DOI: 10.1016/j.ygyno.2024.03.026] [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] [Received: 01/17/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC). METHODS Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death. RESULTS Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87-2.23) for CRD and 1.22 (1.09-1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46-1.58) dropping to 1.29 (1.23-1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77-2.71) persisting to 1.32 (1.09-1.61) after matching for grade, stage, and treatment arm while balancing age and performance status. CONCLUSIONS Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
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Affiliation(s)
- Zachary A Kopelman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jordyn Tumas
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Erica R Hope
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, the University of Mississippi Medical Center, Jackson, MS, USA
| | - John H Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joan L Walker
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Gini F Fleming
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicholas W Bateman
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
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Horowitz NS, Deng W, Peterson I, Mannel RS, Thompson S, Lokich E, Myers T, Hanjani P, O'Malley DM, Chung KY, Miller DS, Ueland FR, Dizon DS, Miller A, Mayadev JS, Leath CA, Monk BJ. Phase II Trial of Cisplatin, Gemcitabine, and Intensity-Modulated Radiation Therapy for Locally Advanced Vulvar Squamous Cell Carcinoma: NRG Oncology/GOG Study 279. J Clin Oncol 2024:JCO2302235. [PMID: 38574312 DOI: 10.1200/jco.23.02235] [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] [Received: 10/13/2023] [Revised: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To assess efficacy and toxicity of cisplatin (C) and gemcitabine (G) with intensity-modulated radiation therapy (IMRT) in patients with locally advanced vulvar cancer not amenable to surgery. METHODS Patients enrolled in a single-arm phase II study. Pretreatment inguinal-femoral nodal assessment was performed. Sixty-four Gy IMRT was prescribed to the vulva, with 50-64 Gy delivered to the groins/low pelvis. Radiation therapy (RT) plans were quality-reviewed pretreatment. C 40 mg/m2 and G 50 mg/m2 were administered once per week throughout IMRT. Complete pathologic response (CPR) was the primary end point. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and adverse events were assessed with Common Terminology Criteria for Adverse Events v 4.0. RESULTS Fifty-seven patients enrolled, of which 52 were evaluable. The median age was 58 years (range, 25-58), and 94% were White. Forty (77%) had stage II or III disease, and all had squamous histology. A median of six chemotherapy cycles (range, 1-8) were received. Eighty-five percent of RT plans were quality-reviewed with 100% compliance to protocol. Seven patients came off trial because of toxicity or patient withdrawal. Of 52 patients available for pathologic assessment, 38 (73% [90% CI, 61 to 83]) achieved CPR. No pelvic exenterations were performed. With a median follow-up of 51 months, the 12-month PFS was 74% (90% CI, 62.2 to 82.7) and the 24-month OS was 70% (90% CI, 57 to 79). The most common grade 3 or 4 adverse events were hematologic toxicity and radiation dermatitis. There was one grade 5 event unlikely related to treatment. CONCLUSION Weekly C and G concurrent with IMRT sufficiently improved CPR in women with locally advanced vulvar squamous cell carcinoma not amenable to surgical resection.
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Affiliation(s)
| | - Wei Deng
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, Buffalo, NY
| | | | - Robert S Mannel
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Spencer Thompson
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | | | - David M O'Malley
- The James CCC & The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - David S Miller
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Austin Miller
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, Buffalo, NY
| | - Jyoti S Mayadev
- University of California San Diego School of Medicine, La Jolla, CA
| | - Charles A Leath
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham; Birmingham, AL
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3
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Ostby SA, Blanchard CT, Sanjanwala AR, Szychowski JM, Leath CA, Huh WK, Subramaniam A. Feasibility, Safety, and Provider Perspectives of Bipolar Electrosurgical Cautery Device for (Opportunistic or Complete) Salpingectomy at the Time of Cesarean Delivery. Am J Perinatol 2024; 41:804-813. [PMID: 35728603 DOI: 10.1055/s-0042-1748525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy. STUDY DESIGN This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT. RESULTS Thirty-nine women were consecutively enrolled (12/2018-11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001). CONCLUSION Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean. KEY POINTS · Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean.. · Greater surgeon satisfaction occurs using a device than without.. · Decreased surgical time with device use is seen making the procedure equal to BTL..
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Affiliation(s)
- Stuart A Ostby
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
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Kincaid K, Boitano TK, Scalise M, Patton S, Leath CA, Straughn JM, Smith HJ. Impact of steroid use and glycemic control on postoperative complications in diabetic gynecologic oncology patients undergoing laparotomy. Gynecol Oncol Rep 2024; 52:101344. [PMID: 38404909 PMCID: PMC10885540 DOI: 10.1016/j.gore.2024.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
Objective We aimed to assess the impact of preoperative steroid administration and perioperative glycemic control on postoperative complications in diabetic gynecologic oncology patients undergoing laparotomy. Methods This retrospective cohort study included gynecologic oncology patients with Type I and Type II diabetes (DM) undergoing laparotomy for any gynecologic indication at a single academic center from 10/2017 to 09/2020. The primary outcome was the rate of postoperative complications. Preoperative steroid administration and 24-hour postoperative average serum blood glucose (BG) ≥ 180 mg/dL were the studied exposures. Data was analyzed with SPSS Statistics v.28. Results 225 patients met inclusion criteria; 47.6 % had postoperative complications. Patient demographics were similar between patients with and without postoperative complications. Patients with complications had higher BMIs (36.8 vs. 34.0; p = 0.03), bowel surgery (33.0 % vs. 17.1 %; p = 0.008), operative time ≥ 240 min (14.2 % vs. 5.1 %; p = 0.02) and average BG ≥ 180 (63.6 % vs. 40.2 %; p < 0.01). On multivariate analysis, bowel surgery (OR 2.4 (1.2-4.8); p = 0.01) and average BG ≥ 180 (OR 2.8 (1.6-4.9); p < 0.01) remained significant predictors of postoperative complications. There were no differences in complication rates (42.3 % vs. 42.6 %; p = 1.0) between patients who received preoperative steroids and those who did not. When stratified by average postoperative BG < 180 mg/dL vs. BG ≥ 180 mg/dL, there was no difference in Clavien-Dindo classification, 30-day readmission rate (28.2 % vs. 22.1 %; p = 0.49) or 30-day mortality rate (2.9 % vs. 0.0 %; p = 0.53). Conclusion The administration of preoperative steroids did not increase complication rates. Perioperative hyperglycemia was associated with an increased risk of postoperative complications. Optimizing perioperative glycemic control is imperative to decrease postoperative complications.
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Affiliation(s)
- Kaitlyn Kincaid
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Teresa K.L. Boitano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew Scalise
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samantha Patton
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Charles A. Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John M. Straughn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haller J. Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
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5
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Sitler CA, Tian C, Hamilton CA, Richardson MT, Chan JK, Kapp DS, Leath CA, Casablanca Y, Washington C, Chappell NP, Klopp AH, Shriver CD, Tarney CM, Bateman NW, Conrads TP, Maxwell GL, Phippen NT, Darcy KM. Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ®-Accredited Facilities in the United States. Cancers (Basel) 2024; 16:1071. [PMID: 38473428 DOI: 10.3390/cancers16051071] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. METHODS Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. RESULTS There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. CONCLUSIONS IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA
| | - Yovanni Casablanca
- Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Christina Washington
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Nicole P Chappell
- Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Ann H Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - George Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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6
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Kucera CW, Chappell NP, Tian C, Richardson MT, Tarney CM, Hamilton CA, Chan JK, Kapp DS, Leath CA, Casablanca Y, Rojas C, Sitler CA, Wenzel L, Klopp A, Jones NL, Rocconi RP, Farley JH, O'Connor TD, Shriver CD, Bateman NW, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Survival disparities in non-Hispanic Black and White cervical cancer patients vary by histology and are largely explained by modifiable factors. Gynecol Oncol 2024; 184:224-235. [PMID: 38340648 DOI: 10.1016/j.ygyno.2024.02.005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities. METHODS Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC). RESULTS This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97-1.06) or AC (AHR = 1.09, 95% CI = 0.96-1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively). CONCLUSIONS Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.
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Affiliation(s)
- Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nicole P Chappell
- George Washington Medical Faculty Associates, George Washington Cancer Center, Washington, DC, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - John K Chan
- Palo Alto Medical Foundation / California Pacific Medical Center /Sutter Health, San Francisco, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Christine Rojas
- Division of Gynecologic Oncology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lari Wenzel
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Ann Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, the University of Mississippi Medical Center, Jackson, MS, USA
| | - John H Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine and Program in Personalized and Genomic Medicine, and Program in Health Equity and Population Health, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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7
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Winkler SS, Tian C, Casablanca Y, Bateman NW, Jokajtys S, Kucera CW, Tarney CM, Chan JK, Richardson MT, Kapp DS, Liao CI, Hamilton CA, Leath CA, Reddy M, Cote ML, O'Connor TD, Jones NL, Rocconi RP, Powell MA, Farley J, Shriver CD, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes. Gynecol Oncol 2024; 184:31-42. [PMID: 38277919 DOI: 10.1016/j.ygyno.2024.01.009] [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] [Received: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups. METHODS Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling. RESULTS There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology. CONCLUSIONS Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants.
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Affiliation(s)
- Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheng-I Liao
- Division of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Megan Reddy
- California Pacific Medical Center, San Francisco, CA, USA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - John Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
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Bednar EM, Rauh-Hain JA, Garcia JJ, de Aguinaga N, Powell MA, Peral SL, Nitecki R, Jorgensen K, Rudy NL, Lu KH, Leath CA, Scarinci IC. Experiences of Family Communication and Cascade Genetic Testing for Hereditary Cancer in Medically Underserved Populations-A Qualitative Study. Cancer Prev Res (Phila) 2024; 17:19-28. [PMID: 37913800 PMCID: PMC10872900 DOI: 10.1158/1940-6207.capr-23-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023]
Abstract
We sought to explore the intrafamilial communication and cascade genetic testing (CGT) experiences of patients with hereditary cancer from diverse, medically underserved populations and their relatives. Participants included patients receiving oncology care at an urban, safety net hospital in Texas or comprehensive cancer center in Alabama and their first-degree relatives. In-depth semi-structured qualitative interviews were completed wherein patients shared their experiences with genetic counseling (GC), genetic testing (GT), and communicating their results to relatives. Relatives shared their experiences receiving information from the patient and considering CGT. Interviews were transcribed, coded, and themes were identified. Of 25 participating patients, most recalled key aspects of GC and their GT results. Most (80%) patients shared their results with relatives, but only some relatives underwent CGT; patients reported low perceived susceptibility to hereditary cancer as a common barrier to CGT for their relatives. Of 16 participating relatives, most reported feeling distress upon learning the patient's GT results. Relatives were fearful of learning their own CGT results but identified prevention and early detection as CGT benefits. Interviews identified opportunities during family communication to improve relatives' perceived susceptibility to hereditary cancer. Tailored resources may support patients and relatives experiencing distress and fear during GT. PREVENTION RELEVANCE This study of intrafamilial communication and cascade genetic testing experiences of patients with hereditary cancer and their relatives from diverse, medically underserved populations identified relatives' perceived susceptibility to hereditary cancer risks, distress, and fear as frequent reactions and barriers to testing. These results may inform future hereditary cancer prevention efforts.
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Affiliation(s)
- Erica M. Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jose J. Garcia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sylvia L. Peral
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roni Nitecki
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Natasha L. Rudy
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen H. Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Boitano TKL, Kako T, Leath CA. New Paradigms in the Treatment of Cervical Cancer. Obstet Gynecol 2023; 142:1322-1332. [PMID: 37826852 PMCID: PMC10841100 DOI: 10.1097/aog.0000000000005413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
Despite effective screening strategies and the development and implementation of prophylactic high-risk human papillomavirus vaccination, cervical cancer remains a significant public health burden. This burden is most pronounced in under-resourced countries without fully developed screening and vaccination programs, although the disease remains present worldwide, including in industrialized countries. To that end, the World Health Organization (WHO) has an active focus on the elimination of cervical cancer, with objective metrics to be achieved by countries by the year 2030. Although increased vaccination and screening will be needed to approach potential eradication of cervical cancer, as recognized by the WHO initiative, treatment will need to continue to not only be effective in the near term, but to improve outcomes as well. Accordingly, assessments to improve primary treatment options, including surgery for women with early-stage disease, modification of chemoradiation for those with locally advanced cervical cancer, and systemic therapy for those with recurrent or metastatic presentations, are ongoing. Accordingly, we highlight important areas of both recent and ongoing focus as they relate to improving cervical cancer outcomes.
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Affiliation(s)
- Teresa K. L. Boitano
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294, USA
| | - Charles A. Leath
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Boitano TKL, Gardner A, Chu DI, Leath CA, Straughn JM, Smith HJ. Use of a mobile health patient engagement technology improves perioperative outcomes in gynecologic oncology patients. Gynecol Oncol 2023; 178:23-26. [PMID: 37742507 PMCID: PMC10873082 DOI: 10.1016/j.ygyno.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To evaluate the impact of a mobile health patient engagement technology (PET) on postoperative outcomes in gynecologic oncology patients. METHODS All gynecologic oncology patients undergoing laparotomy on an enhanced recovery program (ERP) were approached from July 2019 to May 2021 to enroll in a PET, which can be accessed by computer, tablet, or smart phone. This platform provides enhanced pre- and postoperative patient education and remote patient monitoring. Patients who elected to participate were provided with targeted education based on their age and comorbidities and were asked to complete daily health checks during the postoperative period. Participants in the PET were compared to patients who opted out as well as to a historical cohort from prior to PET implementation. Patient and procedure-level factors were recorded. The primary outcomes were length of stay (LOS) and 30-day readmission rate. Analysis was performed using SPSS v.26. RESULTS 682 women met inclusion criteria during the study time; 347 in the PET group and 335 in the control group. Demographic and other factors including race, BMI (kg/m2), Charlson Comorbidity Index (CCI), surgical complexity, and insurance status were not different between the PET and control group; however, patients in the PET cohort were slightly younger (55.0 yo vs. 57.2 yo; p = 0.04). Patients in the PET group had a significantly shorter LOS (2.9 days vs. 3.6 days; p < 0.01) and lower readmission rate (4.3% vs. 8.6%; p < 0.01) when compared with the control group. CONCLUSIONS Use of a PET in our gynecologic oncology patients decreased LOS by nearly one day despite an absence of differences in other demographic and surgical factors other than age. Furthermore, there was a 50% reduction in readmission rates in the PET group. The use of a PET allows for healthcare professionals to engage, evaluate, and treat patients in a way that improves perioperative care.
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Affiliation(s)
- Teresa K L Boitano
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Birmingham, AL, USA.
| | - Austin Gardner
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I Chu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Birmingham, AL, USA
| | - J Michael Straughn
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Birmingham, AL, USA
| | - Haller J Smith
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Birmingham, AL, USA
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11
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Leath CA, Nysenbaum J, Ting J, Zhang YJ, Fiori A, Pauly N. Assessing Geographic Variation in Rates of Cervical Cancer and Recurrent or Metastatic Cervical Cancer Among Medicaid Enrollees. Am J Clin Oncol 2023; 46:392-398. [PMID: 37459055 DOI: 10.1097/coc.0000000000001026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate trends in prevalence of cervical cancer (CC) and rates of recurrent or metastatic cervical cancer (r/mCC) treatment initiation at the state and metropolitan statistical area (MSA) levels among Medicaid enrolled females from 2016 to 2019. METHODS Retrospective analyses of nationwide Medicaid claims data were used to identify adult CC and r/mCC patients from 2016 to 2019. CC prevalence was estimated as the proportion of females diagnosed with CC out of all adult female Medicaid beneficiaries, and r/mCC by the proportion of CC patients who initiated a systemic treatment not associated with surgery or radiation to the number of enrollees with CC diagnosis in each state or MSA. Overall and annual rates were calculated for each state and MSA from 2016 to 2019. RESULTS The analytic cohort included 70,865 adult female Medicaid beneficiaries with CC from 2016 to 2019, among whom 3375 were identified as r/mCC patients. Nationwide annual prevalence of CC remained relatively stable from 2016 to 2019, while r/mCC decreased slightly over the study period. Several MSAs experienced increasing rates of r/mCC from 2016 to 2019, including Mayaguez, PR, Aguadeilla-Isabela, PR, and Green Bay, WI. CONCLUSIONS Claims data demonstrate areas in the United States with disproportionately high or increasing CC or r/mCC burden, indicating a potential gap in preventative care for females and an unmet need for education and health care resource allocation. Future research should evaluate associations between community-level factors and r/mCC burden.
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Affiliation(s)
- Charles A Leath
- Division of Gynecologic Oncology, The University of Alabama at Birmingham, Birmingham, AL
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12
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Eskander RN, Sill MW, Beffa L, Moore RG, Hope JM, Musa FB, Mannel R, Shahin MS, Cantuaria GH, Girda E, Mathews C, Kavecansky J, Leath CA, Gien LT, Hinchcliff EM, Lele SB, Landrum LM, Backes F, O'Cearbhaill RE, Al Baghdadi T, Hill EK, Thaker PH, John VS, Welch S, Fader AN, Powell MA, Aghajanian C. Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. N Engl J Med 2023; 388:2159-2170. [PMID: 36972022 PMCID: PMC10351614 DOI: 10.1056/nejmoa2302312] [Citation(s) in RCA: 109] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Standard first-line chemotherapy for endometrial cancer is paclitaxel plus carboplatin. The benefit of adding pembrolizumab to chemotherapy remains unclear. METHODS In this double-blind, placebo-controlled, randomized, phase 3 trial, we assigned 816 patients with measurable disease (stage III or IVA) or stage IVB or recurrent endometrial cancer in a 1:1 ratio to receive pembrolizumab or placebo along with combination therapy with paclitaxel plus carboplatin. The administration of pembrolizumab or placebo was planned in 6 cycles every 3 weeks, followed by up to 14 maintenance cycles every 6 weeks. The patients were stratified into two cohorts according to whether they had mismatch repair-deficient (dMMR) or mismatch repair-proficient (pMMR) disease. Previous adjuvant chemotherapy was permitted if the treatment-free interval was at least 12 months. The primary outcome was progression-free survival in the two cohorts. Interim analyses were scheduled to be triggered after the occurrence of at least 84 events of death or progression in the dMMR cohort and at least 196 events in the pMMR cohort. RESULTS In the 12-month analysis, Kaplan-Meier estimates of progression-free survival in the dMMR cohort were 74% in the pembrolizumab group and 38% in the placebo group (hazard ratio for progression or death, 0.30; 95% confidence interval [CI], 0.19 to 0.48; P<0.001), a 70% difference in relative risk. In the pMMR cohort, median progression-free survival was 13.1 months with pembrolizumab and 8.7 months with placebo (hazard ratio, 0.54; 95% CI, 0.41 to 0.71; P<0.001). Adverse events were as expected for pembrolizumab and combination chemotherapy. CONCLUSIONS In patients with advanced or recurrent endometrial cancer, the addition of pembrolizumab to standard chemotherapy resulted in significantly longer progression-free survival than with chemotherapy alone. (Funded by the National Cancer Institute and others; NRG-GY018 ClinicalTrials.gov number, NCT03914612.).
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Affiliation(s)
- Ramez N Eskander
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Michael W Sill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lindsey Beffa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Richard G Moore
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Joanie M Hope
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Fernanda B Musa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Robert Mannel
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Mark S Shahin
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Guilherme H Cantuaria
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Eugenia Girda
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Cara Mathews
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Juraj Kavecansky
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Charles A Leath
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lilian T Gien
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily M Hinchcliff
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Shashikant B Lele
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lisa M Landrum
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Floor Backes
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Roisin E O'Cearbhaill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Tareq Al Baghdadi
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily K Hill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Premal H Thaker
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Veena S John
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Stephen Welch
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Amanda N Fader
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Matthew A Powell
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Carol Aghajanian
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
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Leath CA, Nysenbaum J, Ting J, Zhang YJ, Fiori A, Pauly N. Patterns of care and health care resource use among Medicaid-enrolled women with recurrent or metastatic cervical cancer. J Manag Care Spec Pharm 2023; 29:490-498. [PMID: 37121257 PMCID: PMC10388006 DOI: 10.18553/jmcp.2023.29.5.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Cervical cancer is a public health challenge and remains a disease with high unmet need. Previous real-world studies demonstrated significant variability in treatments for patients with recurrent or metastatic cervical cancer (r/mCC). A large proportion of patients with cervical cancer are insured through Medicaid; however, previous studies examining treatment patterns for r/mCC have not included Medicaid patients. As the r/mCC treatment landscape continues to evolve, there is a need to understand current real-world unmet need among patients with r/mCC enrolled in Medicaid. OBJECTIVE: To evaluate treatment patterns and health care resource utilization (HCRU) among Medicaid-enrolled women with r/mCC. METHODS: This is a retrospective analysis of nationwide Medicaid claims to assess patient characteristics, treatment patterns, and HCRU among patients with r/mCC between 2016 and 2019. First-line treatment (1L) for r/mCC was defined by the first administration of systemic therapy without concomitant radiation or surgery. Patient characteristics, treatment patterns, and HCRU were characterized by line of therapy. RESULTS: A total of 3,375 eligible adult female patients initiated systemic treatment for r/mCC between 2016 and 2019. Mean age at treatment initiation was 52.9 (SD ± 12.8) years. Nearly 1,300 (1,294, 38.3%) women had evidence of receiving second-line treatment (2L), with nearly one-third (N = 420) of those also having evidence of third-line treatment. The majority (60.5%) of 1L regimens were doublet chemotherapy ± bevacizumab, consistent with treatment guidelines. In contrast, no clear preferred treatment choice was observed among patients receiving 2L or later (2L+) therapy. Notably, immunotherapy accounted for 21.6% of treatment regimens in 2L/3L overall, with its use increasing substantially over time (<6% in 2016 to 40.8% in 2019). Despite increased use of immunotherapy, however, most patients did not remain on treatment for prolonged durations (immunotherapy median duration 2.2 months vs 2.4 months for nonimmunotherapy; P = 0.5). Across most HCRU measures (inpatient admissions, outpatient visits, emergency department visits, and pharmacy claims), 2L+ patients had significantly less utilization per patient compared with 1L patients in unadjusted analyses. CONCLUSIONS: This analysis found that the majority of Medicaid patients with r/mCC received guideline-recommended standard of care in 1L between 2016 and 2019. However, there was no clear standard of care for patients with 2L+ r/mCC enrolled in Medicaid over this time period. Although immunotherapy use is increasing, short durations of treatment suggest a potential unmet medical need among this population. New therapies should provide meaningful clinical benefit without significant increase in HCRU for Medicaid enrollees needing treatment for r/mCC. DISCLOSURES: Dr Leath has received consulting fees from Seagen Inc. for service on Scientific Advisory Boards, cervical cancer research funding from Agenus, Rubius Therapeutics, and Seagen Inc., and funding from the NCI UG1 CA23330 and P50 CA098252. Dr Ting and Dr Zhang are employees and stock owners of Seagen Inc. Mr Fiori and Dr Pauly are current employees and Ms Nysenbaum is a former employee of Manatt Health Strategies, which received funding from Seagen Inc. to conduct the study described here. Manatt Health Strategies has also previously received consulting fees from other pharmaceutical companies that they are not permitted to publicly disclose. This research was funded by Seagen Inc. Seagen Inc. conceptualized the study approach, methodology, and contributed to article writing and review but was not involved in data acquisition, manipulation, or analysis.
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Affiliation(s)
- Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham
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Ahn ER, Rothe M, Mangat PK, Garrett-Mayer E, Ali-Ahmad HM, Chan J, Maitland ML, Patel SR, Reese Z, Balmanoukian AS, Drescher CW, Li R, Tsimberidou AM, Leath CA, O'Lone R, Grantham GN, Halabi S, Schilsky RL. Pertuzumab Plus Trastuzumab in Patients With Endometrial Cancer With ERBB2/3 Amplification, Overexpression, or Mutation: Results From the TAPUR Study. JCO Precis Oncol 2023; 7:e2200609. [PMID: 37027810 DOI: 10.1200/po.22.00609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
PURPOSE The TAPUR Study is a pragmatic basket trial evaluating antitumor activity of commercially available targeted agents in patients with advanced cancers harboring potentially actionable genomic alterations. Data from a cohort of patients with endometrial cancer (EC) with ERBB2 or ERBB3 (ERBB2/3) amplification, overexpression, or mutation treated with pertuzumab plus trastuzumab (P + T) are reported. METHODS Eligible patients had advanced EC, no standard treatment options, measurable disease (RECIST v1.1), Eastern Cooperative Oncology Group performance status 0-2, adequate organ function, and tumors with ERBB2/3 amplification, overexpression, or mutation. Simon's two-stage design was used with a primary end point of disease control (DC), defined as objective response (OR) or stable disease (SD) of at least 16 weeks (SD16+) duration. Secondary end points include safety, duration of response, duration of SD, progression-free survival (PFS), and overall survival (OS). RESULTS Twenty-eight patients were enrolled from March 2017 to November 2019; all patients were evaluable for efficacy and toxicity. Seventeen patients had tumors with ERBB2/3 amplification and/or overexpression, eight with both ERBB2 amplification and ERBB2/3 mutations, and three with only ERBB2 mutations. Ten patients had DC (two partial response and eight SD16+); all 10 had ERBB2 amplification, and 6 of the 10 patients with DC had >1 ERBB2/3 alteration. DC and OR rates were 37% (95% CI, 21 to 50) and 7% (95% CI, 1 to 24), respectively; the median PFS and median OS were 16 weeks (95% CI, 10-28) and 61 weeks (95% CI, 24-105), respectively. One patient experienced a grade 3 serious adverse event (muscle weakness) at least possibly related to P + T. CONCLUSION P + T has antitumor activity in heavily pretreated patients with EC with ERBB2 amplification and warrants additional study.
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Affiliation(s)
- Eugene R Ahn
- Cancer Treatment Centers of America-Chicago, part of City of Hope, Zion, IL
| | - Michael Rothe
- American Society of Clinical Oncology, Alexandria, VA
| | - Pam K Mangat
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - John Chan
- Sutter Cancer Research Consortium, San Francisco, CA
| | - Michael L Maitland
- Inova Schar Cancer Institute, Fairfax, VA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| | - Sapna R Patel
- Cancer Research Consortium of West Michigan, St Joseph, MI
| | | | - Ani S Balmanoukian
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA
| | | | - Rui Li
- Providence Cancer Institute, Providence Portland Medical Center, Portland, OR
| | | | - Charles A Leath
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Raegan O'Lone
- American Society of Clinical Oncology, Alexandria, VA
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Yin X, Davi R, Lamont EB, Thaker PH, Bradley WH, Leath CA, Moore KM, Anwer K, Musso L, Borys N. Historic Clinical Trial External Control Arm Provides Actionable GEN-1 Efficacy Estimate Before a Randomized Trial. JCO Clin Cancer Inform 2023; 7:e2200103. [PMID: 36608308 DOI: 10.1200/cci.22.00103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To inform continued development of the novel immune agent GEN-1, we compared ovarian cancer patients' end points from a neoadjuvant single-arm phase IB study with those of similar historic clinical trial (HCT) patients who received standard neoadjuvant chemotherapy. METHODS Applying OVATION-1 trial (ClinicalTrials.gov identifier: NCT02480374) inclusion and exclusion criteria to Medidata HCT data, we identified historical trial patients for comparison. Integrating patient-level Medidata historic trial data (N = 41) from distinct neoadjuvant ovarian phase I-III trials with patient-level OVATION-1 data (N = 18), we selected Medidata patients with similar baseline characteristics as OVATION-1 patients using propensity score methods to create an external control arm (ECA). RESULTS Fifteen OVATION-1 patients (15 of 18, 83%) were matched to 15 (37%, 15 of 41) Medidata historical trial control patients. Matching attenuated preexisting differences in attributes between the groups. The median progression-free survival time was not reached by the OVATION-1 group and was 15.8 months (interquartile range, 11.40 months to nonestimable) for the ECA. The hazard of progression was 0.53 (95% CI, 0.16 to 1.73), favoring GEN-1 patients. Compared with ECA patients, OVATION-1 patients had more nausea, fatigue, chills, and infusion-related reactions. CONCLUSION Comparing results of a single-arm early-phase trial to those of a rigorously matched HCT ECA yielded insights regarding comparative efficacy prior to a randomized controlled trial. The effect size estimate itself informed both the decision to continue development and the randomized phase II trial (ClinicalTrials.gov identifier: NCT03393884) sample size. The work illustrates the potential of HCT data to inform drug development.
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Affiliation(s)
- Xiang Yin
- Medidata AI, Medidata Solutions, a Dassault Systèmes Company, New York, NY
| | - Ruthanna Davi
- Medidata AI, Medidata Solutions, a Dassault Systèmes Company, New York, NY
| | - Elizabeth B Lamont
- Medidata AI, Medidata Solutions, a Dassault Systèmes Company, New York, NY
| | - Premal H Thaker
- Siteman Cancer Center, Washington University in St Louis School of Medicine, St Louis, MO
| | | | - Charles A Leath
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Kathleen M Moore
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK.,Sarah Cannon Research Institute, Nashville, TN
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Leitao MM, Zhou QC, Brandt B, Iasonos A, Sioulas V, Lavigne Mager K, Shahin M, Bruce S, Black DR, Kay CG, Gandhi M, Qayyum M, Scalici J, Jones NL, Paladugu R, Brown J, Naumann RW, Levine MD, Mendivil A, Lim PC, Kang E, Cantrell LA, Sullivan MW, Martino MA, Kratz MK, Kolev V, Tomita S, Leath CA, Boitano TKL, Doo DW, Feltmate C, Sugrue R, Olawaiye AB, Goldfeld E, Ferguson SE, Suhner J, Abu-Rustum NR. The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol 2022; 166:417-424. [PMID: 35879128 PMCID: PMC9933771 DOI: 10.1016/j.ygyno.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. METHODS This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. RESULTS We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5). CONCLUSION This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America.
| | - Qin C Zhou
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Benny Brandt
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Vasileios Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Katherine Lavigne Mager
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Mark Shahin
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Shaina Bruce
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Destin R Black
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America; Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Carrie G Kay
- Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Meeli Gandhi
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Maira Qayyum
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Jennifer Scalici
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Nathaniel L Jones
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Rajesh Paladugu
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Monica D Levine
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Alberto Mendivil
- Gynecologic Oncology Associates, Hoag Cancer Center, Newport Beach, CA, United States of America
| | - Peter C Lim
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Elizabeth Kang
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Leigh A Cantrell
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Mackenzie W Sullivan
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Martin A Martino
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Melissa K Kratz
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Valentin Kolev
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Shannon Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Charles A Leath
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - David W Doo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Colleen Feltmate
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Ronan Sugrue
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jessa Suhner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai West/Mount Sinai Morningside, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America
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Armstrong DK, Alvarez RD, Backes FJ, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Chen LM, Chitiyo VC, Cristea M, DeRosa M, Eisenhauer EL, Gershenson DM, Gray HJ, Grisham R, Hakam A, Jain A, Karam A, Konecny GE, Leath CA, Leiserowitz G, Liu J, Martin L, Matei D, McHale M, McLean K, Miller DS, Percac-Lima S, Remmenga SW, Schorge J, Stewart D, Thaker PH, Vargas R, Hendrickson AW, Werner TL, Zsiros E, Dwyer MA, Hang L. NCCN Guidelines® Insights: Ovarian Cancer, Version 3.2022. J Natl Compr Canc Netw 2022; 20:972-980. [PMID: 36075393 DOI: 10.6004/jnccn.2022.0047] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years following diagnosis. The NCCN Guidelines for Ovarian Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with ovarian, fallopian tube, and primary peritoneal cancers. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised guidance on alternative chemotherapy regimens for patients with advanced age and/or comorbidities, a new algorithm for recurrent low-grade serous carcinoma based on developing research and novel therapeutic agents, and updated language regarding tumor molecular analysis applications in ovarian cancer.
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Affiliation(s)
| | | | - Floor J Backes
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Heidi J Gray
- University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Joyce Liu
- Dana-Farber/Brigham and Women's Cancer Center
| | - Lainie Martin
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniela Matei
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Premal H Thaker
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Roberto Vargas
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Lisa Hang
- National Comprehensive Cancer Network
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18
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Yin X, Davi R, Lamont EB, Thaker PH, Bradley WH, Leath CA, Moore KM, Anwer K, Musso L, Borys N. Abstract 1025: Phase Ib trial single-arm efficacy estimates via comparison to a historical clinical trial synthetic control arm. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1025] [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: Innovations in data science and trial design have catalyzed novel clinical research methods which may inform the future success of new experimental therapies more efficiently than previously believed. To guide development of the novel immune agent GEN-1, we compared endpoints experienced by patients from a recent neoadjuvant single-arm phase Ib study of GEN-1 plus standard chemotherapy to those of similar historical clinical trial patients in receipt of standard chemotherapy alone.
Methods: To compare safety and efficacy endpoints following first-line neoadjuvant weekly GEN-1 immunotherapy and carboplatin and paclitaxel to standard first-line neoadjuvant carboplatin and paclitaxel in women with advanced ovarian cancer, we first applied key OVATION-1 trial (NCT02480374) inclusion and exclusion criteria to the Medidata Enterprise Data Store (MEDS) data to identify candidate historical clinical trial patients for comparison. We standardized and integrated patient-level MEDS data (N=41) from distinct phase I-III trials (enrollment years 2015-2016) with patient-level OVATION-1 data (N=18). Standard propensity score methods were used to identify MEDS patients who appeared similar to OVATION-1 patients to create a synthetic control arm (SCA).
Results: Fifteen OVATION-1 patients (15/18, 83%) were matched to 15 (37%, 15/41) MEDS historical trial control patients. Matching attenuated pre-existing differences in attributes between the OVATION-1 and MEDS patients. The median progression-free survival time was not reached by the OVATION-1 group and was 15.8 months for the SCA. The hazard of progression for the OVATION-1 group relative to the SCA was 0.53 (95% CI 0.16, 1.73). Fourteen of 15 OVATION-1 patients (93.3%) and 15 of the SCA patients (100%, 15/15) had at least one MedDRA toxicity. Compared to SCA patients, OVATION-1 patients had a slightly higher incidence in nausea (OVATION-1 73.3%; SCA 53.3%), fatigue (OVATION-1 73.3%; SCA 33.3%), anorexia (OVATION-1 46.7%; SCA 13.3%), chills (OVATION-1 26.7%; SCA 6.7%), and infusion-related reaction (OVATION-1 26.7%; SCA 0%).
Conclusions: The comparison of patient endpoints from a single-arm phase Ib trial to a historical clinical trial SCA provided informative and relatively reliable estimates of efficacy endpoints which were used to inform GEN-1’s expected effect study size in the phase II setting. This information led to a decrease in the number of planned patients for the subsequent randomized phase II trial. More broadly, this approach supports the ability of historical clinical trial patient comparisons to inform drug development via trial design, something which may further increase the scientific value of early phase trials.
Citation Format: Xiang Yin, Ruthanna Davi, Elizabeth B. Lamont, Premal H. Thaker, William H. Bradley, Charles A. Leath, Kathleen M. Moore, Khursheed Anwer, Lauren Musso, Nicholas Borys. Phase Ib trial single-arm efficacy estimates via comparison to a historical clinical trial synthetic control arm [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1025.
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Affiliation(s)
- Xiang Yin
- 1Medidata Solutions, a Dassaults Systemes Company, New York, NY
| | - Ruthanna Davi
- 1Medidata Solutions, a Dassaults Systemes Company, New York, NY
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Leath CA, Nysenbaum J, Fiori A, Ting J, Zhang J, Pauly N. Patterns of care in Medicaid-enrollees with recurrent or metastatic cervical cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17525] [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
e17525 Background: Cervical cancer remains a disease with high unmet need, and a large proportion of patients are insured through Medicaid (̃30%). Previous real-world studies demonstrated significant variability in treatments for recurrent or metastatic cervical cancer (r/mCC) patients following doublet chemotherapy ± bevacizumab, despite the 2018 approval of pembrolizumab in PD-L1+ r/mCC. As r/mCC treatment landscape continues to evolve, there is a need to understand current real-world unmet need among Medicaid r/mCC patients. This study aims to evaluate treatment patterns and healthcare resource utilization (HCRU) among Medicaid-insured r/mCC patients. Methods: This is a retrospective analysis of nationwide Medicaid claims to assess patient characteristics, treatment patterns, and HCRU among r/mCC patients between 2016-2019 (most recent Medicaid data available). First line treatment (1L) for r/mCC was identified as the first administration of systemic therapy without concomitant radiation or surgery. Patient characteristics, treatment patterns, and HCRU were characterized by line of therapy. Results: A total of 2,741 adult females initiated systemic treatment for r/mCC between 2016–2019, mean age was 52.8 (SD = 12.8), and most patients were enrolled in comprehensive managed care plans (58%). Over 41% (N = 1,145) had evidence of second line treatment (2L), with over one third (N = 385) of those also having evidence of third line treatment (3L). Consistent with treatment guidelines, the majority (61%) of 1L regimens were doublet chemotherapy ± bevacizumab. In contrast, no clear standard of care was observed among patients receiving 2L or 3L therapy. Notably, immunotherapy accounted for 22% of treatment regimens in 2L/3L overall, with its use increasing significantly over time (< 6% in 2016 to 41% in 2019; p-value < 0.001); however, despite availability of immunotherapy, most patients did not remain on treatment for a prolonged duration (immunotherapy median duration 2.2 months vs. 2.5 months for non-immunotherapy, p-value = 0.9). Across all HCRU measures (inpatient admissions, outpatient visits, emergency visits, and pharmacy claims), 2L/3L patients had less utilization per patient, compared with 1L patients. Conclusions: There was no clear standard of care for 2L+ r/mCC patients enrolled in Medicaid treated between 2016-2019. Although immunotherapy use is increasing, there is still high medical unmet need based on short durations of treatment and poor historical outcomes. New therapies should provide meaningful clinical benefit without significant increase in HCRU.
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20
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Gien LT, Slomovitz BM, Leitao MM, Van Der Zee A, Creutzberg CL, Reyners AK, Witteveen P, Ayala-Peacock D, Mayadev J, Leath CA, Oonk M. Trial in progress: Phase II activity trial of high-dose radiation and chemosensitization in patients with macrometastatic lymph node spread after sentinel node biopsy in vulvar cancer: Groningen International Study on Sentinel Nodes in Vulvar Cancer III (GROINSS-V III/NRG-GY024). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps5624] [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
TPS5624 Background: Early stage invasive squamous cell carcinoma of the vulva is treated by radical excision of the primary tumor combined with a sentinel node (SN) procedure for the groins. GROINSS-VI and GOG-173 demonstrated that if there is no metastasis to the SN, then standard of care is observation. GROINSS-VII/GOG-270 demonstrated that micrometastatic disease (<2mm) to the SN requires standard radiotherapy (50 Gy) without the need for an inguinofemoral lymphadenectomy (IFL). This study also found that patients with macrometastasis ( > 2mm) required IFL in order to have an acceptably low groin recurrence rate. However, IFL is associated with significant morbidity such as lymphedema, wound healing issues, and recurrent infections. It is hypothesized that for those with macrometastasis ( > 2 mm) in the SN, the efficacy of treatment can be increased by giving a higher dose of radiotherapy along with chemosensitization. Methods: This is an international multicenter single-arm phase II prospective clinical trial. The primary objective is to investigate the safety of replacing IFL by chemoradiation in early-stage vulvar cancer patients with a macrometastasis ( > 2mm) and/or extracapsular extension in the SN. The primary endpoint is the groin recurrence rate in the first two years after primary treatment. Secondary endpoints are short and long-term morbidity associated with the SN procedure and chemoradiation and quality of life as measured by EORTC-QLQc30. Patients with invasive ( > 1mm) squamous cell carcinoma of the vulva, stage T1, tumor size < 4 cm diameter and no suspicious lymph nodes by imaging of the groins will proceed with SN detection. Institutions enrolling patients must demonstrate prior surgical experience with SN detection with the submission of at least 10 successfully completed cases in vulvar cancer. Patients with SN metastases > 2mm and/or with extracapsular extension or those with > 1 SN with micrometastases will be eligible for this study. Treatment will consist of chemoradiation with a dose of 56 Gy to the groin combined with weekly cisplatin 40 mg/m2 IV on days 1, 8, 15, 21 and 29 of radiotherapy. One hundred and fifty-seven patients in Europe, United States and Canada will be enrolled. The study includes continuous monitoring of groin recurrences with stopping rules. Results of this trial may be practice changing and eliminate the need for IFL in all women with clinically early stage vulvar cancer. The study is currently open for enrollment. Clinical trial information: NCT05076942.
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Affiliation(s)
| | | | | | | | - Carien L. Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - An K.L Reyners
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Jyoti Mayadev
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Maaike Oonk
- University Medical Center Groningen, Groningen, Netherlands
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21
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Kincaid K, Boitano TKL, Leath CA, Straughn JM. Impact of paclitaxel versus docetaxel on neuropathy in ovarian cancer patients with diabetes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17616] [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
e17616 Background: Peripheral neuropathy is a common side effect of taxanes, particularly in diabetic patients, which can significantly affect quality of life. The objective of this study was to determine whether there was a difference in the incidence of new or worsening neuropathy between diabetic patients with ovarian cancer who received paclitaxel versus docetaxel as part of their primary therapy. Methods: This retrospective cohort study included ovarian cancer patients with Type I or Type II diabetes at a large academic institution who underwent surgery from 6/2016 to 5/2020 and received neoadjuvant and/or adjuvant chemotherapy. Individual chart review was performed to assess patient characteristics including race, body mass index (BMI), performance status (PS), Charlson Comorbidity Index (CCI), baseline hemoglobin A1c, current diabetic medications. The primary outcome was incidence of new or worsening neuropathy during primary therapy including adjuvant or neoadjuvant chemotherapy. New neuropathy was defined as no neuropathy prior to chemotherapy. Worsening neuropathy was defined as baseline neuropathy that worsened after initiation of chemotherapy. Secondary outcomes included chemotherapy treatment delay, increase of diabetic medications during therapy, and a change of chemotherapy regimen from paclitaxel to docetaxel. Statistical analysis was performed using SPSS v. 26. Results: 32 patients met inclusion criteria. Patient demographics including race, PS, BMI and CCI were similar between patients who received paclitaxel and those who received docetaxel. 24 patients (75%) received paclitaxel and 8 (25%) received docetaxel. The majority (93.8%) of patients had Type II diabetes. Patients who received paclitaxel were more likely to develop new or worsening neuropathy (81% v. 50%; p = 0.028) but less likely to require an increase of diabetic medications (0% v. 50%; p = 0.003) compared with patients receiving docetaxel. During primary therapy, 17% of patients were transitioned from paclitaxel to docetaxel due to treatment-related complications (i.e. neuropathy (50%), allergic reaction (50%)). There was no difference in incidence of treatment delays between the two treatment groups (25% v. 25%; p = 1.0). Conclusions: Patients with ovarian cancer who received paclitaxel were more likely to experience new or worsening neuropathy compared to patients who received docetaxel. There was no difference in treatment delays between the groups, but nearly one-fifth of patients receiving paclitaxel had to be transitioned to docetaxel because of treatment-related complications. Because of fewer side-effects, docetaxel is a reasonable chemotherapy alternative in ovarian cancer patients with diabetes.
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22
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Dholakia J, Cohen AC, Leath CA, Evans ET, Alvarez RD, Thaker PH. Development of Delivery Systems for Local Administration of Cytokines/Cytokine Gene-Directed Therapeutics: Modern Oncologic Implications. Curr Oncol Rep 2022; 24:389-397. [PMID: 35141857 PMCID: PMC10466172 DOI: 10.1007/s11912-022-01221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss modern cytokine delivery systems in oncologic care, focusing on modalities being developed in the clinical trials or currently in use. These include pegylation, immune-cytokine drug conjugates, cytokine-expressing plasmid nanoparticles, nonviral cytokine nanoparticles, viral systems, and AcTakines. RECENT FINDINGS Cytokine therapy has the potential to contribute to cancer treatment options by modulating the immune system towards an improved antitumor response and has shown promise both independently and in combination with other immunotherapy agents. Despite promising preliminary studies, systemic toxicities and challenges with administration have limited the impact of unmodified cytokine therapy. In the last decade, novel delivery systems have been developed to address these challenges and facilitate cytokine-based oncologic treatments. Novel delivery systems provide potential solutions to decrease dose-limiting side effects, facilitate administration, and increase the therapeutic activity of cytokine treatments in oncology care. The expanding clinical and translational research in these systems provides an opportunity to augment the armamentarium of immune oncology and may represent the next frontier of cytokine-based immuno-oncology.
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Affiliation(s)
- Jhalak Dholakia
- Department of Obstetrics & Gynecology, University of Alabama Division of Gynecologic Oncology, 1700 6th Avenue South, Room 10250, Birmingham, AL, 35249-7333, USA.
| | - Alexander C Cohen
- Department of Obstetrics & Gynecology, Washington University in St. Louis Division of Gynecologic Oncology, St. Louis, MO, USA
| | - Charles A Leath
- Department of Obstetrics & Gynecology, University of Alabama Division of Gynecologic Oncology, 1700 6th Avenue South, Room 10250, Birmingham, AL, 35249-7333, USA
| | - Elizabeth T Evans
- Department of Obstetrics & Gynecology, University of Alabama Division of Gynecologic Oncology, 1700 6th Avenue South, Room 10250, Birmingham, AL, 35249-7333, USA
| | - Ronald D Alvarez
- Department of Obstetrics & Gynecology, Vanderbilt University Division of Gynecologic Oncology, Nashville, TN, USA
| | - Premal H Thaker
- Department of Obstetrics & Gynecology, Washington University in St. Louis Division of Gynecologic Oncology, St. Louis, MO, USA
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Walsh CS, Leath CA, Mayadev J, Randall LM, Urban R. Cervical cancer – times… they are a changing A report from the Society of Gynecologic Oncology Journal Club. Gynecol Oncol Rep 2022; 40:100949. [PMID: 35359489 PMCID: PMC8961167 DOI: 10.1016/j.gore.2022.100949] [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] [Received: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 10/30/2022] Open
Abstract
In January 2021, the Society of Gynecologic Oncology (SGO) Clinical Practice and Education Committees launched a “Journal Club” webinar series to invite national experts to discuss literature pertaining to common clinical scenarios encountered by the members of SGO. On December 13, 2021, SGO hosted its third journal club focused on the use of immunotherapy in cervical cancer. Charles A. Leath, III from the O’Neal Comprehensive Cancer at the University of Alabama and Leslie M. Randall from Massey Cancer Center at Virginia Commonwealth University discussed the recently published KEYNOTE-826 trial (Colombo et al., 2021) and Jyoti Mayadev from the University of California, San Diego Moores Cancer Center discussed GOG-9929 (Mayadev et al., 2020). Renata Urban from the University of Washington and Christine S. Walsh from the University of Colorado served as moderators. The following is a report of the journal club presentation.
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Boitano TK, Powell MA, Leath CA, Michael Straughn J, Scarinci IC. Barriers and facilitators affecting presentation in women with early versus advanced stage cervical cancer. Gynecol Oncol Rep 2022; 40:100950. [PMID: 35300052 PMCID: PMC8920856 DOI: 10.1016/j.gore.2022.100950] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Structural and intrapersonal barriers to cervical cancer care persist but differ between early and advanced stage patients. Barriers in the early stage group were lack of knowledge, competing priorities, lack of insurance, and embarrassment. Barriers in the advanced stage group were lack of knowledge/risk, competing priorities, avoidance, fear of the healthcare system. Innovative methods to increase access to care and engagement with the healthcare system are needed.
Background This study was performed to evaluate the barriers and facilitators associated with patient presentation for early stage (ES) versus advanced stage (AS) cervical cancer (CC). Methods A mixed-method approach was used to collect quantitative (i.e., demographics and medical/screening histories) and qualitative data (individual interviews assessing patients’ perceptions regarding their general health, HPV and CC screening, and barriers and facilitators to CC care). Two separate investigators coded the interviews for major themes that occurred with an agreement that 50% or more of the themes would be included. Results Twenty-five women agreed to participate in the study with 80% completing the interview. Patients with ES disease were classified as Stage IA1-Stage IB3; patients with Stage IIA-IVB disease were classified with AS disease. Frequent barriers in the ES group were lack of knowledge, competing priorities, feeling healthy, lack of time or health insurance, and being embarrassed/uncomfortable. Frequent barriers in the AS group were lack of knowledge, competing priorities, avoidance/procrastination, fear of the healthcare system or finding something wrong, and lack of perceived risk to CC. Facilitators for ES included understanding the importance of the Pap test, having an abnormal Pap test, and knowing someone with CC. Having abnormal symptoms was the only facilitator for AS patients. Conclusions Structural and intrapersonal barriers to CC care persist but differ between ES and AS patients. Multi-level interventions are needed to address the wide array of issues that women highlighted in this study including potential innovative methods to increase access to care and engagement with the healthcare system.
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Arend RC, Scalise CB, Dholakia J, Kamal MZ, Thigpen HB, Crossman D, Huh WK, Leath CA. Identifying a molecular profile to predict the risk of recurrence in high-intermediate risk endometrial cancer. Cancer Med 2021; 10:8238-8250. [PMID: 34729947 PMCID: PMC8607249 DOI: 10.1002/cam4.4247] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Patients with high‐intermediate risk endometrial cancer (H‐IR EMCA) have an elevated risk of recurrence compared to low‐risk counterparts. Many H‐IR EMCA patients are treated with radiation or chemotherapy, but their overall survival is not significantly impacted by treatment. The objective of this study was to compare molecular profiles of H‐IR EMCA patients with disease recurrence to those without to identify characteristics that could better predict patient outcomes. Methods Tissue was acquired from H‐IR EMCA patients with disease recurrence (n=15) and without disease recurrence (n=15) who had not received adjuvant therapy and performed DNA and RNA analyses. Results In recurrent population, 5 patients had matchingrecurrent and initial tumor tissues. Of note, 5/7 (71%) African Americanpatients had disease recurrence compared to 10/23 (43%) White patients. Inaddition, several new mutations were found in individual patient’s recurrentcompared to initial tumors. Conclusions Currently the treatment ofendometrial cancer is rapidly changing with molecular profiling becoming partof the standard of care. Additionally, it and is being incorporated intoclinical trials in this group of patients. The specific gene mutations and RNAexpression signatures that were observed in our small cohort need to bevalidated in larger cohorts to determine their impact.
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Affiliation(s)
- Rebecca C Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carly B Scalise
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jhalak Dholakia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maahum Z Kamal
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Haley B Thigpen
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - David Crossman
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Boitano TK, Norton SB, Shrestha KS, Smith HJ, Leath CA, Straughn JM. Use of An Opioid Disposal Bag for Leftover Pills in Gynecologic Oncology Patients Undergoing Surgery. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thaker PH, Bradley WH, Leath CA, Gunderson Jackson C, Borys N, Anwer K, Musso L, Matsuzaki J, Bshara W, Odunsi K, Alvarez RD. GEN-1 in Combination with Neoadjuvant Chemotherapy for Patients with Advanced Epithelial Ovarian Cancer: A Phase I Dose-escalation Study. Clin Cancer Res 2021; 27:5536-5545. [PMID: 34326131 PMCID: PMC9338778 DOI: 10.1158/1078-0432.ccr-21-0360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/25/2021] [Accepted: 07/21/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE GEN-1 (phIL-12-005/PPC), an IL12 plasmid formulated with polyethyleneglycol-polyethyleneimine cholesterol lipopolymer, has preclinical activity when combined with platinum-taxane intravenous chemotherapy and administered intraperitoneally in epithelial ovarian cancer (EOC) models. OVATION I was a multicenter, nonrandomized, open-label phase IB trial to evaluate the safety, preliminary antitumor activity, and immunologic response to GEN-1 in combination with neoadjuvant chemotherapy (NACT) carboplatin-paclitaxel in patients with advanced EOC. PATIENTS AND METHODS A total of 18 patients with newly diagnosed stage IIIC and IV EOC were enrolled. A standard 3+3 dose-escalation design tested four GEN-1 doses (36, 47, 61, 79 mg/m2) to determine the maximum tolerated dose and dose-limiting toxicities (DLTs). GEN-1 was administered in eight weekly intraperitoneal infusions starting at cycle 1 week 2 in combination with three 21-day cycles of NACT carboplatin AUC 6 and weekly paclitaxel 80 mg/m2. RESULTS The most common treatment-emergent adverse events at least possibly related were nausea, fatigue, abdominal pain/cramping, anorexia, diarrhea, and vomiting. Eight patients experience grade 4 neutropenia attributed to NACT. No DLTs occurred. A total of 14 patients were evaluable for response and 12 (85.7%) had radiological response (two complete response and 10 partial response) prior to debulking; nine were R0 at debulking and one patient had complete pathologic response. IL12 and its downstream cytokine, IFNγ, increased in peritoneal washings but not as much in blood. Increased levels of myeloid dendritic cells and T-effector memory cells in peritoneal fluid, plus elevated CD8+ T cells and reduced immunosuppression within the tumor microenvironment were found. A median time to treatment failure of 18.4 months (95% confidence interval, 9.2-24.5) was observed in the intention-to-treat population. CONCLUSIONS Adding GEN-1 to standard NACT is safe, appears active, and has an impact on the tumor microenvironment.
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Affiliation(s)
- Premal H Thaker
- Washington University School of Medicine, St. Louis, Missouri.
| | | | - Charles A Leath
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | | - Wiam Bshara
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kunle Odunsi
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Dholakia J, Kim J, Liang MI, Arend RC, Bevis KS, Straughn JM, Leath CA, Huh WK, Smith HJ. Gynecologic oncology patients are ready for telemedicine in routine care: Results from a pre-COVID survey. Gynecol Oncol Rep 2021; 38:100871. [PMID: 34646930 PMCID: PMC8501666 DOI: 10.1016/j.gore.2021.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives To assess telemedicine readiness of gynecologic oncology patients, particularly those at risk for care access disparities (increased distance to care, rural populations.). Methods Patients at all disease/treatment stages completed an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center from 1/6/2020 to 2/28/2020, conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. Results Of 180 patients approached, 170 completed the survey (94.4%). Mean age was 59.6 years; 73.4% identified as White, 23.7% Black, and 2.9% other race. Ovarian cancer was most common (41.2%), followed by endometrial (27.1%), cervical (20.6%), and vaginal/vulvar (7.1%). Most patients traveled > 50 miles for appointments (63.8%); they were more likely from rural counties with significantly higher travel costs/visit ($60.77 vs $37.98, p = 0.026.) The majority expressed interest in using telemedicine (75.7%) or a smartphone app (87.5%) in their care. The majority of patients with difficulty attending appointments (88.9 vs 70.2%, p = 0.02) or from rural counties (88.7% vs 69.6%, p = 0.03) were interested in telemedicine; those with both characteristics reported 100% interest. The majority in both urban and rural counties had home internet access, and reported similarly high rates of daily use (79% vs 75%). Race and age were not associated with differences in internet access or use or telemedicine interest. Conclusions Telemedicine is attractive to the majority of patients and may offer financial/logistical advantages. Patients have high internet use rates and comfort with using technology for healthcare. Telemedicine should be incorporated into standard practice beyond the COVID-19 pandemic to reduce healthcare access disparities.
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Affiliation(s)
- J Dholakia
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - J Kim
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - M I Liang
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - R C Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - K S Bevis
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - J M Straughn
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - C A Leath
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - W K Huh
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - H J Smith
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Arend RC, Goel N, Roane BM, Foxall ME, Dholakia J, Londoño AI, Wall JA, Leath CA, Huh WK. Systematic Next Generation Sequencing is feasible in clinical practice and identifies opportunities for targeted therapy in women with uterine cancer: Results from a prospective cohort study. Gynecol Oncol 2021; 163:85-92. [PMID: 34372972 DOI: 10.1016/j.ygyno.2021.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Both incidence and mortality of uterine cancer are on the rise and mortality is higher for African American women. The aim of our study was to evaluate how Next Generation Sequencing (NGS) may facilitate identification of and intervention for treatment disparities when integrated into clinical workflows. RESULTS Our cohort included 159 uterine cancer patients with recurrent/progressive and newly diagnosed advanced stage and/or high-risk histology. The most common tumor histological subtypes included EEC (n = 67), SEC (n = 34), UCS (n = 20), and mixed (n = 14). Black patients were most likely to present with aggressive histology: (SEC, 34.0%) and carcinosarcoma (UCS, 14.0%). The four most common mutations across all subtypes were TP53, PIK3CA, PTEN, and ARID1A. There was racial disparity between Black versus non-Black patients who were initiated on targeted therapy (28.2% vs. 38.2%, respectively) and clinical trial (15% vs. 22.6%, respectively). Compared to non-Black patients, Black patients had a significantly higher percentage TP53 mutations (p < 0.05) and a significantly lower percentage ARID1A mutations (p < 0.05). CONCLUSIONS NGS for uterine malignancies provides actionable information for targetable mutations and/or clinical trial enrollment in most patients; further investigation is necessary to identify potentially modifiable factors contributing to current disparities that may improve targeted therapy uptake and clinical trial participation.
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Affiliation(s)
- Rebecca C Arend
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America.
| | - Nidhi Goel
- University of Alabama School of Medicine, Birmingham, AL, United States of America
| | - Brandon M Roane
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - McKenzie E Foxall
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Jhalak Dholakia
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Angelina I Londoño
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Jaclyn A Wall
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Charles A Leath
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Warner K Huh
- University of Alabama in Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
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Berton D, Banerjee SN, Curigliano G, Cresta S, Arkenau HT, Abdeddaim C, Kristeleit RS, Redondo A, Leath CA, Antón Torres A, Guo W, Im E, Andre T. Antitumor activity of dostarlimab in patients with mismatch repair-deficient/microsatellite instability–high tumors: A combined analysis of two cohorts in the GARNET study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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
2564 Background: Dostarlimab is an investigational, humanized programmed death 1 (PD-1) receptor monoclonal antibody that blocks interaction with the PD-1 ligands, PD-L1 and PD-L2. GARNET (NCT02715284) is a phase 1 study assessing the antitumor activity and safety of dostarlimab monotherapy in patients with solid tumors. Methods: This multicenter, open-label, single-arm study is being conducted in 2 parts: dose escalation and expansion. Here we report on the 2 expansion cohorts that enrolled mismatch repairdeficient/microsatellite instabilityhigh (dMMR/MSI-H) patients. Cohort A1 enrolled patients with advanced or recurrent dMMR/MSI-H endometrial cancer (EC), and cohort F enrolled patients with advanced or recurrent dMMR/MSI-H or POLε-hypermutated non-EC solid tumors, mainly gastrointestinal (GI) tumors (99 [93.4%] had GI tumors, including 69 [65.1%] with colorectal cancer). Patients received 500 mg IV of dostarlimab every 3 weeks for 4 cycles, then 1000 mg IV every 6 weeks until disease progression or discontinuation. The primary endpoints were objective response rate (ORR) and duration of response (DOR) by RECIST v1.1. Here we report ORR and DOR, by individual cohort and as an overall population, in patients with dMMR tumors identified by immunohistochemistry testing. Results: For this interim analysis, an efficacy analysis was performed for the patients who had baseline measurable disease and ≥6 months of follow-up in the study (N = 209). The ORR was 41.6% (95% CI, 34.9%48.6%) for the combined A1+F dMMR cohorts (Table). Responses were durable, and median DOR has not been reached in either cohort (median follow-up: cohort A1, 16.3 months; cohort F, 12.4 months). A total of 267 patients were included in the safety population (all patients who received ≥1 dose; cohort A1, N = 126; cohort F, N = 141). Treatment-related adverse events (TRAEs) were consistent across tumor types. Overall, the most frequently reported any-grade TRAEs were asthenia (13.9%), diarrhea (13.5%), and fatigue (11.2%). The most common grade ≥3 TRAEs were anemia (2.2%), lipase increased (1.9%), alanine aminotransferase increased (1.1%), and diarrhea (1.1%). No deaths were attributed to dostarlimab. Conclusions: Dostarlimab demonstrated durable antitumor activity in patients with dMMR solid tumors, with consistent antitumor activity seen across endometrial and nonendometrial tumor types. The safety profile was manageable, with no new safety signals detected. Most TRAEs were low grade and were similar across cohorts. Clinical trial information: NCT02715284. [Table: see text]
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Affiliation(s)
- Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Susana N. Banerjee
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, and University of Milano, Milan, Italy
| | - Sara Cresta
- IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | | | | | | | | | - Wei Guo
- GlaxoSmithKline, Waltham, MA
| | | | - Thierry Andre
- Sorbonne University and Saint-Antoine Hospital, Paris, France
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Ali-Ahmad HM, Rothe M, Mangat PK, Garrett-Mayer L, Ahn E, Chan J, Maitland ML, Balmanoukian AS, Patel SR, Reese Z, Drescher CW, Leath CA, Li R, Tsimberidou AM, Schilsky RL. Pertuzumab plus trastuzumab (P+T) in patients (Pts) with uterine cancer (UC) with ERBB2 or ERBB3 amplification, overexpression or mutation: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5508 Background: TAPUR is a phase II basket study evaluating anti-tumor activity of commercially available targeted agents in pts with advanced cancers with genomic alterations. Results in a cohort of UC pts with ERBB2 or ERBB3 amplification , overexpression or mutation treated with P+T are reported. Methods: Eligible pts had advanced UC, no standard treatment options, measurable disease, ECOG PS 0-2, and adequate organ function. Genomic testing was performed in CLIA-certified, CAP-accredited site selected labs. Pts matched to P+T had UC with ERBB2 or ERBB3 amplification or overexpression or a pre-specified ERBB2 mutation. Recommended dosing was P at an initial dose of 840 mg intravenously (IV) over 60 minutes (m), then 420 mg IV over 30-60 m every 3 weeks (wks), and T at an initial dose of 8 mg/kg IV over 90 m, then 6 mg/kg IV over 30-60 m every 3 wks until disease progression. Simon 2-stage design tested the null disease control (DC) - defined as partial (PR), complete response (CR) or stable disease at 16+ weeks (SD 16+) - rate of 15% vs. 35% (power = 0.85; α = 0.10). If ≥2 of 10 pts in stage 1 have DC, 18 more pts are enrolled. If ≥7 of 28 pts have DC, the null DC rate is rejected. Secondary endpoints are progression-free survival (PFS), overall survival (OS) and safety. Results: Twenty-eight female pts were enrolled from August 2017 to November 2019; all pts were evaluable for efficacy and toxicity. Demographics and outcomes are summarized in Table. Twenty-two pts had tumors with ERBB2 amplification (21) or overexpression (1); 4 tumors had ERBB2 mutations; 1 tumor had ERBB3 amplification; 1 tumor had both an ERBB2 amplification and mutation. Two PR and 7 SD16+ were observed in pts with ERBB2 amplification, and 1 SD16+ was observed in a pt with ERBB2 V8421 mutation only (no amplification) for DC and objective response (OR) rates of 37% (95% CI, 21% to 50%) and 7.1% (95% CI, 0.8% to 24%), respectively. One pt experienced grade 3 muscle weakness at least possibly related to P+T. Conclusions: P+T demonstrated evidence of anti-tumor activity in heavily pre-treated UC pts with ERBB2 amplification or certain mutations. Additional study is warranted to confirm the efficacy of P+T in this pt population. Clinical trial information: NCT02693535. [Table: see text]
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Affiliation(s)
| | - Michael Rothe
- American Society of Clinical Oncology, Alexandria, VA
| | - Pam K. Mangat
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Eugene Ahn
- Cancer Treatment Centers of America, Atlanta, GA
| | - John Chan
- Sutter Cancer Research Consortium, San Francisco, CA
| | | | | | - Sapna R. Patel
- Cancer Research Consortium of West Michigan, Grand Rapids, MI
| | | | | | | | - Rui Li
- Providence Health and Services, Portland, OR
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Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Chen LM, Cristea M, DeRosa M, Eisenhauer EL, Gershenson DM, Gray HJ, Grisham R, Hakam A, Jain A, Karam A, Konecny GE, Leath CA, Liu J, Mahdi H, Martin L, Matei D, McHale M, McLean K, Miller DS, O'Malley DM, Percac-Lima S, Ratner E, Remmenga SW, Vargas R, Werner TL, Zsiros E, Burns JL, Engh AM. Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:191-226. [PMID: 33545690 DOI: 10.6004/jnccn.2021.0007] [Citation(s) in RCA: 290] [Impact Index Per Article: 96.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country's fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Lee-May Chen
- 7UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Heidi J Gray
- 12Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | - Joyce Liu
- 19Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Lainie Martin
- 21Abramson Cancer Center at the University of Pennsylvania
| | - Daniela Matei
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - David M O'Malley
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Roberto Vargas
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Boitano TK, Sanders LJ, Gentry ZL, Smith HJ, Leath CA, Xhaja A, Leal L, Todd A, Straughn JM. Decreasing opioid use in postoperative gynecologic oncology patients through a restrictive opioid prescribing algorithm. Gynecol Oncol 2020; 159:773-777. [DOI: 10.1016/j.ygyno.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
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Toboni MD, Cohen AC, Ostby SA, Gentry ZL, Bae S, Leath CA. Characteristics impacting cervical cancer survival in different geographic regions of the United States. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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KL. Boitano T, Smith HJ, Todd A, Leath CA, Straughn JM. Enhanced Recovery Protocol Decreases Complication and Readmission Rates in High-Risk Gynecologic Oncology Patients Undergoing Non-Emergent Laparotomy. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gentry ZL, Wall JA, Ostby SA, Michael Straughn J, Leath CA. Invasive Procedure Use for Symptomatic Ascites and Pleural Effusions Management in Recurrent Epithelial Ovarian Cancer Patients in the Era of Vascular Endothelial Growth Factor (VEGF) Inhibitor Therapy. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Berek JS, Chen LM, Cristea M, DeRosa M, ElNaggar AC, Gershenson DM, Gray HJ, Hakam A, Jain A, Johnston C, Leath CA, Liu J, Mahdi H, Matei D, McHale M, McLean K, O'Malley DM, Penson RT, Percac-Lima S, Ratner E, Remmenga SW, Sabbatini P, Werner TL, Zsiros E, Burns JL, Engh AM. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019. J Natl Compr Canc Netw 2020; 17:896-909. [PMID: 31390583 DOI: 10.6004/jnccn.2019.0039] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years from diagnosis. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. The best outcomes are observed in patients whose primary treatment includes complete resection of all visible disease plus combination platinum-based chemotherapy. Research efforts are focused on primary neoadjuvant treatments that may improve resectability, as well as systemic therapies providing improved long-term survival. These NCCN Guidelines Insights focus on recent updates to neoadjuvant chemotherapy recommendations, including the addition of hyperthermic intraperitoneal chemotherapy, and the role of PARP inhibitors and bevacizumab as maintenance therapy options in select patients who have completed primary chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Adam C ElNaggar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Heidi J Gray
- University of Washington/Seattle Cancer Care Alliance
| | | | | | | | - Charles A Leath
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Joyce Liu
- Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniela Matei
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - David M O'Malley
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Huh WK, Brady WE, Fracasso PM, Dizon DS, Powell MA, Monk BJ, Leath CA, Landrum LM, Tanner EJ, Crane EK, Ueda S, McHale MT, Aghajanian C. Phase II study of axalimogene filolisbac (ADXS-HPV) for platinum-refractory cervical carcinoma: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2020; 158:562-569. [PMID: 32641240 DOI: 10.1016/j.ygyno.2020.06.493] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Women with persistent, recurrent, and/or metastatic cervical cancer have a poor prognosis. Even with the availability of cisplatin plus paclitaxel and bevacizumab, median overall survival (OS) is only 17.0 months, with median post-progression survival of approximately seven months. We studied the therapeutic vaccine, Axalimogene filolisbac (ADXS-HPV), in women who had progressed following at least one prior line of therapy (Gynecologic Oncology Group protocol 265/NCT01266460). METHODS Volunteers ≥18 years with advanced cervical cancer and GOG performance status score of 0 or 1 were eligible for participation in this 2-stage, phase II trial. In stage 1, women received up to three doses of ADXS-HPV (1 × 109 colony-forming units in 250 mL IV over 15 min every 28 days) and were monitored for tumor progression. In stage 2, women were treated until progression, intolerable adverse events (AEs), or voluntary withdrawal of consent. Co-primary endpoints were safety and proportion of volunteers surviving ≥12 months. An estimated, combined (stages 1 + 2) 12-month OS of 35% was calculated from historical GOG cohorts to declare ADXS-HPV sufficiently active in this platinum-pre-treated population. Secondary endpoints were OS and progression-free survival (PFS). RESULTS Among 50 evaluable volunteers, the 12-month OS was 38% (n = 19). Median OS was 6.1 months (95% CI: 4.3-12.1) and median PFS was 2.8 months (95% CI: 2.6-3.0). The most common treatment-related AEs were fatigue, chills, fever, nausea, and anemia. The majority of AEs were grade 1 or 2 and resolved spontaneously or with appropriate treatment. CONCLUSION At the dose and schedule studied, ADXS-HPV immunotherapy was tolerable and met the protocol-specified benchmark for activity required to warrant further investigation in volunteers with cervical carcinoma.
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Affiliation(s)
- Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - William E Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park, Buffalo, NY 14263, United States of America
| | - Paula M Fracasso
- Department of Medicine, University of Virginia, UVA Cancer Center, Charlottesville, VA 22908, United States of America.
| | - Don S Dizon
- Division of Hematology-Oncology, Lifespan Cancer Institute, Rhode Island Hospital, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States of America
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph Hospital, Phoenix, AZ 85016, United States of America.
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - Lisa M Landrum
- Oklahoma University Health Science Center, OB/GYN, Oklahoma City, OK 73104, United States of America.
| | - Edward J Tanner
- Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States of America.
| | - Erin K Crane
- Department of Gynecologic Oncology, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC 28203, United States of America.
| | - Stefanie Ueda
- University of California, San Francisco, OB/GYN & Reproductive Sciences, Division of Gyn Onc., San Francisco, CA 94115, United States of America.
| | - Michael T McHale
- Moores UCSD Cancer Center, La Jolla, CA 92093, United States of America.
| | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Dept. of Medical Oncology, New York, NY 10021, United States of America.
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Yusufaly T, Miller A, Medina-Palomo A, Williamson CW, Nguyen H, Lowenstein J, Leath CA, Xiao Y, Moore KL, Moxley KM, Chevere-Mourino CM, Eng TY, Zaid T, Mell LK. A Multi-atlas Approach for Active Bone Marrow Sparing Radiation Therapy: Implementation in the NRG-GY006 Trial. Int J Radiat Oncol Biol Phys 2020; 108:1240-1247. [PMID: 32629079 DOI: 10.1016/j.ijrobp.2020.06.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Sparing active bone marrow (ABM) can reduce acute hematologic toxicity in patients undergoing chemoradiotherapy for cervical cancer, but ABM segmentation based on positron emission tomography/computed tomography (PET/CT) is costly. We sought to develop an atlas-based ABM segmentation method for implementation in a prospective clinical trial. METHODS AND MATERIALS A multiatlas was built on a training set of 144 patients and validated in 32 patients from the NRG-GY006 clinical trial. ABM for individual patients was defined as the subvolume of pelvic bone greater than the individual mean standardized uptake value on registered 18F-fluorodeoxyglucose PET/CT images. Atlas-based and custom ABM segmentations were compared using the Dice similarity coefficient and mean distance to agreement and used to generate ABM-sparing intensity modulated radiation therapy plans. Dose-volume metrics and normal tissue complication probabilities of the two approaches were compared using linear regression. RESULTS Atlas-based ABM volumes (mean [standard deviation], 548.4 [88.3] cm3) were slightly larger than custom ABM volumes (535.1 [93.2] cm3), with a Dice similarity coefficient of 0.73. Total pelvic bone marrow V20 and Dmean were systematically higher and custom ABM V10 was systematically lower with custom-based plans (slope: 1.021 [95% confidence interval (CI), 1.005-1.037], 1.014 [95% CI, 1.006-1.022], and 0.98 [95% CI, 0.97-0.99], respectively). We found no significant differences between atlas-based and custom-based plans in bowel, rectum, bladder, femoral heads, or target dose-volume metrics. CONCLUSIONS Atlas-based ABM segmentation can reduce pelvic bone marrow dose while achieving comparable target and other normal tissue dosimetry. This approach may allow ABM sparing in settings where PET/CT is unavailable.
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Affiliation(s)
- Tahir Yusufaly
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Austin Miller
- NRG Oncology, Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | - Ana Medina-Palomo
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Casey W Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | | | | | - Charles A Leath
- Department of Gynecologic Oncology, University of Alabama Birmingham, Birmingham, Alabama
| | - Ying Xiao
- Department of Medical Physics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin L Moore
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Katherine M Moxley
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Carlos M Chevere-Mourino
- Radiation Oncology Center, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - Tony Y Eng
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Tarrick Zaid
- TA Methodist Hospital System, Houston Methodist Hospital, Houston, Texas
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
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Beer H, Arquiette J, Londono AI, Foxall M, Leath CA, Arend RC. Abstract A05: Maintenance therapy for platinum-sensitive (PS) recurrent ovarian cancer (rOC): What are we actually choosing? Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.ovca19-a05] [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: Treatment for platinum-sensitive (PS) recurrent ovarian cancer (rOC) patients generally consists of retreatment with platinum-based chemotherapy. Maintenance therapy with a targeted agent can extend the interval before progression. Patients with a somatic or germline BRCA mutation (BRCAm) have a greater clinical benefit with maintenance PARPi compared to BRCA wild-type (BRCAwt). Data have shown that ~50% of patients eligible for maintenance therapy do not receive it and variation in the type of maintenance therapy prescribed (BEV vs. PARPi) exists both nationally and within institutions. The objective of this study was to analyze the utilization of maintenance therapy in PS rOC at a large, high-volume academic institution.
Methods: This retrospective cohort study evaluated PS rOC patients seen at the University of Alabama at Birmingham (UAB) who completed 2nd line or greater platinum-based chemotherapy for 3-8 cycles since March 27, 2017 (date of FDA approval for PARPi maintenance). Medical records on all patients were reviewed from 9/2018-2/2019 to capture a recent representative sample. Percent of patients and what type of maintenance therapy they received after platinum-based treatment were assessed. The difference in BRCA status between these groups was evaluated. Progression-free survival (PFS) was compared between those who received maintenance therapy and those that did not. PFS was defined as the date of initiation of platinum-based chemotherapy until progression of disease or death regardless of whether or not they were on maintenance therapy (based on PFS definition in BEV maintenance phase III clinical trials).
Results: There were 61 PS rOC patients seen during this time period who were eligible for maintenance therapy. 72% received maintenance therapy: 86% (n=38) received PARPi and 14% (n=6) received BEV. PFS following platinum-based chemotherapy with at least one dose of maintenance therapy was 13.4m (6.5-23.6) vs. 11.4m (7.5-27.0) with no maintenance therapy. Germline and somatic BRCA status were known in ~75% of the cases. 60% (9/15) of the patients with a BRCAm (somatic or germline) received maintenance therapy; all patients received a PARPi. PFS in these patients was 17.5m (15.6-19.0) vs. 10.7m (8.0-27.0) with no maintenance therapy.
Conclusions: Consistent with randomized control trials, maintenance therapy prolonged PFS in PS rOC patients, which was more pronounced in BRCAm patients who received a PARPi, although not statistically significant in our small cohort of patients. At our institution, >50% of patients who were eligible for maintenance therapy received it, which is higher than data obtained from national databases. While 30% of the patients did not receive maintenance therapy, this could have been based on a multitude of factors including toxicity, degree of benefit, cost, etc. Only 60% of the patients with known BRCAm received maintenance PARPi, which warrants further investigation into the potential barriers that exist.
Citation Format: Hannah Beer, Jaclyn Arquiette, Angelina I. Londono, Mckenzie Foxall, Charles A. Leath III, Rebecca C. Arend. Maintenance therapy for platinum-sensitive (PS) recurrent ovarian cancer (rOC): What are we actually choosing? [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr A05.
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Affiliation(s)
- Hannah Beer
- University of Alabama at Birmingham, Birmingham, AL
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Goel N, Londono AI, Farrukh N, Beer HM, Roane B, Arquiette J, Huh WK, Leath CA, Arend RC. Abstract A04: Real-world usage of NGS testing in high-grade serous ovarian cancer (HGSOC)—the landscape is quickly changing. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.ovca19-a04] [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
Introduction: The Precision Medicine Initiative (PMI) study at the University of Alabama at Birmingham (UAB) was developed to include next-generation sequencing (NGS) as part of patients’ standard of care and to follow them prospectively. The objective of this study was to analyze how the usage of NGS in patients with high-grade serous ovarian cancer (HGSOC) affected their management.
Methods: Between 5/2015–2/2019, 224 ovarian cancer patients (167 HGSOC) signed informed consent and were enrolled. Archival tissue was sent to Foundation Medicine for NGS analysis; 324 genes, including genes involved in homologous recombination repair deficiency (HRD genes), microsatellite instability (MSI) status, and tumor mutation burden (TMB) were assessed. A subset of these patients were tested for LOH status and PD-L1 expression. Demographics including germline BRCA status, treatments, duration of targeted therapy, and platinum sensitivity were collected. Correlation between LOH status and both germline and somatic mutations in HRD genes was analyzed, in addition to the correlation between PD-L1 positivity and MSI status and TMB.
Results: 62% (103/167) of HGSOC patients had at least 1 targetable mutation and 40 patients received targeted therapy. 16% (27/167) were germline BRCA+ (gBRCAm+), 12 (10%) somatic BRCA + (sBRCAm+), and 120 wtBRCA. Of the gBRCAm+ patients, 81% were platinum sensitive, compared to 66% of all patients. 22% (36/167) of patients underwent LOH testing: 39% (14/36) were LOH-high. 43% (6/14) of LOH-high patients had an alteration in one of the HRD genes. Of the LOH-low patients, 23% (5/22) harbored mutations in HRD genes: (3) BRCA2, (2) CHEK2. 7% (8/114) of platinum-sensitive patients were placed on PARPi maintenance therapy after two or more lines of platinum-based therapy. Of the s/gBRCA+ patients, 24% (11/39) received PARPi monotherapy; 8 received both maintenance PARPi and monotherapy. 33% (13/167) of patients received a non-PARPi targeted therapy based on their NGS testing. Patients on maintenance PARPi received it for an average of 560 days (range 345-890 days), PARPi monotherapy: 254 days (range 30-750 days), and non-PARP targeted therapy: 186 days (range 24- 435 days). PD-L1 staining was completed for 38 patients; 6 patients had a PD-L1 Tumor Proportion Score > 1, although none of the patients were MSI-H or high TMB and none received immunotherapy.
Conclusions: NGS testing potentially affected the treatment of 23.9% of HGSOC patients. Our division has developed a streamlined mechanism for HGSOC patients to undergo routine NGS testing with limited out-of-pocket patient cost regardless of insurance status. Given the recent upfront approval of PARPi maintenance for all HGSOC who are s/gBRCAm+, we have now integrated both germline and somatic testing during front-line therapy. More information will be required to further elucidate how LOH status affects treatment decisions and outcomes for patients.
Citation Format: Nidhi Goel, Angelina I. Londono, Naveed Farrukh, Hannah M. Beer, Brandon Roane, Jaclyn Arquiette, Warner K. Huh, Charles A. Leath III, Rebecca C. Arend. Real-world usage of NGS testing in high-grade serous ovarian cancer (HGSOC)—the landscape is quickly changing [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr A04.
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Affiliation(s)
- Nidhi Goel
- University of Alabama at Birmingham, Birmingham, AL
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Huh WK, Johnson JL, Elliott E, Boone JD, Leath CA, Kovar JL, Kim KH. Fluorescence Imaging of the Ureter in Minimally Invasive Pelvic Surgery. J Minim Invasive Gynecol 2020; 28:332-341.e14. [PMID: 32615331 DOI: 10.1016/j.jmig.2020.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE Determine near-optimal dose, safety, and efficacy of nerindocianine in pelvic ureter detection with near-infrared fluorescence imaging in women undergoing minimally invasive pelvic surgery with 3 Food and Drug Administration-cleared imaging systems. DESIGN Open label, phase 1/2a study. SETTING University of Alabama at Birmingham. PATIENTS Forty-one female subjects undergoing minimally invasive gynecologic surgery. INTERVENTIONS Subjects received a single dose of nerindocianine sodium, starting at 0.06-mg/kg body weight and increased/decreased until the near-optimal dose was determined (part A). Examine the degree of concordance between endoscopic and robotic devices (part B). MEASUREMENTS AND MAIN RESULTS In part A, composite scores were collected every 10 minutes for 30 minutes and then every 15 minutes through 90 minutes using a scale measuring the anatomy/laterality of ureter visualization. In part B (paired imaging system efficacy), 2 cohorts of 8 subjects each received the near-optimal dose. Composite scores for visualization of the ureter were collected at 10 and 30 minutes postinfusion with the Firefly Imaging System and either the PINPOINT or 1588 AIM endoscope. Composite scores were compared to examine the degree of concordance between devices. Part A comprised 25 total subjects enrolled in dosing groups 1, 2, and 3 (0.06-, 0.12-, and 0.045-mg/kg, respectively). Median time to first ureter visualization was 10 minutes (all groups). The nerindocianine 0.06-mg/kg and 0.12-mg/kg groups had longer length of time of visualization than the 0.045-mg/kg group, resulting in the selection of 0.06 mg/kg as the near-optimal dose. Part B enrolled 16 total subjects in 2 groups dosed at 0.06 mg/kg. Efficacy analysis showed no statistically significant difference in composite scores with Firefly versus PINPOINT or 1588 AIM. CONCLUSION Nerindocianine was well tolerated with visualization of the ureter demonstrated in 88.9% of the subjects through 90 minutes postdosing. No meaningful visualization differences were observed among the Food and Drug Administration-cleared surgical imaging systems used.
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Affiliation(s)
- Warner K Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar).
| | - John L Johnson
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Emily Elliott
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Jonathan D Boone
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Joy L Kovar
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
| | - Kenneth H Kim
- Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama (Drs. Kim, Johnson, Leath III, Huh, and Ms. Elliott); Department of Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee (Dr. Boone); Clinical Research and Development, LI-COR, Inc., Lincoln, Nebraska (Ms. Kovar)
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Penson RT, Valencia RV, Cibula D, Colombo N, Leath CA, Bidziński M, Kim JW, Nam JH, Madry R, Hernández C, Mora PAR, Ryu SY, Milenkova T, Lowe ES, Barker L, Scambia G. Olaparib Versus Nonplatinum Chemotherapy in Patients With Platinum-Sensitive Relapsed Ovarian Cancer and a Germline BRCA1/2 Mutation (SOLO3): A Randomized Phase III Trial. J Clin Oncol 2020; 38:1164-1174. [PMID: 32073956 PMCID: PMC7145583 DOI: 10.1200/jco.19.02745] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [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] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A phase II study (ClinicalTrials.gov identifier: NCT00628251) showed activity of olaparib capsules versus pegylated liposomal doxorubicin in patients with germline BRCA-mutated platinum-resistant or partially platinum-sensitive relapsed ovarian cancer. We conducted a phase III trial (SOLO3) of olaparib tablets versus nonplatinum chemotherapy in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer who had received at least 2 prior lines of platinum-based chemotherapy. PATIENTS AND METHODS In this randomized, open-label trial, patients were randomly assigned 2:1 to olaparib 300 mg twice a day or physician's choice single-agent nonplatinum chemotherapy (pegylated liposomal doxorubicin, paclitaxel, gemcitabine, or topotecan). The primary end point was objective response rate (ORR) in the measurable disease analysis set assessed by blinded independent central review (BICR). The key secondary end point was progression-free survival (PFS) assessed by BICR in the intent-to-treat population. RESULTS Of 266 randomly assigned patients, 178 were assigned to olaparib and 88 to chemotherapy. In patients with measurable disease (olaparib, n = 151; chemotherapy, n = 72), the BICR-assessed ORR was significantly higher with olaparib than with chemotherapy (72.2% v 51.4%; odds ratio [OR], 2.53 [95% CI, 1.40 to 4.58]; P = .002). In the subgroup who had received 2 prior lines of treatment, the ORR was 84.6% with olaparib and 61.5% with chemotherapy (OR, 3.44 [95% CI, 1.42 to 8.54]). BICR-assessed PFS also significantly favored olaparib versus chemotherapy (hazard ratio, 0.62 [95% CI, 0.43 to 0.91]; P = .013; median, 13.4 v 9.2 months). Adverse events were consistent with the established safety profiles of olaparib and chemotherapy. CONCLUSION Olaparib resulted in statistically significant and clinically relevant improvements in ORR and PFS compared with nonplatinum chemotherapy in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer who had received at least 2 prior lines of platinum-based chemotherapy.
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Affiliation(s)
- Richard T Penson
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - David Cibula
- First Faculty of Medicine, Charles University and General University, Prague, Czech Republic
| | - Nicoletta Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mariusz Bidziński
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jae-Weon Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | - Radoslaw Madry
- Medical University K. Marcinkowski and Clinical Hospital of the Transfiguration, Poznań, Poland
| | | | - Paulo A R Mora
- Instituto COI de Educação e Pesquisa, Rio de Janeiro, Brazil
| | - Sang Young Ryu
- Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | | | | | | | - Giovanni Scambia
- Università Cattolica del Sacro Cuore-Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
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Abstract
While screening programs and HPV vaccination have decreased the incidence of cervical cancer, still over 13,000 cases occur in the USA annually. Early-stage cervical cancer has an excellent long-term prognosis, with 5-year survival for localized disease being > 90%. Survival decreases markedly for both locally advanced and metastatic disease, and both are associated with a higher risk of recurrence. Few effective treatment options exist for persistent, recurrent, or metastatic cervical cancer. In 2014, the anti-VEGF antibody bevacizumab was approved in combination with chemotherapy based on the results of the Phase III GOG-240 study. As the majority of cervical cancers have a viral etiology, which impairs the immune system, immunotherapy using checkpoint inhibitors and other agents, appears to be a promising approach. In June 2018, the US FDA approved the anti-PD1 antibody pembrolizumab for recurrent or metastatic cervical cancer with PD-L1 expression that progressed after one or more lines of chemotherapy. Another anti-PD1 antibody, cemiplimab also shows potential in this setting, either as monotherapy or combined with radiotherapy, and it is currently being evaluated in a Phase III trial. Additional checkpoint inhibitors including nivolumab, durvalumab, atezolizumab, and camrelizumab are in different stages of clinical development for the disease. Finally, an additional targeted approach being pursued involves PARP inhibitors (rucaparib and olaparib are both in Phase II) based on earlier study results.
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Affiliation(s)
- Alexander C Cohen
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon M Roane
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1700 6th Avenue South, Room 10250, Birmingham, AL, 35249-7333, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1700 6th Avenue South, Room 10250, Birmingham, AL, 35249-7333, USA.
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Coleman RL, Fleming GF, Brady MF, Swisher EM, Steffensen KD, Friedlander M, Okamoto A, Moore KN, Efrat Ben-Baruch N, Werner TL, Cloven NG, Oaknin A, DiSilvestro PA, Morgan MA, Nam JH, Leath CA, Nicum S, Hagemann AR, Littell RD, Cella D, Baron-Hay S, Garcia-Donas J, Mizuno M, Bell-McGuinn K, Sullivan DM, Bach BA, Bhattacharya S, Ratajczak CK, Ansell PJ, Dinh MH, Aghajanian C, Bookman MA. Veliparib with First-Line Chemotherapy and as Maintenance Therapy in Ovarian Cancer. N Engl J Med 2019; 381:2403-2415. [PMID: 31562800 PMCID: PMC6941439 DOI: 10.1056/nejmoa1909707] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data are limited regarding the use of poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitors, such as veliparib, in combination with chemotherapy followed by maintenance as initial treatment in patients with high-grade serous ovarian carcinoma. METHODS In an international, phase 3, placebo-controlled trial, we assessed the efficacy of veliparib added to first-line induction chemotherapy with carboplatin and paclitaxel and continued as maintenance monotherapy in patients with previously untreated stage III or IV high-grade serous ovarian carcinoma. Patients were randomly assigned in a 1:1:1 ratio to receive chemotherapy plus placebo followed by placebo maintenance (control), chemotherapy plus veliparib followed by placebo maintenance (veliparib combination only), or chemotherapy plus veliparib followed by veliparib maintenance (veliparib throughout). Cytoreductive surgery could be performed before initiation or after 3 cycles of trial treatment. Combination chemotherapy was 6 cycles, and maintenance therapy was 30 additional cycles. The primary end point was investigator-assessed progression-free survival in the veliparib-throughout group as compared with the control group, analyzed sequentially in the BRCA-mutation cohort, the cohort with homologous-recombination deficiency (HRD) (which included the BRCA-mutation cohort), and the intention-to-treat population. RESULTS A total of 1140 patients underwent randomization. In the BRCA-mutation cohort, the median progression-free survival was 34.7 months in the veliparib-throughout group and 22.0 months in the control group (hazard ratio for progression or death, 0.44; 95% confidence interval [CI], 0.28 to 0.68; P<0.001); in the HRD cohort, it was 31.9 months and 20.5 months, respectively (hazard ratio, 0.57; 95 CI, 0.43 to 0.76; P<0.001); and in the intention-to-treat population, it was 23.5 months and 17.3 months (hazard ratio, 0.68; 95% CI, 0.56 to 0.83; P<0.001). Veliparib led to a higher incidence of anemia and thrombocytopenia when combined with chemotherapy as well as of nausea and fatigue overall. CONCLUSIONS Across all trial populations, a regimen of carboplatin, paclitaxel, and veliparib induction therapy followed by veliparib maintenance therapy led to significantly longer progression-free survival than carboplatin plus paclitaxel induction therapy alone. The independent value of adding veliparib during induction therapy without veliparib maintenance was less clear. (Funded by AbbVie; VELIA/GOG-3005 ClinicalTrials.gov number, NCT02470585.).
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Affiliation(s)
- Robert L Coleman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Gini F Fleming
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mark F Brady
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Elizabeth M Swisher
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Karina D Steffensen
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Michael Friedlander
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Aikou Okamoto
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Kathleen N Moore
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Noa Efrat Ben-Baruch
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Theresa L Werner
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Noelle G Cloven
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Ana Oaknin
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Paul A DiSilvestro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mark A Morgan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Joo-Hyun Nam
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Charles A Leath
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Shibani Nicum
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Andrea R Hagemann
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Ramey D Littell
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - David Cella
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Sally Baron-Hay
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Jesus Garcia-Donas
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Mika Mizuno
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Katherine Bell-McGuinn
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Danielle M Sullivan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Bruce A Bach
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Sudipta Bhattacharya
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Christine K Ratajczak
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Peter J Ansell
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Minh H Dinh
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Carol Aghajanian
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
| | - Michael A Bookman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C.); University of Chicago Medicine (G.F.F.) and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University (D.C.), Chicago, and AbbVie, North Chicago (D.M.S., B.A.B., S.B., C.K.R., P.J.A., M.H.D.) - all in Illinois; NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, Buffalo (M.F.B.), and Memorial Sloan Kettering Cancer Center, New York (K.B.-M., C.A.) - both in New York; University of Washington-Seattle Cancer Care Alliance, Seattle (E.M.S.); Lillebaelt University Hospital of Southern Denmark, Vejle, and the University of Southern Denmark, Odense (K.D.S.); Prince of Wales Clinical School, University of New South Wales and Royal Hospital for Women (M.F.), and the Northern Cancer Institute (S.B.-H.), Sydney; Jikei University School of Medicine, Tokyo (A. Okamoto), and Aichi Cancer Center Hospital, Nagoya (M.M.) - both in Japan; Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City (K.N.M.); Kaplan Medical Center, Rehovot, Israel (N.E.B.-B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (T.L.W.); Texas Oncology, U.S. Oncology Research Network, Fort Worth (N.G.C.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (A. Oaknin); Women and Infants Hospital, Providence, RI (P.A.D.); Penn Medicine, Philadelphia (M.A.M.); University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-H.N.); O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham (C.A.L.); Oxford University Hospitals, Oxford, United Kingdom (S.N.); Washington University School of Medicine, St. Louis (A.R.H.); Kaiser Permanente Northern California, San Francisco (R.D.L., M.A.B.); and H.M. Hospitales-Centro Integral Oncológico H.M. Clara Campal, Madrid (J.G.-D.)
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Olawaiye AB, Leath CA. Contemporary management of uterine clear cell carcinoma: A Society of Gynecologic Oncology (SGO) review and recommendation. Gynecol Oncol 2019; 155:365-373. [PMID: 31500893 DOI: 10.1016/j.ygyno.2019.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023]
Abstract
Uterine clear cell cancer (UCCC) is a rare but aggressive disease. Due to its rarity, large, prospective studies focused on UCCC are exceedingly difficult therefore available data are generally from small, retrospective studies. There is also pertinent information from subsection analysis of larger studies that include UCCC and other histotypes. In 2009, the clinical practice committee of the Society of Gynecologic Oncology (SGO) published a review on UCCC aimed at guiding management. Since that publication, there have been developments which are relevant to UCCC, these include availability of data from landmark trials regarding adjuvant therapy, increasing utilization of sentinel lymph node approach and availability of immunotherapy as a treatment option. This SGO review is updated with all relevant, published information since 2009 considered clinically important for management of UCCC. In addition, it follows the new SGO's style for this type of publication which includes utilization of the question and answer format.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sc., University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Ostby SA, Smith HJ, Leath CA. Pyridoxine for prevention and treatment of PARP inhibitor induced nausea and vomiting. Gynecol Oncol Rep 2019; 29:123-125. [PMID: 31517011 PMCID: PMC6722232 DOI: 10.1016/j.gore.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
Poly-ADP ribose polymerase inhibitors (PARPi) are a promising new treatment option for patients with ovarian cancer and are moderately emetogenic. Tolerance of therapy is paramount, and uncontrolled nausea and vomiting may limit use. Although most patients will experience improvement in nausea and vomiting after one to two months, approximately one in twenty patients will discontinue therapy due to unrelieved symptom burden. Three cases of olaparib-related nausea and vomiting mitigated by primary pyridoxine use are reported. Case 1 demonstrates successful use of pyridoxine in breakthrough nausea. Case 2 details the use of pyridoxine following refractory nausea and vomiting requiring hospitalization. Case 3 describes a prophylactic approach for a patient with significant anticipatory nausea. All three patients tolerated olaparib after starting and continuing pyridoxine. Vitamin B6, or pyridoxine, was successful as both a therapeutic and prophylactic option for significant treatment-related nausea and vomiting with PARPi use.
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Affiliation(s)
- Stuart A. Ostby
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, USA
| | - Haller J. Smith
- University of Alabama at Birmingham, Division of Gynecologic Oncology, USA
| | - Charles A. Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, USA
- Corresponding author at: University of Alabama at Birmingham, 619 19th Street South, 176F Room 10250, Birmingham, AL 35233, USA.
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Leath CA, Hamilton CA. Assessing recurrence risk following intraperitoneal chemotherapy for ovarian cancer: A day late and a dollar short? Gynecol Oncol Rep 2019; 29:111-112. [PMID: 31467963 PMCID: PMC6710552 DOI: 10.1016/j.gore.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, USA
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Penson RT, Villalobos Valencia R, Cibula D, Colombo N, Leath CA, Bidziński M, Kim JW, Nam JH, Madry R, Hernández CH, Mora PAR, Ryu SY, Milenkova T, Lowe ES, Barker L, Scambia G. Olaparib monotherapy versus (vs) chemotherapy for germline BRCA-mutated (gBRCAm) platinum-sensitive relapsed ovarian cancer (PSR OC) patients (pts): Phase III SOLO3 trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5506] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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
5506 Background: Data from a randomized Phase II trial (NCT00628251) of olaparib (capsules, 200 or 400 mg bid, n=32 per arm) vs pegylated liposomal doxorubicin (PLD, n=33) in gBRCAm OC pts with recurrence ≤12 months after prior platinum therapy indicated efficacy for olaparib (Kaye et al. JCO 2012). However, the efficacy of PLD was higher than previously reported in this setting. We led a confirmatory Phase III, open-label study of olaparib vs non-platinum chemotherapy in gBRCAm PSR OC pts (NCT02282020). Methods: Pts were randomized (2:1) to olaparib tablets (300 mg bid) or chemotherapy treatment of physician’s choice (TPC) (paclitaxel [P; 80 mg/m2 on day 1 (D1), D8, D15, D22 every 4 weeks (q4w)], topotecan [T; 4 mg/m2 D1, D8, D15 q4w], gemcitabine [G; 1000 mg/m2 D1, D8, D15 q4w] or PLD [50 mg/m2 D1 q4w]) until progression, stratified by: TPC, prior lines of chemotherapy (2–3 vs ≥4) and platinum-free interval (6–12 vs >12 months). Primary endpoint: ORR (blinded independent central review [BICR]). Secondary endpoints included PFS and safety. Results: 266 gBRCAm PSR OC pts were randomized (olaparib, n=178; TPC, n=88 [ PLD, n=47; P, n=20; G, n=13; T, n=8]); 12 in the TPC arm withdrew before receiving study treatment. 223 pts (84%) had baseline BICR measurable disease (olaparib, n=151; TPC, n=72). ORR was 72% with olaparib vs 51% with TPC (OR 2.53, 95% CI 1.40–4.58; P=0.002). HR for PFS by BICR was 0.62 (95% CI 0.43–0.91; P=0.013; median 13.4 vs 9.2 months [olaparib vs TPC]) and by investigator assessment was 0.49 (95% CI 0.35–0.70; P<0.001; median 13.2 vs 8.5 months, respectively). Most common adverse events (AEs) with olaparib were nausea (65% vs 34% [TPC]) and anemia (50% vs 25%) and with TPC were palmar-plantar erythrodysesthesia (PPE; 36% vs 1% [olaparib]) and nausea. Most common grade ≥3 AEs in either arm were anemia (21% [olaparib] vs 0 [TPC]), PPE (0 vs 12%) and neutropenia (6% vs 11%). For olaparib vs TPC, serious AEs were reported by 24% vs 18% and AEs led to treatment discontinuation in 7% vs 20%. Conclusions: Pts with gBRCAm PSR OC receiving olaparib monotherapy had a significant, clinically relevant improvement in ORR and PFS vs TPC, with no new safety signals. Clinical trial information: NCT02282020.
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Affiliation(s)
| | | | - David Cibula
- First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | | | - Mariusz Bidziński
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jae-Weon Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Joo-Hyun Nam
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Radoslaw Madry
- Uniwersytet Medyczny im K Marcinkowskiego w Poznaniu and Szpital Kliniczny Przemienienia Pańskiego, Poznań, Poland
| | | | | | - Sang Young Ryu
- Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | | | | | | | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
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Thaker PH, Bradley WH, Leath CA, Gunderson CC, Borys N, Musso L, Anwer K, Alvarez RD. Phase I study of the safety and activity of formulated IL-12 plasmid administered intraperitoneally in combination with neoadjuvant chemotherapy in patients with newly diagnosed advanced-stage ovarian cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2 Background: This study evaluated weekly intraperitoneal (IP) GEN-1, an IL-12 plasmid formulated with polyethyleneglycol-polyethyleneimine-cholesterol lipopolymer, with intravenous (IV) weekly taxane (T) and carboplatinum (C) every 3 weeks in epithelial ovarian, fallopian tube or primary peritoneal cancer (EOC) patients undergoing neoadjuvant therapy (NAC). The primary objective was to evaluate the tolerability and safety of GEN-1 with NAC. Secondary objectives included objective clinical response and pathological response at interval debulking surgery (IDS). Methods: Newly diagnosed EOC patients with no prior therapies were eligible. The trial utilized a 3+3 design with dose escalation in ~30% increments at GEN-1 IP dose levels of 36 mg/m2, 47 mg/m2, 61 mg/m2, and 79 mg/m2 weekly for 8 treatments with concurrent IV T/C. Dose-limiting toxicity (DLT) was based on the first 4 doses of GEN-1 administered. Results: 18 patients were enrolled into the study and 12 of those patients received all 8 treatments with no DLTs. 14 patients underwent IDS. Most common related toxicities were Gr 1 nausea, abdominal pain and fatigue. One patient experienced Gr 2 fevers associated with GEN-1 but responded to acetaminophen and fluids. Conclusions: Adding GEN-1 to T/C is safe and appears to be active in EOC patients receiving NAC. Dose limiting toxicity was not reached and further dose escalation and safety and activity is being evaluated in an ongoing phase I/II study. Clinical trial information: NCT02480374. [Table: see text]
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