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Carlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, Bradt J, Fuller-Shavel N, Goodman J, Hoffman CJ, Huston A, Mehta A, Paller CJ, Richardson K, Seely D, Siwik CJ, Temel JS, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2023; 41:4562-4591. [PMID: 37582238 DOI: 10.1200/jco.23.00857] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chloe Atreya
- University of California San Francisco, San Francisco, CA
| | | | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
| | | | | | | | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY
| | | | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Chelsea J Siwik
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Fidelman N, Atreya C, Griffith M, Milloy A, Carnevale J, Venook A, Van Loon K. Abstract No. 266 Phase I Prospective Trial of TAS-102 (Trifluridine and Tipiracil) and Radioembolization with 90Y Resin Microspheres for Chemo-Refractory Colorectal Liver Metastases. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.331] [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: 02/27/2023] Open
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Dasari A, Morris VK, Allegra CJ, Atreya C, Benson AB, Boland P, Chung K, Copur MS, Corcoran RB, Deming DA, Dwyer A, Diehn M, Eng C, George TJ, Gollub MJ, Goodwin RA, Hamilton SR, Hechtman JF, Hochster H, Hong TS, Innocenti F, Iqbal A, Jacobs SA, Kennecke HF, Lee JJ, Lieu CH, Lenz HJ, Lindwasser OW, Montagut C, Odisio B, Ou FS, Porter L, Raghav K, Schrag D, Scott AJ, Shi Q, Strickler JH, Venook A, Yaeger R, Yothers G, You YN, Zell JA, Kopetz S. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper. Nat Rev Clin Oncol 2020; 17:757-770. [PMID: 32632268 PMCID: PMC7790747 DOI: 10.1038/s41571-020-0392-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chloe Atreya
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Ki Chung
- Division of Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet S Copur
- CHI Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan B Corcoran
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dustin A Deming
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J George
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stanley R Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MD, USA
| | - Federico Innocenti
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Division of Surgery, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburgh, PA, USA
| | - Hagen F Kennecke
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clara Montagut
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fang-Shu Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Porter
- Patient Advocate, NCI Colon Task Force, Boston, MA, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah Schrag
- Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Zell
- Department of Epidemiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sinha S, Greene C, Kelley R, Cinar P, Venook A, Atreya C, Gordan J, Carnevale J, Anwar M, Feng M. Combined Immunotherapy and Hypofractionated Radiotherapy for Metastatic Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Van Blarigan EL, Zhang S, Ou FS, Venlo A, Ng K, Atreya C, Van Loon K, Niedzwiecki D, Giovannucci E, Wolfe EG, Lenz HJ, Innocenti F, O'Neil BH, Shaw JE, Polite BN, Hochster HS, Atkins JN, Goldberg RM, Mayer RJ, Blanke CD, O'Reilly EM, Fuchs CS, Meyerhardt JA. Association of Diet Quality With Survival Among People With Metastatic Colorectal Cancer in the Cancer and Leukemia B and Southwest Oncology Group 80405 Trial. JAMA Netw Open 2020; 3:e2023500. [PMID: 33125497 PMCID: PMC7599454 DOI: 10.1001/jamanetworkopen.2020.23500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/24/2022] Open
Abstract
IMPORTANCE Diet has been associated with survival in patients with stage I to III colorectal cancer, but data on patients with metastatic colorectal cancer are limited. OBJECTIVE To examine the association between diet quality and overall survival among individuals with metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study of patients with metastatic colorectal cancer who were enrolled in the Cancer and Leukemia Group B (Alliance) and Southwest Oncology Group 80405 trial between October 27, 2005, and February 29, 2012, and followed up through January 2018. EXPOSURES Participants completed a validated food frequency questionnaire within 4 weeks after initiation of first-line treatment for metastatic colorectal cancer. Diets were categorized according to the Alternative Healthy Eating Index (AHEI), Alternate Mediterranean Diet (AMED) score, Dietary Approaches to Stop Hypertension (DASH) score, and Western and prudent dietary patterns derived using principal component analysis. Participants were categorized into sex-specific quintiles. MAIN OUTCOMES AND MEASURES Multivariable hazard ratios (HRs) and 95% CIs for overall survival. RESULTS In this cohort study of 1284 individuals with metastatic colorectal cancer, the median age was 59 (interquartile range [IQR]: 51-68) years, median body mass index was 27.2 (IQR, 24.1-31.4), 521 (41%) were female, and 1102 (86%) were White. There were 1100 deaths during a median follow-up of 73 months (IQR, 64-87 months). We observed an inverse association between the AMED score and risk of death (HR quintile 5 vs quintile 1, 0.83; 95% CI, 0.67-1.04; P = .04 for trend), but the point estimates were not statistically significant. None of the other diet scores or patterns were associated with overall survival. CONCLUSIONS AND RELEVANCE In this prospective analysis of patients with metastatic colorectal cancer, diet quality assessed at initiation of first-line treatment for metastatic disease was not associated with overall survival.
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Affiliation(s)
- Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, Massachusetts
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Alan Venlo
- Department of Medicine, University of California, San Francisco
| | - Kimmie Ng
- Dana-Farber/Partners CancerCare, Boston, Massachusetts
| | - Chloe Atreya
- Department of Medicine, University of California, San Francisco
| | | | - Donna Niedzwiecki
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Edward Giovannucci
- Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric G Wolfe
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Heinz-Josef Lenz
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Federico Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy; Department of Medicine-Hematology, University of North Carolina at Chapel Hill
| | - Bert H O'Neil
- Simon Cancer Center, Indiana University School of Medicine, Indianapolis
| | | | - Blase N Polite
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Howard S Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - James N Atkins
- Southeast Clinical Oncology Research Consortium, Winston-Salem, North Carolina
| | | | | | - Charles D Blanke
- SWOG Group Chair's Office, Knight Cancer Institute, Oregon Health & Science University, Portland
| | | | - Charles S Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
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Van Blarigan EL, Kenfield SA, Chan JM, Paciorek A, Zhang L, Chan H, Savoie M, Bocobo AG, Wong LX, Laffan A, Van Loon K, Atreya C, Riberi A, Riberi O, Miaskowski C, Fukuoka Y, Meyerhardt JA, Venook AP. Abstract A18: Feasibility and acceptability of the Survivor Choices for Eating and Drinking (SUCCEED) digital health dietary intervention after colorectal cancer (CRC): A randomized pilot trial. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.modpop19-a18] [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] Open
Abstract
Abstract
Background: Dietary factors after CRC are associated with risk of recurrence and death. Our objective was to develop a digital health intervention to help individuals with CRC adopt healthy dietary habits.
Methods: We conducted an unblinded 12-week (wk) pilot randomized trial to determine the feasibility and acceptability of a web-based dietary intervention with text messaging among individuals with CRC at the University of California, San Francisco. Eligible patients (pts) had colon or rectal adenocarcinoma, were not receiving chemotherapy, were disease-free or had stable disease, were able to speak and read English, and had a mobile phone. We excluded pts meeting ≥4 of the 6 target dietary behaviors. Pts were randomized 1:1 to intervention or control. All pts received print materials on diet after CRC. Pts in the intervention group received 12 wks of access to a website and daily text messaging that recommended ≥5 servings (serv)/day (d) of vegetables, ≥3 serv/d of whole grains, ≥2 serv/wk of fish, ≤2 alcoholic drinks/d for men and ≤1 alcoholic drinks/d for women, and no processed meat or sugar-sweetened beverages. Pts were encouraged to use the website to track intake of target dietary factors. Primary outcomes included feasibility (enrollment, time spent on website, text message response rate) and acceptability (self-administered online questionnaire). Secondarily, we estimated the effect of the intervention on diet using 4-d diet records, body size, blood pressure, and fasting C-reactive protein, hemoglobin A1c, glucose, cholesterol, and triglycerides using linear regression.
Results: We screened 94 pts for eligibility; 75 were eligible and we randomized 50 to intervention (25) or control (25) between April 2017-May 2018. Over the course of the 12-wk study, the intervention arm accessed the website on a median of 2 d [interquartile range (IQR): 1-9 d] and spent a median of 28 min on the site (IQR: 4-51 min). Pts responded to a median of 15/21 text messages that asked for a reply (IQR: 8-20). 22/25 intervention pts completed the feedback survey; 82% were satisfied or very satisfied with the text messages. When asked to rate the quality of the website on a scale from 0-100, the median rating was 72 (IQR: 55-83). Diet records were available at baseline and 12 wks for 23 control and 22 intervention pts. Comparing baseline and 12 wks, intervention pts increased intake of whole grains (0.7 serv/d to 1.6 serv/d) and fatty fish (0 serv/d to 0.4 serv/d); controls did not change intake of whole grains (0.7 and 0.6 serv/d) or fatty fish (0.1 and 0 serv/d). We did not observe changes in either arm for other dietary factors, body size, blood pressure, or circulating markers.
Conclusion: Individuals with CRC participating in a digital health dietary intervention engaged with text messaging more than a study website. The intervention led to changes in certain dietary behaviors. Additional work is needed to find strategies to increase engagement and modify other dietary factors.
Trial Registration: NCT02965521 Funding: 5K07CA197077.
Citation Format: Erin L. Van Blarigan, Stacey A. Kenfield, June M. Chan, Alan Paciorek, Li Zhang, Hilary Chan, Marissa Savoie, Andrea Grace Bocobo, Louis X. Wong, Angela Laffan, Katherine Van Loon, Chloe Atreya, Anthony Riberi, Olivier Riberi, Christine Miaskowski, Yoshimi Fukuoka, Jeffrey A. Meyerhardt, Alan P. Venook. Feasibility and acceptability of the Survivor Choices for Eating and Drinking (SUCCEED) digital health dietary intervention after colorectal cancer (CRC): A randomized pilot trial [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A18.
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Affiliation(s)
| | | | - June M. Chan
- 1University of California, San Francisco, San Francisco, CA,
| | - Alan Paciorek
- 1University of California, San Francisco, San Francisco, CA,
| | - Li Zhang
- 1University of California, San Francisco, San Francisco, CA,
| | - Hilary Chan
- 1University of California, San Francisco, San Francisco, CA,
| | - Marissa Savoie
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Louis X. Wong
- 1University of California, San Francisco, San Francisco, CA,
| | - Angela Laffan
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Chloe Atreya
- 1University of California, San Francisco, San Francisco, CA,
| | - Anthony Riberi
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | - Yoshimi Fukuoka
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Alan P. Venook
- 1University of California, San Francisco, San Francisco, CA,
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Savoie M, Paciorek A, Van Blarigan E, Smith J, Laffan A, Zhang L, Levin A, Kenfield S, Anwar M, Atreya C, Venook A, Van Loon K, Rowen T. 006 Sexual Function in Women after Treatment for Colorectal Cancer and Anal Cancer. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.242] [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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Le D, Kavan P, Kim T, Burge M, Van Cutsem E, Hara H, Boland P, Van Laethem J, Geva R, Taniguchi H, Crocenzi T, Sharma M, Atreya C, Diaz L, Liang L, Marinello P, Dai T, O’Neill B. Safety and antitumor activity of pembrolizumab in patients with advanced microsatellite instability–high (MSI-H) colorectal cancer: KEYNOTE-164. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parikh A, Atreya C, Korn WM, Venook AP. Prolonged Response to HER2-Directed Therapy in a Patient With HER2-Amplified, Rapidly Progressive Metastatic Colorectal Cancer. J Natl Compr Canc Netw 2017; 15:3-8. [PMID: 28040715 PMCID: PMC5564419 DOI: 10.6004/jnccn.2017.0002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/13/2016] [Indexed: 12/21/2022]
Abstract
HER2 gene amplifications and activating mutations in the HER2 receptor tyrosine kinase are present in 4% of metastatic colorectal cancers (mCRCs). HER2-targeted therapy is not standard of care, although preclinical and clinical data suggest that patients with HER2 amplifications and/or HER2-activating mutations may benefit from HER2-directed therapy. HER2 amplifications and activating mutations have also been implicated in resistance to anti-epidermal growth factor receptor-based therapy. This report describes a patient with KRAS, NRAS, and BRAF wild-type mCRC who experienced disease progression on first-line treatment with FOLFIRI and cetuximab after only 5 months, and subsequently experienced progression on second-line treatment with capecitabine and oxaliplatin plus bevacizumab after 2 months with significant functional decline. Next-generation sequencing of the primary tumor identified HER2 amplification, and we were able to obtain trastuzumab-DM1 for off-label use. The patient had symptomatic clinical benefit from trastuzumab-DM1 and had radiographic disease control for 7 months. On progression, therapy was changed to trastuzumab and pertuzumab, but the patient's disease progressed 3 months later. Treatment with the trastuzumab-DM1 resulted in a sustained response that was longer than his prior responses in the first and second lines of treatment, with a dramatic improvement in the patient's functional status. This case represents the first report, to our knowledge, of successful single-agent treatment of HER2-amplifed CRC with trastuzumab-DM1. Clinical trials targeting patients with HER2-mutated and -amplified metastatic colon cancer are currently underway. Molecular insights from investigating HER2 activation and the impact of HER2-directed therapies in a wide variety of solid tumors will create the needed evidence base to more broadly inform patient care.
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Affiliation(s)
- Aparna Parikh
- From University of California San Francisco, Hellen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Chloe Atreya
- From University of California San Francisco, Hellen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - W Michael Korn
- From University of California San Francisco, Hellen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Alan P Venook
- From University of California San Francisco, Hellen Diller Family Comprehensive Cancer Center, San Francisco, California
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Van Cutsem E, Atreya C, André T, Bendell J, Schellens J, Gordon M, McRee A, Yoshino T, Muro K, ODwyer P, Tabernero J, Middleton G, Ducreux M, van Geel R, Sidhu R, Greger J, Rangwala F, Liu Y, Wu Y, Mookerjee B, Corcoran R. LBA-07 Updated Results of the MEK inhibitor trametinib (T), BRAF inhibitor dabrafenib (D), and anti-EGFR antibody panitumumab (P) in patients (pts) with BRAF V600E mutated (BRAFm) metastatic colorectal cancer (mCRC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv262.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fidelman N, Kerlan R, Taylor A, Kolli K, Kohi M, Hawkins R, Pampaloni M, Atreya C, Bergsland E, Kelley R, Ko A, Korn W, Van Loon K, Luan J, McWhirter R, Johanson C, Venook A. Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.511] [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] Open
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Kelley RK, Atreya C, Venook AP, Febbo PG. Predictive Biomarkers in Advance of a Companion Drug: Ahead of Their Time? J Natl Compr Canc Netw 2012; 10:303-9. [DOI: 10.6004/jnccn.2012.0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Martucci WE, Udier-Blagovic M, Atreya C, Babatunde O, Vargo MA, Jorgensen WL, Anderson KS. Novel non-active site inhibitor of Cryptosporidium hominis TS-DHFR identified by a virtual screen. Bioorg Med Chem Lett 2008; 19:418-23. [PMID: 19059777 DOI: 10.1016/j.bmcl.2008.11.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 11/13/2008] [Accepted: 11/17/2008] [Indexed: 11/29/2022]
Abstract
The essential enzyme thymidylate synthase-dihydrofolate reductase (TS-DHFR) is a validated drug target for many pathogens, but has been elusive in Cryptosporidium hominis, as active site inhibitors of the enzymes from related parasitic protozoa show decreased potency and lack of species specificity over the human enzymes. As a rational approach to discover novel inhibitors, we conducted a virtual screen of a non-active site pocket in the DHFR linker region. From this screen, we have identified and characterized a noncompetitive inhibitor, flavin mononucleotide (FMN), with micromolar potency that is selective for ChTS-DHFR versus the human enzymes. These results describe a novel allosteric pocket amenable to inhibitor targeting, and a lead compound with which to move towards potent, selective inhibitors of ChTS-DHFR.
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Affiliation(s)
- W Edward Martucci
- Department of Molecular Biophysics and Biochemistry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Abstract
In the US alone, more than 250,000 people have impaired renal function that necessitates treatment by dialysis. A debilitating complication of long-term treatment is the deposition of beta2-microglobulin (beta2m) as amyloid fibers within the joint space. However, the intrinsic propensity of isolated beta2m protein to initiate in vitro fiber formation is negligible under conditions matched to the neutral pH and ionic conditions of serum. Here, we present evidence for a novel interaction between beta2m and Cu(2+) at a concentration within institutionally recommended limits for this metal ion in dialysate solution. Mass spectrometry, using electrospray ionization from native conditions, demonstrates that the binding of Cu(2+) is specific over Ca(2+) or Zn(2+). Despite maintaining a native-like conformation upon Cu(2+) binding, the folded protein is unusually destabilized against thermal and urea denaturation. We further demonstrate that destabilization by Cu(2+) uniquely promotes de novo fiber formation at 37 degrees C and neutral pH. Since the incidence of amyloidosis is dramatically reduced upon elimination of copper from dialysis membranes, our results provide a molecular understanding for dialysis-associated amyloid formation by beta2m.
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Affiliation(s)
- C J Morgan
- Department of Molecular Biophysics and Biochemistry, Yale University, 260 Whitney Avenue, P.O. Box 208114, New Haven, CT 06520-8114, USA
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