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Teixeira L, Diéras V, Crestani B, Lederlin M, Villanueva C, Duchemann B, Pierga JY, Cadranel J. [Diagnosis and management of interstitial lung disease induced by antibody-drug conjugates in breast cancer: A French expert opinion paper]. Bull Cancer 2023; 110:937-949. [PMID: 37331827 DOI: 10.1016/j.bulcan.2023.04.013] [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: 01/25/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 06/20/2023]
Abstract
Interstitial lung disease (ILD) has been reported with many cancer drugs including some recent antibody-drug conjugates (ADCs). The mechanisms of ILD induced by many chemotherapy drugs, other drug classes and ADCs used in cancer, including breast cancer, are not clearly elucidated. In the absence of specific clinical or radiological signs, the diagnosis of drug-induced ILD is often a diagnosis of exclusion. When present, the most frequent symptoms are respiratory signs (cough, dyspnea, chest pain) and general signs (fatigue, fever). Any suspicion of ILD should be evaluated by imaging and, if in doubt, the CT scan should be evaluated by a pulmonologist and a radiologist. A network of multidisciplinary experts for proactive early management of ILD is important, including oncologist, radiologist, pulmonologist, infectious disease specialist and nurses. Patient education is essential to report new or exacerbated lung symptoms and prevent high-grade ILD. Study drug is discontinued temporarily or permanently according to ILD severity and type of ADC. For asymptomatic cases (Grade 1), the efficacy of corticosteroids is not clearly established; for higher grades, the benefit/risk balance of long-term corticosteroid therapy should be considered for the dose and treatment duration. Hospitalization and oxygen supplementation are required for severe cases (Grades 3-4). For patient follow-up, the expertise of a pulmonologist is necessary with repeated chest scans, spirometry and DLCO. Preventing ADC-induced ILDs and evolution to high grade rests on a network of multidisciplinary experts for assessment of individual risk factors, early management, close follow-up and patient education.
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Affiliation(s)
- Luis Teixeira
- AP-HP, hôpital Saint-Louis, service de sénologie, Inserm U976, HIPI, Paris, France; Université Paris Cité, Paris, France.
| | - Véronique Diéras
- Centre Eugène-Marquis, département d'oncologie médicale, Rennes, France
| | - Bruno Crestani
- Université Paris Cité, Inserm U1152, Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Bichat, département de pneumologie, Paris, France
| | - Mathieu Lederlin
- CHU de Rennes, université de Rennes, département de radiologie, Rennes, France
| | - Cristian Villanueva
- Centre de cancérologie de Montpellier, département d'oncologie médicale, Montpellier, France
| | - Boris Duchemann
- Hôpital Avicenne, département d'oncologie médicale, Bobigny, France
| | - Jean-Yves Pierga
- Institut Curie, département d'oncologie médicale, Paris et Saint-Cloud, France; Université Paris Cité, Paris, France
| | - Jacques Cadranel
- AP-HP Tenon, Sorbonne université, centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et oncologie thoracique, Paris, France
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Loirat D, de la barre MD, Thery JC, Hrab I, Jouannaud C, Mouysset JL, Salabert L, Soibinet P, Mailliez A, Valery R, Creisson A, Villanueva C, Dohollou N, Fumet JD, grellety T, Perez-staub N, Lachaier E, Iltis-roux A, delbado M, Najem A, Scodan RL, Curtit E, aldabbagh K, Pujol P, DE LA MOTTE ROUGE T. Abstract P4-01-20: Phase IV study evaluating talazoparib in patients with locally advanced or metastatic negative HER2 breast cancer and a somatic or germline BRCA1/2 mutation (ViTAL) – Analysis of cohort 1 according to hormonal receptor status. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-20] [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: 03/06/2023]
Abstract
Abstract
Background: Talazoparib (TALA) is a highly potent, dual-mechanism PARP inhibitor that has demonstrated clinical benefit in EMBRACA Phase III trial for patients with germline BRCA1/2 mutated locally advanced or metastatic HER2- breast cancer.
Objective: The aim of the study is to ensure the effectiveness and safety of TALA in real-life setting among patients with locally advanced or metastatic HER2- breast cancer, with somatic or germline BRCA1/2 mutation.
Methods: ViTAL is an ambispective, multicentric, longitudinal, phase IV study. It includes two ambispective cohorts:
- Cohort 1: patients treated through the French Early Access Program and inclusion of patients with somatic BRCA1/2 mutation was allowed.
- Cohort 2: patients treated according to the European Marketing Approval granted in 09/21/2021.
Here we present the results of the primary and some secondary endpoints for cohort 1.
Results: From November 2018 to May 2021, 86 patients were included in Cohort 1, with updated results after a median follow-up of 17.3 months (11.2 - 24.4).
Patients’ characteristics are 53.5% of ER+ BC/46.5% of TNBC (refer to the table).
The median Time to Treatment Discontinuation (mTTD) was 9.0 months [range 6.0; 11.5] with 37.7% of patients still on treatment at 12 months. Subgroup analysis shows similar mTTD according HR status, germline vs somatic mutation and prior platinum exposure (refer to the table).
The Clinical Benefit Rate assessed by the investigators is 82.4% (Complete Response for 25.7%, Partial response R for 32.4% and stable disease for 24.3%).
The median of duration of CNS metastases control was 6.6 months, and 80.0% of patients had control of CNS metastases during TALA.
Out of the 85 treated patients, 69 patients (80,2%) experienced a TALA permanent discontinuation for progressive disease (84.1%), toxicity (10.1%), cancer-related death (1.4%), or other reasons (1.4%).
After discontinuation of TALA, 65.1% of patients received a subsequent treatment with a TTD of 2.3 months [1.7; 2.7]. The most common subsequent treatments were non-platinum chemotherapy (64.3%), platinum chemotherapy (19.6%) and others (19.1%).
At least one adverse events (AEs) was recorded in 74.4% of patients. Hematologic AEs (any grade) occurred in 48.8% (anemia 27.9%, thrombocytopenia 12.8%, neutropenia 10.5%).
Most common non-hematologic AEs were alopecia (8.1%) and asthenia (7.0%). Related Serious Hematologic AEs occurred in 10 patients (11.6%) including 7 (8.1%) Anemia.
Related Serious Non-hematologic AEs (vomiting, pyelonephritis and ascitis) were seen in 3 patients (3.6%). AEs associated with temporary drug interruption, dose modification and permanent drug discontinuation occurred in 36 (41.9%), 24 (27.9%), and 7 (10.1%) patients respectively.
The mOS is expected to be reached at the time of the congress, with 51.9% of patients still alive at 24 months.
Conclusions: ViTAL is the largest study that reports real-word data with TALA. Outcomes and safety in Cohort 1 are consistent with the results of EMBRACA study and give additional data on subgroups of interest (ie patients previously treated with carboplatin, presence of CNS).
(Litton et al. NEJM 2018)
mTTD on subgroups of interest
Patients’ characteristics
Citation Format: Delphine Loirat, Marie Duboys de la barre, Jean-Christophe Thery, Ioana Hrab, Christelle Jouannaud, Jean-Loup Mouysset, Laura Salabert, Pauline Soibinet, Audrey Mailliez, Romain Valery, Anne Creisson, Cristian Villanueva, Nadine Dohollou, Jean-david Fumet, Thomas grellety, Nathalie Perez-staub, Emma Lachaier, Aurore Iltis-roux, Miguel delbado, Abeer Najem, Romuald Le Scodan, Elsa Curtit, kais aldabbagh, Pascal Pujol, thibault DE LA MOTTE ROUGE. Phase IV study evaluating talazoparib in patients with locally advanced or metastatic negative HER2 breast cancer and a somatic or germline BRCA1/2 mutation (ViTAL) – Analysis of cohort 1 according to hormonal receptor status [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-20.
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Affiliation(s)
- Delphine Loirat
- 1Institut Curie, Medical Oncology Department and D3i, Paris, France, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aurore Iltis-roux
- 18Clinique Sainte-Anne, Strasbourg, France, Strasbourg, Alsace, France
| | - Miguel delbado
- 19Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Abeer Najem
- 20Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | | | | | | | - Pascal Pujol
- 24CHU and University of Montpellier, Montpellier, France
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Loirat D, de la barre MD, Villanueva C, Mailliez A, Isambert N, Moreau L, Jacquet E, Spaëth D, Creisson A, Jouannaud C, Legouffe E, delbado M, Deiana L, Soibinet P, Hrab I, grellety T, Dohollou N, Longo R, Thery JC, Fumet JD, Zineb S, Pujol P, DE LA MOTTE ROUGE T. Abstract P4-01-04: Phase IV multicenter study evaluating RWE and the safety of talazoparib in patients with locally advanced or metastatic negative HER2 breast cancer and a BRCA1/2 mutation (ViTAL) - Cohort 2: patients treated according to the EMA. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-04] [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: 03/06/2023]
Abstract
Abstract
Background: Talazoparib (TALA) is a highly potent, dual-mechanism PARP inhibitor that has demonstrated clinical benefit in EMBRACA Phase III trial for patients with germline BRCA1/2 (BRCA1/2)-mutated locally advanced or metastatic HER2- breast cancer. Objective: The aim of the study is to ensure the effectiveness and safety of TALA in the real-world setting among patients with locally advanced or metastatic HER2- breast cancer, with somatic or germline BRCA1/2 mutation. Methods: ViTAL is an ambispective, multicentric, longitudinal, phase IV study. It includes two ambispective cohorts: - Cohort 1: patients treated through the French Early Access Program and inclusion of patients with somatic BRCA1/2 mutation was allowed. - Cohort 2: patients treated according to the European Marketing Approval granted in 09/21/2021. The primary endpoint of the study is the Time to Treatment Discontinuation (TTD) which is defined as time between the date of first dose of TALA and the date of last dose or death. Results: From November 2018 to May 2021, 85 patients were included in Cohort 2, Patients’ characteristics are: - a median age of 49.0 years; - 65.8% ER+ BC/34.2% TNBC; - 42.1% mBRCA1/55.3 % mBRCA2/2,6% mBRCA1 and mBRCA2. - 85.7% ECOG PS 0 or 1; - 23.4% de novo mBC. - Visceral, bones and CNS metastases were found in 59.0%, 61.5% and 10.3% of patients respectively. - No breast or ovarian cancer family history at 1st degree was found in 39 patients (50.0%). - 38.5% were chemo-naïve; - 21.8% received prior platinum in (neo)adjuvant or metastatic setting, with a median of prior cytotoxic regimen of 1 - For patients with ER+/HER2- ABC the median number of prior endocrine therapy was 1 and 62.0% of these patients received a CDK4/6 inhibitor prior to TALA. - 8 patients (10.3%) had CNS metastases. Out of the 78 treated patients, 57 patients (73.0%) experienced a TALA permanent discontinuation for Progressive disease (80.7%), toxicity (12.3%), cancer-related death (1.8%), or other reasons (1.8%). The median TTD for TALA is 9.6 months [6.7;10.8] with 34.5% of patients still on treatment at 12 months. After discontinuation of TALA, 59.0% of patients received a subsequent treatment with a TTD of 3.9 months [2.1; 45]. The most common subsequent treatments were non-platinum chemotherapy (67.4%), platinum therapy (6.5%) and other (26.1%). The Clinical Benefit Rate assessed by the investigators is 87.6% (Complete Response for 14.1%, Partial Response for 56.3% and Stable Disease for 17.2%). The median duration of CNS metastases control was 10.2 months, and 25.0% of patients had a control of CNS metastases. At least one adverse events (AEs) was recorded in 67.9% of patients. Hematologic adverse events (AEs) (any grade) occurred in 55.1% (anemia 37.2%, thrombocytopenia 16.7%, neutropenia 15.4%). Most common non-hematologic AEs were Nausea (15.4%) and asthenia (15.4%). Related Serious Hematologic AEs occurred in 6 patients (7.7%) including 3 (3.8%) thrombocytopenia and 3 (3.8%) anemia. Related Serious Non-hematologic AEs (metrorrhagia) were seen in 1 patient (1.3%). AEs associated with temporary drug interruption, dose modification and permanent drug discontinuation occurred in 26 (33.3%), 22 (28.2%), and 7 (12.3%) patients respectively. The mOS is not mature for this analysis. Conclusions: ViTAL is the largest study that reports real-word data with TALA. Outcomes and safety in Cohort 2 (patients treated with TALA according to the European Marketing Approval), are consistent with the results of EMBRACA study and with the Cohort 1. (Litton et al. NEJM 2018)
Citation Format: Delphine Loirat, Marie Duboys de la barre, Cristian Villanueva, Audrey Mailliez, Nicolas Isambert, Lionel Moreau, Emmanuelle Jacquet, Dominique Spaëth, Anne Creisson, Christelle Jouannaud, Eric Legouffe, Miguel delbado, Laura Deiana, Pauline Soibinet, Ioana Hrab, Thomas grellety, Nadine Dohollou, Raffaele Longo, Jean-Christophe Thery, Jean-david Fumet, Sellam Zineb, Pascal Pujol, thibault DE LA MOTTE ROUGE. Phase IV multicenter study evaluating RWE and the safety of talazoparib in patients with locally advanced or metastatic negative HER2 breast cancer and a BRCA1/2 mutation (ViTAL) - Cohort 2: patients treated according to the EMA [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-04.
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Affiliation(s)
- Delphine Loirat
- 1Institut Curie, Medical Oncology Department and D3i, Paris, France, Paris, France
| | | | | | | | | | | | | | | | | | | | | | - Miguel delbado
- 12Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | | | | | - Ioana Hrab
- 15Centre François Baclesse, Caen, France
| | | | | | | | | | | | | | - Pascal Pujol
- 22CHU and University of Montpellier, Montpellier, France
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Pivot X, Manikhas AG, Shamrai V, Dzagnidze G, Soo Hoo HF, Kaewkangsadan V, Petrelli F, Villanueva C, Kim J, Pradhan S, Jaison L, Feyaerts P, Kaufman L, Derde MP, Deforce F, Cox DG. Final analysis of the phase 3 randomized clinical trial comparing HD201 vs. referent trastuzumab in patients with ERBB2-positive breast cancer treated in the neoadjuvant setting. BMC Cancer 2023; 23:112. [PMID: 36721174 PMCID: PMC9890819 DOI: 10.1186/s12885-023-10574-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The TROIKA trial established that HD201 and trastuzumab were equivalent in terms of primary endpoints (total pathological complete response) following neoadjuvant treatment. The objective of the present analysis was to compare survival outcomes and final safety. METHODS In the TROIKA trial, patients with ERBB2-positive early breast cancer were randomized and treated with either HD201 or the referent trastuzumab. Eligible patients received 8 cycles of either HD201 or referent trastuzumab (loading dose, 8 mg/kg; maintenance dose, 6 mg/kg) every 3 weeks in combination with 8 cycles of chemotherapy (4 cycles of docetaxel, 75 mg/m2, followed by 4 cycles of epirubicin, 75 mg/m2, and cyclophosphamide, 500 mg/m2) in the neoadjuvant setting. The patients then underwent surgery followed by 10 cycles of adjuvant HD201 or referent trastuzumab according to their initial randomization to complete one year of trastuzumab-directed therapy. Event-free and overall survival rates were calculated using Kaplan-Meier analysis. The hazard ratio for event-free survival was estimated by Cox proportional hazards regression. RESULTS The final analysis was performed after all patients completed the study at a median follow-up of 37.7 months (Q1-Q3, 37.3-38.1 months). A total of 502 randomized patients received either HD201 or the referent trastuzumab, and 474 (94.2%) were eligible for inclusion in the per-protocol set. In this population, the 3-year event-free survival rates were 85.6% (95% CI: 80.28-89.52) and 84.9% (95% CI: 79.54-88.88) in the HD201 and referent trastuzumab groups, respectively (log rank p = 0.938) (HR 1.02, 95% CI: 0.63-1.63; p = 0.945). The 3-year overall survival rates were comparable between the HD201 (95.6%; 95% CI: 91.90-97.59) and referent trastuzumab treatment groups (96.0%, 95% CI: 92.45-97.90) (log rank p = 0.606). During the posttreatment follow-up period, adverse events were reported for 64 (27.4%) and 72 (29.8%) patients in the HD201 and the reference trastuzumab groups, respectively. Serious adverse events were rare and none of which were related to the study treatment. CONCLUSIONS This final analysis of the TROIKA trial further confirms the comparable efficacy and safety of HD201 and trastuzumab. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03013504.
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Affiliation(s)
- Xavier Pivot
- Institute of Cancer Strasbourg, 17 Rue Albert Calmette, 67033 Strasbourg, France
| | | | - Volodymyr Shamrai
- Vinnytsia Regional Clinical Oncological Dispensary, Vinnytsia, Ukraine
| | | | - Hwoei Fen Soo Hoo
- grid.412516.50000 0004 0621 7139Penang General Hospital, Penang Island, Malaysia
| | - Viriya Kaewkangsadan
- grid.414965.b0000 0004 0576 1212Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Bergamo, Trevigilio Italy
| | - Cristian Villanueva
- grid.477174.60000 0004 0598 9639Clinique Clementville, Montpellier, Montpellier, France
| | - Jamie Kim
- Prestige BioPharma Ltd, Singapore, Singapore
| | | | | | | | | | | | | | - David G. Cox
- Institute of Cancer Strasbourg, 17 Rue Albert Calmette, 67033 Strasbourg, France
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Pivot X, Manikhas A, Shamrai V, Dzagnidze G, Soo H, Kaewkangsadan V, Petrelli F, Villanueva C, Kim J, Pradhan S, Jaison L, Feyaerts P, Kaufman L, Derde MP, Deforce F, Cox D. 2MO Final analysis of the phase III randomized clinical trial, comparing HD201 vs referent trastuzumab in patients with ERBB2-positive breast cancer treated in the neoadjuvant setting. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.009] [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: 12/07/2022] Open
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Pivot X, Georgievich MA, Shamrai V, Dzagnidze G, Soo Hoo HF, Kaewkangsadan V, Petrelli F, Villanueva C, Nikolaevich LO, Hii J, Kim J, Pradhan S, Jaison L, Feyaerts P, Kaufman L, Derde MP, Bonamy GMC, Deforce F, Cox DG. Efficacy of HD201 vs Referent Trastuzumab in Patients With ERBB2-Positive Breast Cancer Treated in the Neoadjuvant Setting: A Multicenter Phase 3 Randomized Clinical Trial. JAMA Oncol 2022; 8:698-705. [PMID: 35238873 PMCID: PMC8895313 DOI: 10.1001/jamaoncol.2021.8171] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022]
Abstract
Importance The drug HD201 is a biosimilar candidate for breast cancer treatment as the reference trastuzumab. Objective To compare the efficacy of HD201 with referent trastuzumab. Design, Setting, and Participants This randomized clinical trial (TROIKA) included 502 women with ERBB2-positive early breast cancer treated with either HD201 or referent trastuzumab. It was conducted across 70 centers in 12 countries, including Western and Eastern Europe and Asian countries. Randomization was stratified by tumor hormone receptor status, clinical stage, and geographic region of recruitment. This analysis was conducted on February 12, 2021, after the completion of the adjuvant phase at a median of 31 months (IQR, 28-33 months) of follow-up. Interventions Patients with ERBB2-positive early breast cancer were randomly assigned to receive HD201 or referent trastuzumab in the neoadjuvant setting for 8 cycles, concurrently with 4 cycles of docetaxel, which was followed by 4 cycles of epirubicin and cyclophosphamide. Patients then underwent surgery, which was followed by treatment with 10 cycles of adjuvant HD201 or referent trastuzumab. Main Outcome and Measures The primary end point was the total pathological complete response (tpCR) assessed after neoadjuvant treatment. Equivalence was concluded if the 95% CI of the absolute difference in tpCR between arms in the per-protocol set was within the margin of more or less than 15%. Other objectives included the breast pathological complete response, overall response, event-free and overall survival, safety, pharmacokinetics, and immunogenicity. Results A total of 502 female patients (mean [range] age, 53 [26-82] years) were randomized to receive either HD201 or referent trastuzumab, and 474 (94.2%) were eligible for inclusion in the per-protocol set. The baseline characteristics were well balanced between the 2 arms; 195 tumors (38.8%) were hormone receptor-negative , and 213 patients (42.4%) had clinical stage III disease. The tpCR rates were 45% and 48.7% for HD201 and referent trastuzumab, respectively. The difference between the 2 groups was not significant at -3.8% (95% CI, -12.8% to 5.4%) and fell within the predefined equivalence margins. The ratio of the tpCR rates between the 2 arms was 0.92 (95% CI, 0.76 to 1.12). A total of 433 patients (86.1%) presented with 2232 treatment-emergent adverse events of special interest for trastuzumab during the entire treatment period, with 220 (88.0%) and 213 (84.5%) patients in the HD201 and referent trastuzumab groups, respectively. Conclusions and Relevance The results of this randomized clinical trial found that HD201 demonstrated equivalence to referent trastuzumab in terms of efficacy for the end point of tpCR, with a similar safety profile. Trial Registration ClinicalTrials.gov Identifier: NCT03013504.
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Affiliation(s)
- Xavier Pivot
- Institute of Cancer Strasbourg, Strasbourg, France
| | - M. A. Georgievich
- St Petersburg GBUZ City Clinical Oncology Dispensary, St Petersburg, Russia
| | - Volodymyr Shamrai
- Vinnytsia Regional Clinical Oncological Dispensary, Vinnytsia, Ukraine
| | | | | | | | - Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Trevigilio, Bergamo, Italy
| | | | - Lipatov O. Nikolaevich
- Republican Clinical Oncology Dispensary of Ministry of Health Bashkortostan Republic, Republic of Russia
| | | | | | | | | | | | | | | | | | | | - David G. Cox
- Institute of Cancer Strasbourg, Strasbourg, France
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Ziegelmann M, Winkelman A, Holler J, Breyer B, Herndon A, Villanueva C, Kern N. Adult Patient's Opinions on Surgical Correction of Congenital Penile Curvature. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loirat D, de Labarre MD, Essner C, Hrab I, Thery JC, Jouannaud C, Villanueva C, Vuagnat P, Soibinet-Oudot P, Creisson A, Mailliez A, Mouysset JL, Salabert L, Dohollou N, Fumet JD, De La Motte Rouge T, Vauthier JM, Decrop M, Pujol P. Abstract P1-18-28: Phase IV study evaluating effectiveness and safety of talazoparib in patients with locally advanced or metastatic HER2 negative breast cancer and a BRCA1 or BRCA2 mutation (ViTAL). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-28] [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: Talazoparib (TALA) is a highly potent PARP inhibitor that has demonstrated clinical benefit in the phase III EMBRACA trial for patients with germline BRCA1 or BRCA2-mutation and a locally advanced or metastatic HER2 negative (HER2-) breast cancer (BC). Methods: ViTAL is an ambispective, multi-center longitudinal, phase IV study that aims to ensure the effectiveness and safety of TALA in the real-world setting among patients with locally advanced or metastatic HER2- BC, with somatic or germline BRCA mutation (sBRCA or gBRCA). This study includes two cohorts: - Cohort 1: patients treated through the French Early Access Program from November 2018 to September 2019. Inclusion of patients with sBRCA mutation was allowed. - Cohort 2: patients treated according to the European Marketing Approval granted 21/09/2021. The primary endpoint is Time to Treatment Discontinuation (TTD) for TALA defined as Time between the date of first dose of TALA and the date of last dose or death. Results: We present the results of Cohort 1 in which includes 85 patients. Patients’ characteristics are as follows: median age 50 years; 46% triple negative BC and 54% ER+ BC; 47% BRCA1-mutated and 53% BRCA2-mutated; 94% gBRCA and 6% sBRCA; 95% ECOG PS 0 or 1; 31% premenopausal status; 40% de novo metastatic BC (mBC). Visceral, bones and central nervous system metastases were found in 61%, 54% and 11% of patients, respectively. No breast or ovarian cancer in first degree relative was found in 35 patients (41%). The median number of prior cytotoxic regimen was 2, 15% were chemo-naïve for mBC; 35% received prior platinum in the neoadjuvant, adjuvant or metastatic setting. For patients with ER+/HER2- mBC the median number of prior endocrine therapy was 2 and 74% of these patients received a CDK4/6 inhibitor prior to TALA. The median follow-up was 17.4 months [range 15.7-20.5]. Of 85 treated patients, 66 patients (78%) experienced permanent discontinuation of TALA due to progressive disease (88%), toxicity (8%), cancer-related death (3%), or other reasons (1.5%). The median TTD for TALA was 9.0 months [range 6.0-11.0] with 35% of patients still in under treatment at 12 months. At least one adverse event (AEs) was recorded in 71% of patients. Hematologic AEs (any grade) occurred in 44% of patients (anemia for 26%, thrombocytopenia for 9%, neutropenia for 8%). The most common non-hematologic AEs were alopecia (6%) and asthenia (5%). Related serious hematologic AEs occurred in 7 (8%) patients including 6 (7%) with anemia. Related serious non-hematologic AEs (vomiting, pyelonephritis) were seen in 2 patients (2%). AEs associated with temporary drug interruption, dose modification and permanent drug discontinuation occurred in 32 (38%), 16 (19%), and 5 (8%) patients respectively. After discontinuation of TALA, 83% of patients received a subsequent treatment with a TTD of 2.4 months [range 1.7-3.3]. The most common subsequent treatments were non-platinum chemotherapy (64%) and platinum therapy (24%). Conclusions: The TTD of 9 months is consistent with the outcomes and safety results of the EMBRACA study. ViTAL, the first real-word study with TALA confirms its interest in locally advanced or metastatic HER2- BC. Analysis of Cohort 2 will occur when data are mature. (Ref Litton JK, Rugo HR, Ellt J et al. Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation. N Engl J Med. 2018; 379:753-763.
Citation Format: Delphine Loirat, Marie Duboys de Labarre, Christine Essner, Ioana Hrab, Jean-Christophe Thery, Christelle Jouannaud, Cristian Villanueva, Perrine Vuagnat, Pauline Soibinet-Oudot, Anne Creisson, Audrey Mailliez, Jean-Loup Mouysset, Laura Salabert, Nadine Dohollou, Jean-David Fumet, Thibault De La Motte Rouge, Jean-Michel Vauthier, Maylis Decrop, Pascal Pujol. Phase IV study evaluating effectiveness and safety of talazoparib in patients with locally advanced or metastatic HER2 negative breast cancer and a BRCA1 or BRCA2 mutation (ViTAL) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-28.
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De Laurentiis M, Lambertini M, Chia S, Rugo HS, Petrakova K, Villanueva C, Hurvitz S, Beck JT, Lteif A, Haftchenary S, Deore U, Wu J, El-Saghir N. Abstract P1-18-11: Analysis of first-line (1L) patients (pts) with de novo disease vs late relapse and all pts with vs without prior chemotherapy (CT) in the MONALEESA-3 (ML-3) trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-11] [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: The phase 3 ML-3 trial demonstrated significant OS benefit for ribociclib (RIB) + fulvestrant (FUL) over placebo (PBO) + FUL as first- or second- line therapy in postmenopausal pts with HR+/HER2- advanced breast cancer (ABC). Prior treatment ([neo]adjuvant or advanced setting) may impact subsequent therapy outcomes, including OS; therefore, understanding the potential effect of prior treatment is of high clinical interest. Here, we present PFS and OS data from 2 subgroup analyses in ML-3: 1L pts with de novo disease vs late relapse and all pts with vs without prior CT. Methods: ML-3 (NCT02422615) enrolled postmenopausal pts who were randomized 2:1 to receive RIB + FUL or PBO + FUL. Pts with prior ET ([neo]adjuvant or ≤1 prior ET for ABC) and no CT for ABC were included. Pts with de novo disease were defined as initially diagnosed as ABC with no prior treatment for ABC. Pts with late relapse were defined as those who relapsed >12 months from completion of (neo)adjuvant ET with no prior treatment for ABC. Since prior CT for ABC was not allowed in ML-3, the prior CT analysis compares pts with prior (neo)adjuvant CT vs those without prior (neo)adjuvant CT. Results: The data cutoff was October 30, 2020. Within the 1L population, in the de novo vs late relapse analysis, 132 pts (RIB: n = 91; PBO: n = 41) had de novo disease, and 153 had late relapse (RIB: n = 98; PBO: n = 55). Baseline characteristics were generally balanced between the de novo and late relapse groups, with some notable exceptions: a higher proportion of pts with de novo disease were aged <65 years (52.3% vs 41.8%) and a lower proportion had visceral disease (53.0% vs 63.4%). In the late relapse group, 70.6% had prior (neo)adjuvant CT. De novo disease or late relapse did not appear to be prognostic as both PFS and OS were generally comparable between those 2 groups among pts treated with RIB or those treated with PBO (Table). Treatment with RIB + FUL demonstrated consistent PFS and OS benefits over PBO + FUL in both pts with de novo disease and those with late relapse. In the prior CT analysis, 391 pts (RIB: n = 265; PBO: n = 126) had prior CT (41.4% in 1L and 55.5% in 2L/early relapse [3.1% data missing]) and 334 (RIB: n = 219; PBO: n = 115) had no prior CT (60.8% in 1L, 38.9% in 2L/early relapse [0.3% data missing]). Baseline characteristics were generally balanced between pts with and without prior CT, with some exceptions: a higher proportion of pts with prior CT were aged <65 years (62.1% vs 42.8%) and had prior ET in any setting (86.4% vs 53.0%). Pts without prior CT had longer median PFS and OS compared with those who had prior CT in both the RIB and PBO arms (OS without vs with prior CT treated with RIB: HR, 0.68 [95% CI, 0.52-0.89]; PBO: HR, 0.72 [95% CI, 0.52-1.00]). Treatment with RIB + FUL demonstrated consistent PFS and OS benefits over PBO + FUL in both pts with prior CT and those without (OS for RIB vs PBO with prior CT: HR, 0.76 [95% CI, 0.58-1.01]; without prior CT: HR, 0.70 [95% CI, 0.50-0.97]). Conclusions: This exploratory analysis demonstrated that metastatic presentation (de novo vs late relapse) was not prognostic for disease outcomes; however, prior CT exposure, even in (neo)adjuvant, was associated with poorer PFS and OS. The addition of RIB showed consistent PFS and OS benefit across all subgroups in this analysis. Particularly, the addition of RIB resulted in a consistent and clinically meaningful PFS and OS benefit with a decrease in relative risk of death by 24% in pts with prior exposure to CT.
RIB + FULPBO + FULHR (RIB vs PBO)De novo/late relapseMedian PFS (95% CI), monthsDe novo35.6. (27.1-42.0)22.1. (14.6-33.1)0.55. (0.35-0.86)Late relapse35.8. (20.0-44.4)22.0. (16.5-27.7)0.60. (0.40-0.89)HR (de novo vs late elapse)0.93. (0.64-1.36)0.996. (0.63-1.57)Median OS (95% CI), monthsDe novo59.9. (52.7-NE)52.9. (39.6-NE)0.67. (0.38-1.19)Late relapseNE. (54.9-NE)52.3. (40.4-NE)0.69. (0.42-1.13)HR (de novo vs late relapse)0.899. (0.552-1.465)0.91. (0.51-1.62)Prior (neo)adjuvant CTMedian PFS (95% CI), monthsWithout prior CT28.3. (23.3-35.6)17.5. (13.6-21.9)0.60. (0.46-0.78)With prior CTa17.9. (14.3-19.9)10.8. (7.2-12.3)0.61. (0.48-0.78)HR (without vs with prior CT)0.76. (0.60-0.94)0.72. (0.55-0.95)Median OS (95% CI), monthsWithout prior CTNE (54.9-NE)44.9 (38.5-58.1)0.70. (0.50-0.97)With prior CTa43.0 (39.1-51.2)40.1 (30.3-48.6)0.76. (0.58-1.01)HR (without vs with prior CT)0.68 (0.52-0.89)0.72 (0.52-1.00)NE, not estimable a Includes 4 patients who received prior CT for ABC (protocol violation).
Citation Format: Michelino De Laurentiis, Matteo Lambertini, Stephen Chia, Hope S Rugo, Katarina Petrakova, Cristian Villanueva, Sara Hurvitz, J. Thaddeus Beck, Agnes Lteif, Sina Haftchenary, Uday Deore, Jiwen Wu, Nagi El-Saghir. Analysis of first-line (1L) patients (pts) with de novo disease vs late relapse and all pts with vs without prior chemotherapy (CT) in the MONALEESA-3 (ML-3) trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-11.
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Affiliation(s)
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | | | - Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Cristian Villanueva
- University Hospital of Besançon, Jean-Minjoz University Hospital, Besançon, France
| | - Sara Hurvitz
- University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | - Agnes Lteif
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Uday Deore
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Nagi El-Saghir
- American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
Traumatic tricuspid valve injury is rare, accounting for 0.02% of traumatic injuries. The majority of cases result from blunt force trauma to the chest, however penetrating injuries have been documented in literature. Patients' can be in the full spectrum of disease, from asymptomatic to cardiogenic shock. Indications for surgery include right heart failure or evidence of right heart volume overload in the setting of significant tricuspid regurgitation. Early surgical repair is warranted to preserve right ventricular function. Surgery also needs to be planned in conjunction with the patients' other injuries. In some cases, it may be beneficial for surgery to be delayed whilst the patient is closely observed, in order for the patient to recover from concomitant injuries. We report two cases of tricuspid regurgitation in the context of blunt trauma, and our approach to the management of these patients.
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Castets S, Villanueva C, Vergier J, Brue T, Saveanu A, Reynaud R. Clinical, radiological, and molecular diagnosis of congenital pituitary diseases causing short stature. Arch Pediatr 2022; 28:8S33-8S38. [PMID: 37870532 DOI: 10.1016/s0929-693x(22)00041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Short stature in children can be caused by congenital pituitary disorders involving at least one form of growth hormone deficiency. Clinical and radiological evaluations of the index case and family history assessments are essential to guide genetic diagnostic testing and interpret results. The first-line approach is panel testing of genes involved in pituitary development with variants known to be pathogenic in this context. It identifies a genetic cause in less than 10% of cases, however. Whole-exome and whole-genome sequencing techniques may provide original information but also raise new questions regarding the pathophysiological role of identified variants. These new tools can make genetic counselling more complex. The role of clinicians in these interpretations is therefore important. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- S Castets
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France.
| | - C Villanueva
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - J Vergier
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - T Brue
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - A Saveanu
- Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Laboratoire de Biologie Moléculaire, Hôpital de la Conception, Marseille, France
| | - R Reynaud
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
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Mouillet G, Falcoz A, Fritzsch J, Almotlak H, Jacoulet P, Pivot X, Villanueva C, Mansi L, Kim S, Curtit E, Meneveau N, Adotevi O, Jary M, Eberst G, Vienot A, Calcagno F, Pozet A, Djoumakh O, Borg C, Westeel V, Anota A, Paget-Bailly S. Feasibility of health-related quality of life (HRQoL) assessment for cancer patients using electronic patient-reported outcome (ePRO) in daily clinical practice. Qual Life Res 2021; 30:3255-3266. [PMID: 33387291 DOI: 10.1007/s11136-020-02721-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Routine Electronic Monitoring of Health-Related Quality of Life (HRQoL) (REMOQOL) in clinical care with real-time feedback to physicians could help to enhance patient-centered care. We evaluated the feasibility of REMOQOL in the French context in the QOLIBRY study. The primary objective was to assess the patients' compliance with REMOQOL. METHODS The QOLIBRY study was a single-center, prospective study conducted in the University Hospital of Besançon (France). Eligible patients were those treated with systemic therapies for breast, lung or colorectal cancer at any stage. Patients were invited to complete the EORTC QLQ-C30 questionnaire and cancer-site-specific modules before each visit on tablets and/or computers in the hospital or at home. During the consultation, physicians had real-time access to visual summaries of HRQoL scores. Compliance was assessed as adequate if at least 66% of HRQoL assessments were completed during the 4 months of follow-up. RESULTS Between March 2016 and October 2018, 177 patients were included in the QOLIBRY study. Median age was 64 years (IQR 54-71). The proportion of patients with an adequate compliance rate was 95.5% (n = 63) in the breast cancer cohort, 98.2% (n = 55) in the colorectal cancer cohort, and 90.9% (n = 50) in the lung cancer cohort. The physicians checked the HRQoL results in 73.1% of visits and prescribed supportive care and adapted patient management in 8.3% and 5.2% of visits, respectively. CONCLUSION & PERSPECTIVES The results of QOLIBRY study suggest that REMOQOL is feasible in the French context. However, information about HRQoL monitoring, training of the physicians in the use of the software, and recommendations for using HRQoL results to guide care are essential and must be improved.
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Affiliation(s)
- Guillaume Mouillet
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France.
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France.
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France.
| | - Antoine Falcoz
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Joëlle Fritzsch
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Hamadi Almotlak
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Pascale Jacoulet
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Xavier Pivot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | | | - Laura Mansi
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Nathalie Meneveau
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Olivier Adotevi
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Guillaume Eberst
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Angelique Vienot
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Fabien Calcagno
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
| | - Astrid Pozet
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Oumelkheir Djoumakh
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
| | - Virginie Westeel
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- Respiratory Medicine Department, University Hospital of Besançon, 25000, Besançon, France
| | - Amélie Anota
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
- French National Platform Quality of Life and Cancer, Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, 25000, Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University Bourgogne Franche-Comté, 25000, Besançon, France
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Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, McAfee D, Catalán MJ, Alonso-Frech F, Villanueva C, Jesús S, Mir P, Aguilar M, Pastor P, García Caldentey J, Esltelrich Peyret E, Planellas LL, Martí MJ, Caballol N, Hernández Vara J, Martí Andrés G, Cabo I, Ávila Rivera MA, López Manzanares L, Redondo N, Martinez-Martin P, McAfee D. Non-motor symptom burden is strongly correlated to motor complications in patients with Parkinson's disease. Eur J Neurol 2020; 27:1210-1223. [PMID: 32181979 DOI: 10.1111/ene.14221] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to analyze the relationship between motor complications and non-motor symptom (NMS) burden in a population of patients with Parkinson's disease (PD) and also in a subgroup of patients with early PD. METHODS Patients with PD from the COPPADIS cohort were included in this cross-sectional study. NMS burden was defined according to the Non-Motor Symptoms Scale (NMSS) total score. Unified Parkinson's Disease Rating Scale (UPDRS) part IV was used to establish motor complication types and their severity. Patients with ≤5 years of symptoms from onset were included as patients with early PD. RESULTS Of 690 patients with PD (62.6 ± 8.9 years old, 60.1% males), 33.9% and 18.1% presented motor fluctuations and dyskinesia, respectively. The NMS total score was higher in patients with motor fluctuations (59.2 ± 43.1 vs. 38.3 ± 33.1; P < 0.0001) and dyskinesia (63.5 ± 40.7 vs. 41.4 ± 36.3; P < 0.0001). In a multiple linear regression model and after adjustment for age, sex, disease duration, Hoehn & Yahr stage, UPDRS-III score and levodopa equivalent daily dose, UPDRS-IV score was significantly related to a higher NMSS total score (β = 0.27; 95% confidence intervals, 2.81-5.61; P < 0.0001), as it was in a logistic regression model on dichotomous NMSS total score (≤40, mild or moderate vs. >40, severe or very severe) (odds ratio, 1.31; 95% confidence intervals, 1.17-1.47; P < 0.0001). In the subgroup of patients with early PD (n = 396; mean disease duration 2.7 ± 1.5 years), motor fluctuations were frequent (18.1%) and similar results were obtained. CONCLUSIONS Motor complications were frequent and were associated with a greater NMS burden in patients with PD even during the first 5 years of disease duration.
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Affiliation(s)
- D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - T de Deus Fonticoba
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - E Suárez Castro
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - A Aneiros Díaz
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - D McAfee
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - S Jesús
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Sevilla, Spain
| | - P Mir
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Sevilla, Spain
| | - M Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - P Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | - L L Planellas
- Hospital Clínic de Barcelona, Fundació Clínic, IDIBAPS, CIBERNED, Barcelona, Spain
| | - M J Martí
- Hospital Clínic de Barcelona, Fundació Clínic, IDIBAPS, CIBERNED, Barcelona, Spain
| | - N Caballol
- Hospital de Sant Joan Despí Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | | | | | - I Cabo
- Hospital de Pontevedra, Pontevedra, Spain
| | - M A Ávila Rivera
- Hospital General de l'Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - N Redondo
- Hospital Universitario de la Princesa, Madrid, Spain
| | - P Martinez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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Bazan F, Dobi E, Royer B, Curtit E, Mansi L, Menneveau N, Paillard MJ, Meynard G, Villanueva C, Pivot X, Chaigneau L. Systemic high-dose intravenous methotrexate in patients with central nervous system metastatic breast cancer. BMC Cancer 2019; 19:1029. [PMID: 31675937 PMCID: PMC6823971 DOI: 10.1186/s12885-019-6228-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 01/06/2023] Open
Abstract
Background Infusion of high-dose intravenous methotrexate (MTX) has been demonstrating to penetrate the blood-brain barrier. The aim of this present study was to assess the efficacy and safety of high dose MTX in patients with central nervous system (CNS) metastases of breast cancer. Methods Twenty-two patients with CNS metastases treated by MTX (3 g/m2) between April 2004 and October 2009 were enrolled. Clinical response rate, time to progression (TTP), overall survival (OS), and safety were assessed. Results In terms of brain metastases, 2 patients (9%) achieved a partial response, 10 patients (45%) had disease stabilization, and 10 patients (45%) had disease progression. In others metastatic sites, 7 patients (39%) achieved a disease stabilization, and 11 patients (61%) had disease progression. TTP and OS were 2.1 (95%CI 1.4–2.9) and 6.3 (95%CI 1.8–10) months, respectively. Conclusion High-dose MTX demonstrated a moderate activity at 3 g/m2. Nonetheless, the favorable toxicity profile should suggest the possibility to increase the dosage and further study are planned.
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Affiliation(s)
- F Bazan
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - E Dobi
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - B Royer
- Department of Clinical Pharmacology and Toxicology, University Hospital of Besancon, Besancon, France
| | - E Curtit
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - L Mansi
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - N Menneveau
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - M J Paillard
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - G Meynard
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - C Villanueva
- Centre de Cancérologie du grand Montpellier, Montpellier, France
| | - X Pivot
- Centre Paul Strauss, Porte de l'Hopital Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France. .,Department of Medical Oncology, University Hospital Jean Minjoz, Boulevard Alexandre Fleming, F-25000, Besancon, France.
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15
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Royce M, Bachelot T, Villanueva C, Özgüroglu M, Azevedo SJ, Cruz FM, Debled M, Hegg R, Toyama T, Falkson C, Jeong J, Srimuninnimit V, Gradishar WJ, Arce C, Ridolfi A, Lin C, Cardoso F. Everolimus Plus Endocrine Therapy for Postmenopausal Women With Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: A Clinical Trial. JAMA Oncol 2019; 4:977-984. [PMID: 29566104 DOI: 10.1001/jamaoncol.2018.0060] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Cotargeting the mammalian target of rapamycin pathway and estrogen receptor may prevent or delay endocrine resistance in patients receiving first-line treatment for advanced breast cancer. Objective To investigate the combination of everolimus plus endocrine therapy in first-line and second-line treatment settings for postmenopausal women with estrogen receptor-positive, human epidermal growth receptor 2-negative advanced breast cancer. Design, Setting, and Participants In the multicenter, open-label, single-arm, phase 2 BOLERO-4 (Breast Cancer Trials of Oral Everolimus) clinical trial, 245 patients were screened for eligibility; 202 were enrolled between March 7, 2013, and December 17, 2014. A median follow-up of 29.5 months had been achieved by the data cutoff date (December 17, 2016). Interventions Patients received first-line treatment with everolimus, 10 mg/d, plus letrozole, 2.5 mg/d. Second-line treatment with everolimus, 10 mg/d, plus exemestane, 25 mg/d, was offered at the investigator's discretion upon initial disease progression. Main Outcomes and Measures The primary end point was investigator-assessed progression-free survival in the first-line setting per Response Evaluation Criteria in Solid Tumors, version 1.0. Safety was assessed in patients who received at least 1 dose of study medication and at least 1 postbaseline safety assessment. Results A total of 202 women treated in the first-line setting had a median age of 64.0 years (interquartile range, 58.0-70.0 years) with metastatic (194 [96.0%]) or locally advanced (8 [4.0%]) breast cancer. Median progression-free survival was 22.0 months (95% CI, 18.1-25.1 months) with everolimus and letrozole. Median overall survival was not reached; 24-month estimated overall survival rate was 78.7% (95% CI, 72.1%-83.9%). Fifty patients started second-line treatment; median progression-free survival was 3.7 months (95% CI, 1.9-7.4 months). No new safety signals were observed. In the first-line setting, the most common all-grade adverse event was stomatitis (139 [68.8%]); the most common grade 3 to 4 adverse event was anemia (21 [10.4%]). In the second-line setting, the most common adverse events were stomatitis and decreased weight (10 [20.0%] each); the most common grade 3 to 4 adverse event was hypertension (5 [10.0%]). There were 50 (24.8%) deaths overall during the study; 40 were due to study indication (breast cancer). Conclusions and Relevance The results of this trial add to the existing body of evidence suggesting that everolimus plus endocrine therapy is a good first-line treatment option for postmenopausal women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. Trial Registration clinicaltrials.gov Identifier: NCT01698918.
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Affiliation(s)
- Melanie Royce
- University of New Mexico Comprehensive Cancer Center, Albuquerque
| | - Thomas Bachelot
- Breast Cancer Unit and the Clinical Trial Unit, Centre Léon Bérard, Lyon, France
| | - Cristian Villanueva
- Service d'Oncologie Médicale, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Mustafa Özgüroglu
- Department of Oncology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sergio J Azevedo
- Oncology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Marc Debled
- Département d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Roberto Hegg
- Centro de Referência da Saúde da Mulher, Hospital Pérola Byington/Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Carla Falkson
- University of Alabama Comprehensive Cancer Center, Birmingham
| | - Joon Jeong
- Department of Surgery, Breast Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Vichien Srimuninnimit
- Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - William J Gradishar
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christina Arce
- Novartis Oncology, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Antonia Ridolfi
- Global Medical Affairs Biostatistics, Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - Chinjune Lin
- Novartis Oncology, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
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16
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Santos García D, Jesús S, Aguilar M, Planellas LL, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Catalán MJ, López Díaz L, Puente V, García Moreno JM, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Menéndez González M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, Fábregues‐Boixar O, González Ardura J, Prieto Jurczynska C, Martinez‐Martin P, Mir P, Adarmes Astrid D, Almeria M, Alonso Cánovas A, Alonso Frech F, Aneiros Díaz A, Arnáiz S, Arribas S, Ascunce Vidondo A, Bernardo Lambrich N, Bejr‐Kasem H, Blázquez Estrada M, Botí M, Cabello González C, Cámara Lorenzo A, Carrillo F, Casas E, Clavero P, Cortina Fernández A, Cots Foraster A, Crespo Cuevas A, de Deus Fonticoba T, Díez‐Fairen M, Erro E, Estelrich Peyret E, Fernández Guillán N, Gámez P, Gallego M, García Campos C, Gómez Garre MP, González Aloy J, González García B, González Palmás MJ, González Toledo GR, Golpe Díaz A, Grau Solá M, Guardia G, Horta‐Barba A, Infante J, Labandeira C, Labrador MA, Lacruz F, Lage Castro M, López Seoane B, Macías Y, Mata M, Martí Andres G, Martí MJ, McAfee D, Meitín MT, Méndez del Barrio C, Miranda Santiago J, Morales Casado MI, Moreno Diéguez A, Nogueira V, Novo Amado A, Novo Ponte S, Ordás C, Pagonabarraga J, Pareés I, Pascual‐Sedano B, Pastor P, Pérez Fuertes A, Pérez Noguera R, Prats MA, Pueyo Morlans M, Redondo Rafales N, Rodríguez Méndez L, Rodríguez Pérez AB, Roldán F, Ruíz De Arcos M, Sánchez‐Carpintero M, Sánchez Díez G, Sánchez Rodríguez A, Santacruz P, Segundo Rodríguez JC, Serarols A, Sierra Peña M, Suárez Castro E, Tartari JP, Vargas L, Vázquez Gómez R, Villanueva C, Vives B, Villar MD. COPPADIS
‐2015 (
CO
hort of Patients with PArkinson's
DI
sease in Spain, 2015): an ongoing global Parkinson's disease project about disease progression with more than 1000 subjects included. Results from the baseline evaluation. Eur J Neurol 2019; 26:1399-1407. [DOI: 10.1111/ene.14008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 01/03/2023]
Affiliation(s)
- D. Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña A CoruñaSpain
| | - S. Jesús
- Hospital Universitario Virgen del Rocío SevillaSpain
| | - M. Aguilar
- Hospital Universitari Mutua de Terrassa Terrassa Barcelona Spain
| | | | | | - N. Caballol
- Consorci Sanitari Integral Hospital Moisés Broggi Sant Joan Despí Barcelona Spain
| | - I. Legarda
- Hospital Universitario Son Espases Palma de MallorcaSpain
| | | | - I. Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | | | - M. A. Ávila Rivera
- Consorci Sanitari Integral Hospital General de L'Hospitalet, L'Hospitalet de Llobregat Barcelona Spain
| | - M. J. Catalán
- Hospital Universitario Clínico San Carlos Madrid Spain
| | - L. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO) Orense Spain
| | | | | | | | - B. Solano Vila
- Institut d'Assistència Sanitària (IAS) – Institut Català de la Salut Girona Spain
| | | | - L. Vela
- Fundación Hospital de Alcorcón MadridSpain
| | - S. Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC) Tortosa Tarragona Spain
| | - E. Cubo
- Complejo Asistencial Universitario de Burgos Burgos Spain
| | - F. Carrillo Padilla
- Hospital Universitario de Canarias San Cristóbal de la LagunaSanta Cruz de Tenerife Spain
| | | | | | - M. G. Alonso Losada
- Hospital Álvaro Cunqueiro Complejo Hospitalario Universitario de Vigo (CHUVI) Vigo Spain
| | | | - I. Gastón
- Complejo Hospitalario de Navarra Pamplona Spain
| | | | | | - M. Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | - C. Valero
- Hospital Arnau de Vilanova Valencia Spain
| | - M. Kurtis
- Hospital Ruber Internacional Madrid Spain
| | | | | | | | - P. Martinez‐Martin
- Centro Nacional de Epidemiología y CIBERNED Instituto de Salud Carlos III Madrid Spain
| | - P. Mir
- Hospital Universitario Virgen del Rocío SevillaSpain
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O'Shaughnessy J, Campone M, Andre F, Nusch A, Grischke EM, Villanueva C, Marschner N, Winer EP, Paluch-Shimon S, Rodriguez-Lorenc K, Hilliard A, Le Gac F, Ridolfi A, Hortobagyi GN. First-line (1L) ribociclib (RIB) plus letrozole (LET) for postmenopausal women with hormone receptor-positive (HR+), HER2- advanced breast cancer (ABC): MONALEESA-2 long-term safety results. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1078 Background: In the phase III MONALEESA-2 study (NCT01958021), 1L treatment (Tx) with RIB (cyclin-dependent kinase 4/6 inhibitor) plus LET significantly prolonged PFS vs placebo (PBO) + LET in patients (pts) with HR+/HER2– ABC (HR 0.56; P<0.0001). In the primary publication (data cutoff, Jan 2016), the median duration of exposure was 13.0 mo (RIB + LET) and 12.4 mo (PBO + LET), and the most common all-grade adverse events (AEs) in the RIB + LET arm were neutropenia (74.3%), nausea (51.5%), infections (50.3%), fatigue (36.5%), and diarrhea (35.0%; Hortobagyi GN, et al. N Engl J Med. 2016;375:1738-48). Here we present long-term safety data from MONALEESA-2. Methods: Pts received either RIB + LET (n=334) or PBO + LET (n=330). AEs were graded per CTCAE v4.03. Results: As of data cutoff (Oct 2018), 79 (24%) pts (RIB + LET) and 39 (12%) pts (PBO + LET) remained on Tx. The median duration of exposure was 20.2 mo (range, 0-54) for RIB + LET and 14.1 mo for PBO + LET, and 30% and 17%, respectively, had ≥ 36 mo of exposure. Neutropenia was the most common exposure-adjusted any-grade AE of special interest (AESI) in the RIB + LET arm (Table). AEs were the most common reason for RIB dose reductions (56.6%) and interruptions (73.4%). Discontinuations due to AEs occurred in 19.2% and 4.2% of pts in the RIB + LET and PBO + LET arms, respectively, and the most common AEs leading to discontinuation in the RIB + LET arm were increased ALT (4.5%), GI disorders (3.3%), and increased AST (2.7%). Prolonged QT led to dose interruption in 0.9% of patients (no discontinuations), and the additional follow-up did not reveal any sudden deaths related to prolonged QT interval beyond the 1 identified in the primary analysis. Conclusions: AEs occurring with 1L RIB + LET in postmenopausal pts with HR+/HER2– ABC were manageable and the safety profile was comparable to that in the primary report. Clinical trial information: NCT01958021. [Table: see text]
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Affiliation(s)
| | - Mario Campone
- Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | | | - Arnd Nusch
- Onkologische Praxis Velbert, Velbert, Germany
| | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | | | | | | | - Annie Hilliard
- Novartis Pharmaceuticals Corporation, Basel, Switzerland
| | - Fabienne Le Gac
- Clinical Development & Analytics Global Drug Development-Oncology, Basel, Switzerland
| | - Antonia Ridolfi
- Novartis Pharmaceuticals Corporation, Rueil-Malmaison, France
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18
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Villanueva C, Doyle M, Parikh R, Manganas C. Patient Safety and Current Practice During Chest Drain Insertion. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Villanueva C, Yazbek G, Beuzeboc P, Viel E, Dohollou N, Luporsi E, Eymard JC, Levy E, Mouret-Reynier MA, Dourthe LM, Malaurie E, Madelenat M, Denden A, Antoine EC. Breast cancer (BC) treatment (tx) with everolimus (EVE) and exemestane (EXE) in hormone receptor positive (HR+)/ HER2-negative (HER2−) postmenopausal women: Final analysis of the French observational TANGO study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.325] [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: 11/14/2022] Open
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Curtit E, Bazan F, Chaigneau L, Mouillet G, Dobi E, Mansi L, Meneveau N, Paillard MJ, Meynard G, Klajer E, Villanueva C, Montcuquet P, Pivot X, Cals L. Prolonged overall survival for patients with bone-only metastases at presentation of metastatic breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Klajer E, Paget-Bailly S, Meynard G, Meurisse A, Bazan F, Chaigneau L, Dobi E, Meneveau N, Montcuquet P, Villanueva C, Thiery-Vuillemin A, Kalbacher E, Populaire C, Collonge-Rame MA, Gligorov J, Curtit E, Pivot X, Mansi L. Impact of BRCA status on outcomes and survival in high-risk early breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.207] [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: 11/13/2022] Open
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Hortobagyi GN, Paluch-Shimon S, Petrakova K, Villanueva C, Chan A, Nusch A, Yap YS, Hart L, Favret A, Marschner N, Sonke GS, Oma Ohnstad H, Arteaga C, Su F, He W, Miller MK, Stemmer SM. First-line ribociclib (RIB) + letrozole (LET) in hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC): MONALEESA-2 biomarker analyses. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Arlene Chan
- Breast Cancer Research Centre - WA & Curtin University, Perth, Australia
| | - Arnd Nusch
- Onkologische Praxis Velbert, Velbert, Germany
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Lowell Hart
- Florida Cancer Specialists, Sarah Cannon Research Institute, Fort Myers, FL
| | | | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany
| | - Gabe S. Sonke
- Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands
| | - Hege Oma Ohnstad
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Carlos Arteaga
- Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Fei Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Wei He
- Novartis Institute for Biomedical Research, Cambridge, MA
| | | | - Salomon M. Stemmer
- Davidoff Center, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Hortobagyi GN, Stemmer S, Campone M, Sonke GS, Arteaga CL, Paluch-Shimon S, Petrakova K, Villanueva C, Nusch A, Grischke EM, Chan A, Jakobsen E, Marschner N, Hart LL, Alba E, Ohnstand HO, Blau S, Yardley DA, Solovieff N, Su F, Germa C, Yap YS. Abstract PD4-06: First-line ribociclib + letrozole in hormone receptor-positive, HER2-negative advanced breast cancer: Efficacy by baseline circulating tumor DNA alterations in MONALEESA-2. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd4-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: The addition of first-line ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) to letrozole (LET) significantly improved progression-free survival (PFS) compared with placebo (PBO) + LET in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC) in the Phase III MONALEESA-2 study. Identifying biomarkers that predict response to treatment remains a key challenge in pts with HR+ ABC. Here we analyze results from MONALEESA-2 by molecular alterations detected in circulating tumor DNA (ctDNA) at baseline, including PIK3CA mutations and other alterations considered to be important in HR+ ABC.
Methods: Postmenopausal women (N=668) with HR+, HER2– ABC who had not received any prior therapy for ABC were randomized 1:1 to RIB (600 mg/day; 3-weeks-on/1-week-off) + LET (2.5 mg/day; continuous) or PBO + LET. The primary endpoint was PFS. Biomarker analysis of the ctDNA mutation profile was an exploratory endpoint. Plasma samples for ctDNA analysis were collected at baseline and end of treatment. ctDNA was analyzed using next-generation sequencing with a targeted panel of ˜550 genes.
Results: Baseline ctDNA was successfully sequenced in 494 pts (RIB + LET: n=212; PBO + LET: n=215); 67 (14%) of 494 pts were removed from the analysis due to limited tumor DNA in circulation. 427 (86%) pts had ≥1 alteration, including 1,573 mutations, 513 short insertions/deletions, 166 amplifications, and 8 translocations. Alterations (frequency) were commonly observed in the following genes: PIK3CA (33%), TP53 (12%), ZNF703/FGFR1 (5%), and ESR1 (4%), and in genes involved in receptor tyrosine kinase (RTK) signaling (12%). RIB + LET treatment benefit was consistent in pts with wild-type (WT) and altered PIK3CA, and in pts with WT and altered TP53 (Table). RIB + LET improved PFS regardless of RTK or ZNF703/FGFR1 alterations. However, there was a weak trend for increased benefit in pts with WT vs altered RTK genes and in pts with WT vs altered ZNF703/FGFR1 genes. These results should be interpreted with caution due to the small number of pts with these alterations. There were too few ESR1 alterations for firm conclusions to be drawn.
Events, n/NMedian PFS, months Gene(s)RIB + LETPBO + LETRIB + LETPBO + LETHazard ratio (95% confidence interval)PIK3CAWT54/14393/14229.614.70.44 (0.31–0.62)Altered40/6955/7319.212.70.53 (0.35–0.81)TP53WT72/180129/19427.614.70.44 (0.33–0.59)Altered22/3219/2110.25.50.43 (0.23–0.83)ZNF703/FGFR1WT88/202139/20524.814.60.47 (0.36–0.62)Altered6/109/1010.611.40.73 (0.23–2.29)RTKWT81/189128/18724.814.40.46 (0.35–0.61)Altered13/2320/2821.311.40.72 (0.34–1.53)
Conclusions: Consistent RIB + LET treatment benefit was observed compared with PBO + LET, irrespective of the status of baseline ctDNA biomarkers.
Citation Format: Hortobagyi GN, Stemmer S, Campone M, Sonke GS, Arteaga CL, Paluch-Shimon S, Petrakova K, Villanueva C, Nusch A, Grischke E-M, Chan A, Jakobsen E, Marschner N, Hart LL, Alba E, Ohnstand HO, Blau S, Yardley DA, Solovieff N, Su F, Germa C, Yap Y-S. First-line ribociclib + letrozole in hormone receptor-positive, HER2-negative advanced breast cancer: Efficacy by baseline circulating tumor DNA alterations in MONALEESA-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD4-06.
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Affiliation(s)
- GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Stemmer
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - M Campone
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - GS Sonke
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - CL Arteaga
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Paluch-Shimon
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - K Petrakova
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - C Villanueva
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - A Nusch
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E-M Grischke
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - A Chan
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E Jakobsen
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - N Marschner
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - LL Hart
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E Alba
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - HO Ohnstand
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Blau
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - DA Yardley
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - N Solovieff
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - F Su
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - C Germa
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - Y-S Yap
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
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O'Shaughnessy J, Petrakova K, Sonke GS, Conte P, Arteaga CL, Cameron DA, Hart LL, Villanueva C, Jakobsen E, Beck JT, Lindquist D, Souami F, Mondal S, Germa C, Hortobagyi GN. Ribociclib plus letrozole versus letrozole alone in patients with de novo HR+, HER2- advanced breast cancer in the randomized MONALEESA-2 trial. Breast Cancer Res Treat 2017; 168:127-134. [PMID: 29164421 PMCID: PMC5847028 DOI: 10.1007/s10549-017-4518-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Determine the efficacy and safety of first-line ribociclib plus letrozole in patients with de novo advanced breast cancer. METHODS Postmenopausal women with HR+ , HER2- advanced breast cancer and no prior systemic therapy for advanced disease were enrolled in the Phase III MONALEESA-2 trial (NCT01958021). Patients were randomized to ribociclib (600 mg/day; 3 weeks-on/1 week-off) plus letrozole (2.5 mg/day; continuous) or placebo plus letrozole until disease progression, unacceptable toxicity, death, or treatment discontinuation. The primary endpoint was investigator-assessed progression-free survival; predefined subgroup analysis evaluated progression-free survival in patients with de novo advanced breast cancer. Secondary endpoints included safety and overall response rate. RESULTS Six hundred and sixty-eight patients were enrolled, of whom 227 patients (34%; ribociclib plus letrozole vs placebo plus letrozole arm: n = 114 vs. n = 113) presented with de novo advanced breast cancer. Median progression-free survival was not reached in the ribociclib plus letrozole arm versus 16.4 months in the placebo plus letrozole arm in patients with de novo advanced breast cancer (hazard ratio 0.45, 95% confidence interval 0.27-0.75). The most common Grade 3/4 adverse events were neutropenia and leukopenia; incidence rates were similar to those observed in the full MONALEESA-2 population. Ribociclib dose interruptions and reductions in patients with de novo disease occurred at similar frequencies to the overall study population. CONCLUSIONS Ribociclib plus letrozole improved progression-free survival vs placebo plus letrozole and was well tolerated in postmenopausal women with HR+, HER2- de novo advanced breast cancer.
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Affiliation(s)
- Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
| | - Katarina Petrakova
- Masaryk Memorial Cancer Institute, Žlutý kopec 543/7, 656 53, Brno, Czech Republic
| | - Gabe S Sonke
- Netherlands Cancer Institute and BOOG Study Center, IJsbaanpad 9, 1076 CV, Amsterdam, The Netherlands
| | - Pierfranco Conte
- University of Padova and Istituto Oncologico Veneto, IRCCS, Via Gattamelata, 64, Padua, Italy
| | - Carlos L Arteaga
- Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - David A Cameron
- Edinburgh Cancer Centre, University of Edinburgh, Crewe Rd S, Edinburgh, EH4 2XR, UK
| | - Lowell L Hart
- Sarah Cannon Research Institute, Fort Myers, FL, 33916, USA
| | - Cristian Villanueva
- University Hospital of Besançon, Jean-Minjoz University Hospital, 3 Boulevard Alexandre Fleming, 25000, Besançon, France
| | - Erik Jakobsen
- Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark
| | - Joseph T Beck
- Highlands Oncology Group, 3232 N Northhills Blvd, Fayetteville, AR, 72703, USA
| | - Deborah Lindquist
- Arizona Oncology, US Oncology Network, 3700 W State Rte 89A, Sedona, AZ, 86336, USA
| | - Farida Souami
- Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland
| | - Shoubhik Mondal
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA
| | - Caroline Germa
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA
| | - Gabriel N Hortobagyi
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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25
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Sonke GS, Hart LL, Campone M, Erdkamp F, Janni W, Verma S, Villanueva C, Jakobsen E, Alba E, Wist E, Favret AM, Bachelot T, Hegg R, Wheatley-Price P, Souami F, Sutradhar S, Miller M, Germa C, Burris HA. Ribociclib with letrozole vs letrozole alone in elderly patients with hormone receptor-positive, HER2-negative breast cancer in the randomized MONALEESA-2 trial. Breast Cancer Res Treat 2017; 167:659-669. [PMID: 29058175 PMCID: PMC5807486 DOI: 10.1007/s10549-017-4523-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
Purpose Determine the efficacy and safety of first-line ribociclib plus letrozole in elderly patients with HR+, HER2− advanced breast cancer. Methods 668 postmenopausal women with HR+, HER2− advanced breast cancer and no prior systemic therapy for advanced disease were enrolled in the Phase III MONALEESA-2 trial (NCT01958021); 295 patients were aged ≥ 65 years. Patients were randomized to ribociclib (600 mg/day; 3-weeks-on/1-week-off) plus letrozole (2.5 mg/day) or placebo plus letrozole until disease progression, unacceptable toxicity, death, or treatment discontinuation. The primary endpoint was PFS, which was evaluated in elderly (≥ 65 years) and younger (< 65 years) patients. Secondary endpoints included response rates and safety. Results Ribociclib plus letrozole significantly improved PFS vs placebo plus letrozole in elderly (hazard ratio: 0.608; 95% CI 0.394–0.937) and younger patients (hazard ratio: 0.523; 95% CI 0.378–0.723). Overall response rates were numerically higher in the ribociclib vs placebo arm, regardless of age. Ribociclib plus letrozole was well tolerated in elderly patients, with the safety profile similar to the overall study population. Nausea, vomiting, alopecia, and diarrhea were > 10% more frequent in the ribociclib plus letrozole vs placebo plus letrozole arm in both subgroups; most events were grade 1/2. In elderly patients, grade 1/2 anemia and fatigue were > 10% more frequent in the ribociclib plus letrozole vs placebo plus letrozole arm and discontinuation rates were similar in both arms. Conclusions Addition of ribociclib to letrozole is a valid therapeutic option for elderly patients with HR+, HER2− advanced breast cancer in the first-line setting.
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Affiliation(s)
- Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute/BOOG Study Center, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Lowell L Hart
- Florida Cancer Specialists, 8931 Colonial Center Dr Suite 300, Fort Myers, FL, 33905, USA.,Sarah Cannon Research Institute, 250 25th Avenue North #100, Nashville, TN, 37203, USA
| | - Mario Campone
- Institut de Cancérologie de l'Ouest - René Gauducheau Centre de Recherche en Cancérologie, Boulevard Jacques Monod, Nantes, 44805, Saint-Herblain, France
| | - Frans Erdkamp
- Zuyderland Medical Center, Sittard-Geleen/Heerlen, 6162 BG, Geleen, The Netherlands
| | - Wolfgang Janni
- Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Sunil Verma
- Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, AB, T2N 4N2, Canada
| | - Cristian Villanueva
- University Hospital of Besançon, Hospital Jean-Minjoz, 25000, Besançon, France
| | - Erik Jakobsen
- Lillebælt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark
| | - Emilio Alba
- Hospital Universitario Virgen de la Victoria, IBIMA, 29010, Málaga, Spain
| | - Erik Wist
- Oslo University Hospital, Ullernchausseen 70 Radiumhospitalet, 0379, Oslo, Norway
| | - Anne M Favret
- Virginia Cancer Specialists PC, US Oncology, 8503 Arlington Blvd #400, Fairfax, VA, 22031, USA
| | - Thomas Bachelot
- Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Roberto Hegg
- Hospital Pérola Byington Centro de Referência da Saúde da Mulher, Av. Brigadeiro Luís Antônio, 683-Bela Vista, São Paulo, SP, 01317-000, Brazil
| | - Paul Wheatley-Price
- Ottawa Hospital Research Institute, University of Ottawa, 501, Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | | | - Santosh Sutradhar
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA
| | - Michelle Miller
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA
| | - Caroline Germa
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA
| | - Howard A Burris
- Sarah Cannon Research Institute, 250 25th Avenue North #100, Nashville, TN, 37203, USA
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Bachelot T, Royce M, Villanueva C, Melo Cruz F, Hegg R, Falkson C, Jeong J, Srimuninnimit V, Arce C, Ridolfi A, Lin C, Gradishar W, Ozguroglu M, Cardoso F, Azevedo S. Everolimus (EVE) + letrozole (LET) in patients (pts) with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC): Progression-free survival (PFS) subgroup analyses in BOLERO-4. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.007] [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: 11/14/2022] Open
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Andre F, Stemmer SM, Campone M, Petrakova K, Paluch-Shimon S, Yap YS, Marschner N, Chan A, Villanueva C, Hart LL, Arteaga CL, Sonke GS, Grischke EM, Alba E, Nusch A, Yardley DA, Jakobsen E, Blau S, Tolaney SM, Su F, He W, Germa C, Hortobagyi GN. Abstract CT045: Ribociclib + letrozole for first-line treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC): efficacy by baseline tumor markers. Clin Trials 2017. [DOI: 10.1158/1538-7445.am2017-ct045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cardoso F, Villanueva C, Royce M, Cruz F, Debled M, Hegg R, Toyama T, Falkson CI, Jeong J, Srimuninnimit V, Ozguroglu M, Gradishar WJ, Azevedo SJ, Arce CH, Ridolfi A, Lin C, Bachelot TD. Everolimus (EVE) plus endocrine therapy in patients with estrogen receptor–positive (ER+), human epidermal growth factor receptor 2–negative (HER2−) advanced breast cancer (BC): First- and second-line data from the BOLERO-4 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1010 Background: Initial first-line (1L) data from the phase 2 BOLERO-4 (NCT01698918) study of EVE + letrozole (LET) in postmenopausal patients (pts) with ER+, HER2− metastatic BC (MBC) or locally advanced BC (LABC) have been previously reported. Here, we present updated 1L progression-free survival (PFS) data, plus new data describing second-line (2L) EVE + exemestane (EXE) in pts with disease progression after EVE + LET. Methods: Postmenopausal pts with ER+, HER2− MBC or LABC with no prior therapy for advanced disease received EVE 10 mg/day + LET 2.5 mg/day. After disease progression, pts could receive EVE + EXE 25 mg/day until further disease progression, unacceptable toxicity, or withdrawal of consent. Primary endpoint: 1L PFS. Secondary endpoints: overall response rate (ORR), clinical benefit rate (CBR), 2L PFS, overall survival (OS), and safety (1L and 2L). Results: Among 202 pts (median age, 64 years) with 1L MBC (96%) or LABC (4%), median PFS (95% CI) was 21.7 (18.123.9) months, ORR was 43.6%, and CBR was 74.3%. 42 pts (median age, 62 years) with MBC (88%) or LABC (12%) who progressed on 1L EVE + LET received optional 2L EVE + EXE. 2L median PFS (95% CI) was 3.7 (1.89.1) months, ORR was 4.8%, and CBR was 21.4%. Common 1L adverse events (all grades, regardless of drug relationship) were stomatitis (69%), weight loss (44%), diarrhea (40%), nausea (37%), and anemia (35%); 2L adverse events included stomatitis (19%) and weight loss (19%). Median duration of follow-up from start of 1L to the data cutoff for these new analyses (17 June 2016) was 23.5 months. OS will be analyzed at a later data cut. Conclusions: EVE + LET is an effective regimen in 1L ER+, HER2− advanced BC. Thesedata support previously reported BOLERO-2 data demonstrating a PFS improvement from addition of EVE to an aromatase inhibitor. 2L data, although limited by the small number of pts, show preliminary evidence of EVE activity when continued beyond disease progression. No new safety signals were seen. Lower rates of stomatitis in 2L were noted. Clinical trial information: NCT01698918.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | | | - Melanie Royce
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Felipe Cruz
- Instituto Brasileiro de Controle do Câncer, Mooca, Brazil
| | | | - Roberto Hegg
- Hospital Pérola Byington/FMUSP, Centro de Referência da Saúde da Mulher, São Paulo, Brazil
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Joon Jeong
- Yonsei University Health System, Seoul, Republic of Korea
| | | | | | | | | | | | | | - Chinjune Lin
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Campone M, Marschner N, Villanueva C, Sonke G, Alba E, Jakobsen E, Su F, He W, Germa C, André F. First-line ribociclib + letrozole in HR+, HER2– ABC: Efficacy by baseline tumor markers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Guyon A, Inocente C, Villanueva C, Lin J, Franco P. 0953 PREVALENCE OF METABOLIC SYNDROME AND LIVER STEATOSIS IN CHILDREN WITH IDIOPATHIC NARCOLEPSY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.952] [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: 11/14/2022] Open
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Villanueva C, Malvestiti J, Chaigneau L, Cals L, Pivot X. Nouvelles approches thérapeutiques dans le cancer du sein HER2 positif. ONCOLOGIE 2017. [DOI: 10.1007/s10269-015-2534-z] [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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O'Shaughnessy J, Petrakova K, Sonke GS, André F, Conte P, Arteaga CL, Cameron DA, Hart LL, Villanueva C, Jakobsen EH, Lindquist D, Souami F, Li X, Germa C, Hirawat S, Hortobagyi GN. Abstract P4-22-05: First-line ribociclib plus letrozole in patients with de novo HR+, HER2– advanced breast cancer (ABC): A subgroup analysis of the MONALEESA-2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Around 15,000 US patients per year are diagnosed with de novo ABC. Due to the absence of prior systemic treatment for breast cancer, tumors of patients with de novo ABC may exhibit a different disease biology, which could result in different tumor responses compared with patients who have relapsed breast cancer. Ribociclib is an orally bioavailable cyclin-dependent kinase (CDK) 4/6 inhibitor. Results from MONALEESA-2, a double-blind, placebo-controlled, randomized Phase 3 trial (NCT01958021), demonstrated that first-line therapy with ribociclib + letrozole significantly improved progression-free survival (PFS) vs placebo + letrozole in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) ABC. Many patients with de novo ABC receive endocrine therapy in the first line and in subsequent lines; here we present results from the MONALEESA-2 study in a subpopulation of patients with de novo ABC.
Methods: Postmenopausal women (N=668) with HR+, HER2– ABC who had no prior systemic therapy for ABC were randomized 1:1 (stratified by liver and/or lung metastases) to receive ribociclib (600 mg/day; 3-weeks-on/1-week-off) + letrozole (2.5 mg/day; continuous) or placebo + letrozole. Patients with de novo ABC were eligible. Additional eligibility criteria included measurable disease or ≥1 predominantly lytic bone lesion, Eastern Cooperative Oncology Group performance status ≤1, and adequate bone marrow/organ function. Prior CDK4/6 inhibitors or systemic therapy for ABC were prohibited. Patients may have received ≤14 days of letrozole or anastrozole for ABC. The primary endpoint was locally assessed PFS; a predefined subgroup analysis evaluated PFS in patients with de novo ABC.
Results: In total, 227 patients with de novo ABC were enrolled. Patients with de novo ABC were equally distributed with 114 (34%) and 113 (34%) in the ribociclib + letrozole and placebo + letrozole arms, respectively. Median duration of exposure to study treatment in the ribociclib + letrozole vs placebo + letrozole arms was 14.1 vs 12.8 months. Treatment was discontinued in 84 (37%) patients with de novo ABC (ribociclib + letrozole vs placebo + letrozole, n [%]; 34 [30%] vs 50 [44%]). Reasons for treatment discontinuation (ribociclib + letrozole vs placebo + letrozole, n [%]) included disease progression (21 [18%] vs 41 [36%]), patient/physician decision (5 [4%] vs 6 [5%]), and adverse events (6 [5%] vs 3 [3%]). PFS was increased in patients with de novo ABC who received ribociclib + letrozole vs placebo + letrozole (hazard ratio=0.448 [95% confidence interval: 0.267–0.750]). The 12-month PFS event-free probability in patients with de novo ABC was 82% in the ribociclib + letrozole arm vs 66% in the placebo + letrozole arm.
Conclusions: The combination of ribociclib + letrozole significantly improved PFS compared with placebo + letrozole in postmenopausal women with HR+, HER2– de novo ABC at diagnosis and therefore may become an important treatment option in the de novo ABC setting.
Keywords: Advanced breast cancer; CDK4/6 inhibitor; Letrozole; Ribociclib
Citation Format: O'Shaughnessy J, Petrakova K, Sonke GS, André F, Conte P, Arteaga CL, Cameron DA, Hart LL, Villanueva C, Jakobsen EH, Lindquist D, Souami F, Li X, Germa C, Hirawat S, Hortobagyi GN. First-line ribociclib plus letrozole in patients with de novo HR+, HER2– advanced breast cancer (ABC): A subgroup analysis of the MONALEESA-2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-05.
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Affiliation(s)
- J O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - K Petrakova
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - GS Sonke
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - F André
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - P Conte
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - CL Arteaga
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - DA Cameron
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - LL Hart
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - C Villanueva
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - EH Jakobsen
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - D Lindquist
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - F Souami
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - X Li
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - C Germa
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - S Hirawat
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - GN Hortobagyi
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
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Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Abstract P2-11-08: Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-11-08] [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
Stomatitis is the most frequent adverse event reported in trials of mTOR-inhibitors, including EVE. In the pivotal phase 3 BOLERO-2 study, stomatitis incidence in the EVE + exemestane (EXE) arm was 59%. The BOLERO-4 study (NCT01698918) evaluated the efficacy and safety of first-line EVE + LET in postmenopausal pts with HR+, HER2− metastatic or locally advanced breast cancer (ABC). BOLERO-4 also assessed the effectiveness of an alcohol-free dexamethasone (0.5 mg/ 5ml; DEX) oral rinse for treating stomatitis in a subset of pts (USA).
Methods
Postmenopausal pts with HR+, HER2− ABC previously untreated for advanced disease received EVE (10 mg/day) + LET (2.5 mg/day).At disease progression, pts were offered EVE (10 mg/day) + EXE (25 mg/day). Pts who had at least one episode of stomatitis received oral stomatitis daily questionnaire (OSDQ), which is a 6 question pt-reported outcome (PRO) survey (Stiff et al, JCO. 2006). A subset of these pts (USA) was randomized (1:1) to receive DEX or standard of care (SOC). The primary objective of investigator-assessed progression-free survival in the first-line setting for ABC was presented previously. A secondary objective was to evaluate the effectiveness of the DEX oral rinse in reducing the severity and duration of stomatitis, using OSDQ data.
Results
Of the total 202 pts enrolled in this study, 52 pts were enrolled in USA, of which, 24 (46.2%) were randomized to receive DEX (n=11) or SOC (n=13), upon confirmation of stomatitis. The median duration of first stomatitis episode was longer per OSDQ (DEX, not estimable vs SOC, 13.7 wk) compared with physician-reported duration (DEX, 1.6 wk vs SOC, 1.9 wk). PRO OSDQ results were similar in both arms.
Among the 202 pts enrolled, 89 (44.1%) filled the OSDQ at their first stomatitis episode. The median time from treatment initiation to first stomatitis episode was 1.7 wk; median duration of stomatitis was 13.7 wk (OSDQ) vs 2.1 wk (physician reported). The majority of pts experiencing stomatitis had moderate/little/no soreness, moderate/low/no pain, and stomatitis had low/no effect on daily activities (Table 1).
Table 1. OSDQ Key Results (N=87)Questions (Score)First Day of Stomatitis Episode, n (%)End of First Stomatitis Episode, n (%)Overall healthPoor (0-4)20 (23.0)23 (26.4)Moderate (5-7)40 (46.0)32 (36.8)Perfect (8-10)27 (31.0)32 (36.8)Mouth and throat sorenessNo/a little/moderate (0-2)64 (73.6)84 (96.6)A lot or extreme (3-4)23 (26.4)3 (3.4)Mouth pain severityNo/low/moderate (0-4)51 (58.6)73 (83.9)Severe (5-7)24 (27.6)10 (11.5)Unbearable (8-10)12 (13.8)4 (4.6)Effect on daily activitiesNo/low (0-4)70 (80.5)78 (89.7)Moderate (5-7)11 (12.6)4 (4.6)High (8-10)6 (6.9)5 (5.7)
Conclusions
Overall, patient-reported median duration of stomatitis was longer than that reported by physicians, most likely due to differences in perceptions and the challenges in collecting and cleaning PRO data. Overall good health score was maintained in the majority of pts experiencing stomatitis and stomatitis had low/no effect on daily activities. However, these results, especially in the randomized subset need to be interpreted with caution owing to the small sample size, missing data and lack of commercially available DEX in most countries.
Citation Format: Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-08.
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Affiliation(s)
- C Villanueva
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - K Tsugawa
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - T Toyama
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - W Noh
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - J Jeong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Cardoso
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Sriuranpong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Srimuninnimit
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Ozguroglu
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - S Kendall
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Falkson
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Cianfrocca
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Manlius
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - JCJ Lin
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Ringeisen
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - A Ridolfi
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Royce
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
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Meynard G, Mansi L, Lebahar P, Villanueva C, Klajer E, Calcagno F, Vivalta A, Chaix M, Collonge-Rame MA, Populaire C, Algros MP, Colpart P, Neidich J, Pivot X, Curtit E. First description of a double heterozygosity for BRCA1 and BRCA2 pathogenic variants in a French metastatic breast cancer patient: A case report. Oncol Rep 2017; 37:1573-1578. [DOI: 10.3892/or.2017.5422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/02/2017] [Indexed: 11/06/2022] Open
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Sonke G, Hart L, Campone M, Erdkamp F, Janni W, Verma S, Villanueva C, Jakobsen E, Alba E, Wist E, Favret A, Bachelot T, Hegg R, Wheatley-Price P, Souami F, Sutradhar S, Miller M, Germa C, Burris H. Efficacy and safety of ribociclib (LEE011) + letrozole in elderly patients with hormone receptor-positive (HR+), HER2-negative (HER2−) advanced breast cancer (ABC) in MONALEESA-2. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30091-6] [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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Herrera EA, Cifuentes-Zúñiga F, Figueroa E, Villanueva C, Hernández C, Alegría R, Arroyo-Jousse V, Peñaloza E, Farías M, Uauy R, Casanello P, Krause BJ. N-Acetylcysteine, a glutathione precursor, reverts vascular dysfunction and endothelial epigenetic programming in intrauterine growth restricted guinea pigs. J Physiol 2016; 595:1077-1092. [PMID: 27739590 DOI: 10.1113/jp273396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/11/2016] [Indexed: 12/19/2022] Open
Abstract
KEY POINTS Intrauterine growth restriction (IUGR) is associated with vascular dysfunction, oxidative stress and signs of endothelial epigenetic programming of the umbilical vessels. There is no evidence that this epigenetic programming is occurring on systemic fetal arteries. In IUGR guinea pigs we studied the functional and epigenetic programming of endothelial nitric oxide synthase (eNOS) (Nos3 gene) in umbilical and systemic fetal arteries, addressing the role of oxidative stress in this process by maternal treatment with N-acetylcysteine (NAC) during the second half of gestation. The present study suggests that IUGR endothelial cells have common molecular markers of programming in umbilical and systemic arteries. Notably, maternal treatment with NAC restores fetal growth by increasing placental efficiency and reverting the functional and epigenetic programming of eNOS in arterial endothelium in IUGR guinea pigs. ABSTRACT In humans, intrauterine growth restriction (IUGR) is associated with vascular dysfunction, oxidative stress and signs of endothelial programming in umbilical vessels. We aimed to determine the effects of maternal antioxidant treatment with N-acetylcysteine (NAC) on fetal endothelial function and endothelial nitric oxide synthase (eNOS) programming in IUGR guinea pigs. IUGR was induced by implanting ameroid constrictors on uterine arteries of pregnant guinea pigs at mid gestation, half of the sows receiving NAC in the drinking water (from day 34 until term). Fetal biometry and placental vascular resistance were followed by ultrasound throughout gestation. At term, umbilical arteries and fetal aortae were isolated to assess endothelial function by wire-myography. Primary cultures of endothelial cells (ECs) from fetal aorta, femoral and umbilical arteries were used to determine eNOS mRNA levels by quantitative PCR and analyse DNA methylation in the Nos3 promoter by pyrosequencing. Doppler ultrasound measurements showed that NAC reduced placental vascular resistance in IUGR (P < 0.05) and recovered fetal weight (P < 0.05), increasing fetal-to-placental ratio at term (∼40%) (P < 0.001). In IUGR, NAC treatment restored eNOS-dependent relaxation in aorta and umbilical arteries (P < 0.05), normalizing eNOS mRNA levels in EC fetal and umbilical arteries (P < 0.05). IUGR-derived ECs had a decreased DNA methylation (∼30%) at CpG -170 (from the transcription start site) and this epigenetic signature was absent in NAC-treated fetuses (P < 0.001). These data show that IUGR-ECs have common molecular markers of eNOS programming in umbilical and systemic arteries and this effect is prevented by maternal treatment with antioxidants.
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Affiliation(s)
- Emilio A Herrera
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia 7500922, Santiago, Chile
| | - Francisca Cifuentes-Zúñiga
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Esteban Figueroa
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia 7500922, Santiago, Chile
| | - Cristian Villanueva
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia 7500922, Santiago, Chile
| | - Cherie Hernández
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile.,Division of Obstetrics & Gynaecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - René Alegría
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia 7500922, Santiago, Chile
| | - Viviana Arroyo-Jousse
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Estefania Peñaloza
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Marcelo Farías
- Division of Obstetrics & Gynaecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Ricardo Uauy
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Paola Casanello
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile.,Division of Obstetrics & Gynaecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
| | - Bernardo J Krause
- Department of Neonatology, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago 8330024, Santiago, Chile
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Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Paluch-Shimon S, Campone M, Blackwell KL, André F, Winer EP, Janni W, Verma S, Conte P, Arteaga CL, Cameron DA, Petrakova K, Hart LL, Villanueva C, Chan A, Jakobsen E, Nusch A, Burdaeva O, Grischke EM, Alba E, Wist E, Marschner N, Favret AM, Yardley D, Bachelot T, Tseng LM, Blau S, Xuan F, Souami F, Miller M, Germa C, Hirawat S, O'Shaughnessy J. Ribociclib as First-Line Therapy for HR-Positive, Advanced Breast Cancer. N Engl J Med 2016; 375:1738-1748. [PMID: 27717303 DOI: 10.1056/nejmoa1609709] [Citation(s) in RCA: 1173] [Impact Index Per Article: 146.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The inhibition of cyclin-dependent kinases 4 and 6 (CDK4/6) could potentially overcome or delay resistance to endocrine therapy in advanced breast cancer that is positive for hormone receptor (HR) and negative for human epidermal growth factor receptor 2 (HER2). METHODS In this randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of the selective CDK4/6 inhibitor ribociclib combined with letrozole for first-line treatment in 668 postmenopausal women with HR-positive, HER2-negative recurrent or metastatic breast cancer who had not received previous systemic therapy for advanced disease. We randomly assigned the patients to receive either ribociclib (600 mg per day on a 3-weeks-on, 1-week-off schedule) plus letrozole (2.5 mg per day) or placebo plus letrozole. The primary end point was investigator-assessed progression-free survival. Secondary end points included overall survival, overall response rate, and safety. A preplanned interim analysis was performed on January 29, 2016, after 243 patients had disease progression or died. Prespecified criteria for superiority required a hazard ratio of 0.56 or less with P<1.29×10-5. RESULTS The duration of progression-free survival was significantly longer in the ribociclib group than in the placebo group (hazard ratio, 0.56; 95% CI, 0.43 to 0.72; P=3.29×10-6 for superiority). The median duration of follow-up was 15.3 months. After 18 months, the progression-free survival rate was 63.0% (95% confidence interval [CI], 54.6 to 70.3) in the ribociclib group and 42.2% (95% CI, 34.8 to 49.5) in the placebo group. In patients with measurable disease at baseline, the overall response rate was 52.7% and 37.1%, respectively (P<0.001). Common grade 3 or 4 adverse events that were reported in more than 10% of the patients in either group were neutropenia (59.3% in the ribociclib group vs. 0.9% in the placebo group) and leukopenia (21.0% vs. 0.6%); the rates of discontinuation because of adverse events were 7.5% and 2.1%, respectively. CONCLUSIONS Among patients receiving initial systemic treatment for HR-positive, HER2-negative advanced breast cancer, the duration of progression-free survival was significantly longer among those receiving ribociclib plus letrozole than among those receiving placebo plus letrozole, with a higher rate of myelosuppression in the ribociclib group. (Funded by Novartis Pharmaceuticals; ClinicalTrials.gov number, NCT01958021 .).
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Affiliation(s)
- Gabriel N Hortobagyi
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Salomon M Stemmer
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Howard A Burris
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Yoon-Sim Yap
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Gabe S Sonke
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Shani Paluch-Shimon
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Mario Campone
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Kimberly L Blackwell
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Fabrice André
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Eric P Winer
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Wolfgang Janni
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Sunil Verma
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Pierfranco Conte
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Carlos L Arteaga
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - David A Cameron
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Katarina Petrakova
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Lowell L Hart
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Cristian Villanueva
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Arlene Chan
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Erik Jakobsen
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Arnd Nusch
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Olga Burdaeva
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Eva-Maria Grischke
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Emilio Alba
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Erik Wist
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Norbert Marschner
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Anne M Favret
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Denise Yardley
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Thomas Bachelot
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Ling-Ming Tseng
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Sibel Blau
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Fengjuan Xuan
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Farida Souami
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Michelle Miller
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Caroline Germa
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Samit Hirawat
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
| | - Joyce O'Shaughnessy
- From the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.), and Texas Oncology-Baylor Charles A. Sammons Cancer Center and the U.S. Oncology Network, Dallas (J.O.) - all in Texas; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv (S.M.S.), and Sheba Medical Center, Ramat Gan (S.P.-S.) - both in Israel; the Sarah Cannon Research Institute (H.A.B., D.Y.), Vanderbilt-Ingram Cancer Center (C.L.A.), and Tennessee Oncology (D.Y.) - all in Nashville; National Cancer Center Singapore, Singapore (Y.-S.Y.); Netherlands Cancer Institute and BOOG Study Center, Amsterdam (G.S.S.); Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain (M.C.), Institut Gustave Roussy, Université Paris Sud, Villejuif (F.A.), University Hospital of Besançon, Besançon (C.V.), and Centre Léon Bérard, Lyon (T.B.) - all in France; Duke University Medical Center, Durham, NC (K.L.B.); Dana-Farber Cancer Institute, Boston (E.P.W.); University of Ulm, Ulm (W.J.), Onkologische Praxis, Velbert (A.N.), University of Tübingen, Tübingen (E.-M.G.), and Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg (N.M.) - all in Germany; Tom Baker Cancer Centre, Calgary, AB, Canada (S.V.); University of Padua and Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.); Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh (D.A.C.); Masaryk Memorial Cancer Institute, Brno, Czech Republic (K.P.); Florida Cancer Specialists-Sarah Cannon Research Institute, Fort Myers (L.L.H.); Breast Cancer Research Centre-Western Australia and Curtin University, Perth, Australia (A.C.); Department of Oncology, Vejle Hospital, Vejle, Denmark (E.J.); Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia (O.B.); Hospital Universitario Virgen de la Victoria, Institute of Biomedical Research in Málaga, Málaga, Spain (E.A.); Oslo University Hospital, Oslo (E.W.); Virginia Cancer Specialists, Arlington (A.M.F.); Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (L.-M.T.); Rainier Hematology-Oncology, Northwest Medical Specialties, Puyallup, WA (S.B.); Novartis Pharmaceuticals, East Hanover, NJ (F.X., M.M., C.G., S.H.); and Novartis Pharma, Basel, Switzerland (F.S.)
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Dénommé F, Kroemer M, Montcuquet P, Nallet G, Thiery-Vuillemin A, Bazan F, Mouillet G, Villanueva C, Demarchi M, Stein U, Almotlak H, Chaigneau L, Curtit E, Meneveau N, Maurina T, Dobi E, Hon TNT, Cals L, Mansi L, Verlut C, Pana-Katatali H, Caubet M, Paillard MJ, Limat S, Pivot X, Nerich V. [Prevalence and management of pain in patients with metastatic cancer in Franche-Comté]. Bull Cancer 2016; 103:849-860. [PMID: 27692731 DOI: 10.1016/j.bulcan.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/12/2016] [Revised: 07/15/2016] [Accepted: 08/29/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Pain management is a major public health problem, especially in oncology. In order to assess professional practice, the IRFC-FC conducted a survey amongst patients with metastatic osteophilic solid tumor in Franche-Comté. The aims were to assess the pain prevalence, and its characteristics, its management and its impact on patients' quality of life in patients in pain. METHODS An observational, prospective and multicenter survey was conducted using a self-report questionnaire. Patients with metastatic breast or prostate cancer managed in 5 day-hospitals of the IRFC-FC over a period of three months were included. RESULTS Two hundred thirty-three questionnaires were analyzed. Pain prevalence rate was 48.5%. Three quarters of patients in pain had chronic background pain, moderate to severe, with or without breakthrough pain. Considering their pain intensity and their analgesic therapy, 42.0% of patients seem to have an inadequate treatment. Eighty-five percent of treated patients reported to be compliant and felt that their pain was well managed despite a strong impact on their quality of life. CONCLUSION The setting of a specific clinical pathway is essential to secure the standardized, optimal and efficient management of patients in pain. The assessment of patient satisfaction and quality of life must be integrated in clinical practice to identify patients in pain for which the treatment is inappropriate.
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Affiliation(s)
- Fanny Dénommé
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Marie Kroemer
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France
| | - Philippe Montcuquet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Gilles Nallet
- Oncolie, réseau de cancérologie de Franche-Comté, pôle cancérologie, 2, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Antoine Thiery-Vuillemin
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Fernando Bazan
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Guillaume Mouillet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Cristian Villanueva
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Martin Demarchi
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Ulrich Stein
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Hamadi Almotlak
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Loïc Chaigneau
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Elsa Curtit
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Nathalie Meneveau
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Tristan Maurina
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Erion Dobi
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Thierry Nguyen Tan Hon
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Laurent Cals
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Laura Mansi
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Clotilde Verlut
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Héloïse Pana-Katatali
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Mathieu Caubet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Marie-Justine Paillard
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Samuel Limat
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France
| | - Xavier Pivot
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Virginie Nerich
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France.
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Royce M, Villanueva C, Ozguroglu M, Bachelot T, Azevedo S, Melo Cruz F, Hegg R, Debled M, Gradishar W, Manlius C, Ridolfi A, Lin J, Ringeisen F, Cardoso F. BOLERO-4: Phase 2 trial of first-line everolimus (EVE) plus letrozole (LET) in estrogen receptor–positive (ER+), human epidermal growth factor receptor 2–negative (HER2-) advanced breast cancer (BC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moss S, Doyle M, Villanueva C. A Presentation of Single Centre Data on Aortic Valve Surgery in an Octogenarian Population Group. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Petracci F, Zarba J, Michelotti A, Livi L, Villanueva C, Bordonaro R, Sherstnev V, Kowalyszyn R, Marinsek N, Zhou Z, Macalalad A, Koo V, Trieschman E, Xie J, Signorovitch J, Ratto B, Higuchi K, Saghatchian M. Abstract 2269: Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: This study aims to compare patient characteristics and outcomes of everolimus (EVE) + endocrine therapy (ET) vs ET monotherapy among postmenopausal women with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (aBC) across multiple countries.
Methods: This retrospective chart review included postmenopausal patients with HR+/HER2- aBC who were previously treated with a nonsteroidal aromatase inhibitor (NSAI) and later received EVE + ET, ET monotherapy, or chemotherapy (the index treatment) from 17 sites in 6 countries (Canada, the Netherlands, France, Italy, Russia, and Argentina). This is a subset analysis comparing patients who received EVE + ET vs ET monotherapy. Stratified sampling by index treatment and line of therapy was used to ensure the sample groups included different treatments and lines of therapy. Patient characteristics were compared using Wilcoxon rank-sum tests for continuous variables and Fisher exact tests for categorical variables. Progression-free survival (PFS) was estimated using Kaplan-Meier analysis and was compared between the 2 groups using Cox proportional hazards models adjusting for age, country, line of therapy, metastatic sites, symptoms, comorbidities, prior chemotherapy, recurrent vs de novo cancer, and time from the last adjuvant ET to aBC diagnosis.
Results: A total of 119 patients in the EVE + ET group (77 in 1st/2nd, and 42 in 3rd/4th lines) and 102 patients in the ET monotherapy group (76 in 1st /2nd, and 26 in 3rd/4th lines) were included in the study. All but 2 patients in the EVE + ET group received EVE + exemestane; ET monotherapy included fulvestrant (46.1%), exemestane (21.6%), NSAIs (16.7%), and tamoxifen (14.7%). Patients in the EVE + ET group were numerically younger (median 63.0 vs 66.0 years; P = .10); appeared to have fewer comorbidities, particularly hypertension (11.8% vs 35.3%; P < .01); had a higher proportion of visceral metastasis (43.7% vs 32.4%; P = .10) and a higher
number of metastatic sites (median 2.0 vs 1.0; P = .14); had a lower proportion of bone/joint symptoms (30.3% vs 42.2%; P = .07); and had a shorter time from initiation of the last adjuvant ET to aBC diagnosis (median 43.1 vs 55.6 months; P = .05). In the unadjusted analysis, patients in the EVE + ET group had similar PFS as those in the ET monotherapy group (median 9.1 vs 9.2 months; unadjusted HR = 0.98; P = .90), but after adjustment for baseline characteristics, the hazard of progression or death of any cause was lower (adjusted HR = 0.67; P = .05).
Conclusions: Patients who received EVE + ET tended to be younger with fewer comorbidities yet have disease with faster progression and a higher burden of metastases. After adjusting for these characteristics, EVE + ET was associated with longer PFS compared with ET monotherapy.
Citation Format: Fernando Petracci, Jose Zarba, Andrea Michelotti, Lorenzo Livi, Cristian Villanueva, Roberto Bordonaro, Viktor Sherstnev, Rubén Kowalyszyn, Nina Marinsek, Zhou Zhou, Alexander Macalalad, Valerie Koo, Erich Trieschman, Jipan Xie, James Signorovitch, Barbara Ratto, Keiko Higuchi, Mahasti Saghatchian. Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2269.
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Affiliation(s)
| | - Jose Zarba
- 2Centro Médico San Roque Tucuman, San Miguel de Tucuman, Argentina
| | - Andrea Michelotti
- 3Oncologia Medica I, Ospedale S.Chiara, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lorenzo Livi
- 4Azienda Ospedaliero Universitaria Careggi Firenze, Firenze, Italy
| | | | - Roberto Bordonaro
- 6UOC Oncologia Medica ARNAS Garibaldi Nesima-Catania, Nesima-Catania, Italy
| | - Viktor Sherstnev
- 7Oncology Clinical Oncology Dispensary #5, Moscow, Russian Federation
| | | | | | | | | | | | | | | | | | - Barbara Ratto
- 11Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Keiko Higuchi
- 11Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Curtit E, Meynard G, Villanueva C, Mansi L, Chaix M, Vilalta A, Kuo JZ, Villa M, Neidich J, Tomar A, Arianpour A, Lebahar P, Pivot X. Abstract P2-09-10: Double heterozygosity for BRCA1 and BRCA2 pathogenic variants in a French metastatic breast cancer patient. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-10] [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
Double heterozygosity is an extremely rare occurrence in hereditary breast and ovarian cancer syndrome (HBOC [MIM 604370; MIM 612555]) where two pathogenic variants, one in BRCA1 and one in BRCA2, are found in an individual. To date, only a few case reports and case series have been reported in the literature (1-3). Furthermore, little is known about the clinical characteristics, family history, and tumor histology in these patients. In this study, we utilized targeted gene testing with next-generation sequencing (NGS) technology in an early-onset metastatic breast cancer patient from France. We evaluated germline variants using Pathway Genomics' BRCATrueTM NGS test, which analyzes variants covering all exons and exon flanking regions in both the BRCA1 and BRCA2 genes. All variant calls were determined after alignment and mapping to the GRCh37/hg19 reference genome. Variant calls were confirmed by Sanger sequencing. In this patient, a c.1016dupA (p.V340GfsX6) frameshift variant was found in BRCA1 along with a c.6814delA (p.R2272EfsX8) frameshift variant in BRCA2. Both frameshift variants are predicted to truncate the BRCA proteins. The BRCA1 c.1016dupA variant is considered a Norwegian founder mutation but has also been observed in individuals who are of French-Canadian, French, Italian or Dutch ancestry (4-7). The BRCA2 c.6814delA (p.R2272Efs*8) pathogenic variant, also known as 7042delA, is predicted to truncate the BRCA2 protein and has been identified in individuals with a personal or family history of breast and/or ovarian cancer (8,9). To the best of our knowledge, the combination of these two pathogenic variants in an individual has not been previously reported. In a clinical diagnostic setting, the possibility of double heterozygosity of pathogenic variants in more than one susceptibility gene should be considered, especially in patients with early-onset metastatic cancers. Furthermore, genetic testing and genetic counseling should also be indicated for high-risk family members.
1. Heidemann, S. et al. (2012) Breast cancer research and treatment 134, 1229-1239
2. Lavie, O., et al. (2011) Annals of oncology : official journal of the European Society for Medical Oncology / ESMO 22, 964-966
3. Nomizu, T., et al. (2012). Breast cancer
4. Andersen, T. I., Borresen, A. L., and Moller, P. (1996) American journal of human genetics 59, 486-487
5. Caputo, S., et al. (2012) Nucleic acids research 40, D992-1002
6. Dorum, A., et al. (1999). American journal of human genetics 65, 671-679
7. Simard, J., et al. (1994). Nature genetics 8, 392-398
8. Novakovic, S., et al. (2012) International journal of oncology 41, 1619-1627
9. Tea, M. K., et al. (2014) Maturitas 77, 68-72.
Citation Format: Curtit E, Meynard G, Villanueva C, Mansi L, Chaix M, Vilalta A, Kuo JZ, Villa M, Neidich J, Tomar A, Arianpour A, Lebahar P, Pivot X. Double heterozygosity for BRCA1 and BRCA2 pathogenic variants in a French metastatic breast cancer patient. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-10.
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Affiliation(s)
- E Curtit
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - G Meynard
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - C Villanueva
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - L Mansi
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - M Chaix
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - A Vilalta
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - JZ Kuo
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - M Villa
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - J Neidich
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - A Tomar
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - A Arianpour
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - P Lebahar
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
| | - X Pivot
- Service Oncologie Médicale-CHU Besançon, Besançon, Cédex, France; Pathway Genomics, San Diego, CA
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Bachelot T, Villanueva C, Royce M, Debled M, Cruz FM, Hegg R, Brechenmacher T, Manlius C, Ringeisen F, Cardoso F. PO56 BOLERO-4: A PHASE 2, OPEN-LABEL, MULTICENTER, SINGLE-ARM TRIAL INVESTIGATING THE EFFICACY AND SAFETY OF FIRST-LINE EVEROLIMUS (EVE) IN COMBINATION WITH LETROZOLE (LET) IN POSTMENOPAUSAL PATIENTS (PTS) WITH ESTROGEN RECEPTOR–POSITIVE (ER+), HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2–NEGATIVE (HER2–) METASTATIC OR LOCALLY ADVANCED UNRESECTABLE BREAST CANCER (BC). Breast 2015. [DOI: 10.1016/s0960-9776(15)30068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Grimsby GM, Keays MA, Villanueva C, Bush NC, Snodgrass WT, Gargollo PC, Jacobs MA. Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation. J Pediatr Urol 2015; 11:275.e1-4. [PMID: 26233553 DOI: 10.1016/j.jpurol.2015.04.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic hernia repair with percutaneous ligation of the patent processes vaginalis is a minimally invasive alternative to open inguinal herniorrhaphy in children. With the camera port concealed at the umbilicus, this technique offers an excellent cosmetic result. It is also faster than the traditional laparoscopic repair with no differences in complication rates or hospital stay. The goal of this study was to describe a series of consecutive patients, emphasizing the impact of suture materials (absorbable vs. non-absorbable) on hernia recurrences. METHODS A retrospective review was performed of consecutive transperitoneal laparoscopic subcutaneous ligations of a symptomatic hernia and/or communicating hydrocele by 4 surgeons. Patients > Tanner 2 or with prior hernia repair were excluded. The success of the procedure and number of sutures used was compared between cases performed with absorbable vs. non-absorbable suture. Risk factors for surgical failure (age, weight, number of sutures used, suture type) were assessed with logistic regression. RESULTS 94 patients underwent laparoscopic percutaneous hernia ligation at a mean age of 4.9 years. Outcomes in 85 (90%) patients with 97 hernia repairs at a mean of 8 months after surgery revealed 26% polyglactin vs 4% polyester recurrences (p = 0.004) which occurred at mean of 3.6 months after surgery, Table 1. Repairs performed with non-absorbable suture required only 1 suture more often than those performed with absorbable suture (76% vs 60%, p = 0.163). Logistic regression revealed suture type was an independent predictor for failure (p = 0.017). Weight (p = 0.249), age (p = 0.055), and number of sutures (p = 0.469) were not significantly associated with recurrent hernia. DISCUSSION Our review of consecutive hernia repairs using the single port percutaneous ligation revealed a significantly higher recurrent hernia rate with absorbable (26%) versus non-absorbable (4%) suture. This finding remained significant in a logistic regression model irregardless of number of sutures placed, age, and weight. Though the authors acknowledge the drawback of the potential for learning curve to confound our data, we still feel these findings are clinically important as this analysis of outcomes has changed our surgical practice as now all providers involved perform this procedure with exclusively non-absorbable suture. We thus suggest that surgeons who perform this technique, especially those newly adopting it, use non-absorbable suture for optimal patient outcomes. CONCLUSIONS Recurrent hernia after laparoscopic percutaneous hernia ligation was significantly lower in repairs performed with non-absorbable suture. Based on this data, we recommend the use of non-absorbable suture during laparoscopic ligation of inguinal hernias in children.
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Affiliation(s)
- G M Grimsby
- Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110, USA; Children's Health, 2350 N Stemmons Fwy, Dallas, TX 75207, USA.
| | - M A Keays
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario K1H 8L1, Canada.
| | - C Villanueva
- Omaha Pediatric Urology, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - N C Bush
- PARC Urology, 5680 Frisco Square Blvd., Frisco, TX 75034, USA.
| | - W T Snodgrass
- PARC Urology, 5680 Frisco Square Blvd., Frisco, TX 75034, USA.
| | - P C Gargollo
- Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX 77030, USA.
| | - M A Jacobs
- Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110, USA; Children's Health, 2350 N Stemmons Fwy, Dallas, TX 75207, USA.
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Paillard MJ, Curtit E, Dobi E, Mansi L, Bazan F, Villanueva C, Chaigneau L, Montcuquet P, Meneveau N, Thiery-Vuillemin A, Nerich V, Pivot X. Efficacité, tolérance et coût de l’éribuline chez des patientes présentant un cancer du sein métastatique. Bull Cancer 2015; 102:737-48. [DOI: 10.1016/j.bulcan.2015.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
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Bush NC, Keays M, Adams C, Mizener K, Pritzker K, Smith W, Traylor J, Villanueva C, Snodgrass WT. Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. J Pediatr Urol 2015; 11:126.e1-7. [PMID: 25842992 DOI: 10.1016/j.jpurol.2015.01.011] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES 2011 American Academy of Pediatrics guidelines recommended renal-bladder ultrasound (RBUS) as the only evaluation after febrile urinary tract infection (FUTI) in infants aged 2-24 months. We determined the sensitivity, specificity, and false negative rate of RBUS to identify DMSA-detected renal damage in this age group as well as in older children. METHODS Consecutive patients referred to pediatric urology with a history of FUTI underwent DMSA ≥ 3 months after FUTI. Abnormal RBUS was defined as: Society of Fetal Urology hydronephrosis grades I-IV; hydroureter ≥ 7 mm; renal scar defined as focal parenchymal thinning; and/or size discrepancy ≥ 1 cm between kidneys. Abnormal DMSA was presence of any focal uptake defects and/or split renal function < 44%. We calculated sensitivity, specificity, positive and negative predictive values, and false negative rates of RBUS compared to DMSA. RESULTS 618 patients (79% female), median age 3.4 years, were referred for FUTIs. Of the 512 (83%) with normal RBUS, 99 (19%) had abnormal DMSA. Children with normal RBUS after their first FUTI had abnormal DMSA in 15/151 (10%) aged ≤ 24 months and 23/119 (19%) aged > 24 months. RBUS had poor sensitivity (34%) and low positive predictive value (47%) to identify patients with renal damage. 99/149 (66%) children with renal damage on DMSA had normal RBUS. CONCLUSION After FUTI, 66% of children with reduced renal function and/or renal cortical defects found by DMSA scintigraphy had a normal RBUS. Since abnormal DMSA may correlate with increased risk for VUR, recurrent FUTI and renal damage, our data suggest RBUS alone will fail to detect a significant proportion of patients at risk. The data suggest that imaging after FUTI should include acute RBUS and delayed DMSA, reserving VCUG for patients with abnormal DMSA and/or recurrent FUTI.
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Affiliation(s)
- N C Bush
- Pediatric & Adult Reconstructive Center for Urology, Dallas, TX, USA.
| | - M Keays
- Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | - C Adams
- University of Texas Southwestern, Dallas, TX, USA
| | - K Mizener
- Pediatric & Adult Reconstructive Center for Urology, Dallas, TX, USA.
| | - K Pritzker
- University of Texas Southwestern, Dallas, TX, USA
| | - W Smith
- University of Texas Southwestern, Dallas, TX, USA
| | - J Traylor
- University of Texas Southwestern, Dallas, TX, USA
| | - C Villanueva
- Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, USA
| | - W T Snodgrass
- Pediatric & Adult Reconstructive Center for Urology, Dallas, TX, USA.
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Tapia A, Villanueva C, Peón-Escalante R, Quintal R, Medina J, Peñuñuri F, Avilés F. The bond force constant and bulk modulus of small fullerenes using density functional theory and finite element analysis. J Mol Model 2015; 21:139. [PMID: 25957657 DOI: 10.1007/s00894-015-2649-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/18/2014] [Accepted: 03/09/2015] [Indexed: 11/27/2022]
Abstract
Dedicated bond force constant and bulk modulus of C n fullerenes (n = 20, 28, 36, 50, 60) are computed using density functional theory (DFT). DFT predicts bond force constants of 611, 648, 675, 686, and 691 N/m, for C20, C28, C36, C50, and C60, respectively, indicating that the bond force constant increases for larger fullerenes. The bulk modulus predicted by DFT increases with decreased fullerene diameter, from 0.874 TPa for C60 to 1.830 TPa for C20. The bond force constants predicted by DFT are then used as an input for finite element analysis (FEA) of the fullerenes, considered as spatial frames in structural models where the bond stiffness is represented by the DFT-computed bond force constant. In agreement with DFT, FEA predicts that smaller fullerenes are stiffer, and underestimates the bulk modulus with respect to DFT. The difference between the FEA and DFT predictions of the bulk modulus decreases as the size of the fullerene increases, from 20.9% difference for C20 to only 4% difference for C60. Thus, it is concluded that knowing the appropriate bond force constant, FEA can be used as a plausible approximation to model the elastic behavior of small fullerenes.
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Affiliation(s)
- A Tapia
- Facultad de Ingeniería, Universidad Autónoma de Yucatán, Av. Industrias no contaminantes por Periférico Norte, Cordemex, C.P. 97310, Mérida, Yucatán, Mexico,
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Cortes J, Vrdoljak E, Puglisi F, Marschner N, Gligorov J, Zielinski C, Villanueva C, Romieu G, Lang I, Ciruelos E, Veyret C, Fontana A, Oestergaard M, de Ducla S, Freudensprung U, von Minckwitz G. Abstract P3-06-08: Plasma (p) biomarker results from the TANIA trial evaluating continued or reintroduced bevacizumab (BEV) after 1st-line BEV for HER2-negative metastatic breast cancer (mBC). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-06-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: A potential predictive and prognostic effect of pretreatment pVEGF-A concentrations was suggested in exploratory analyses of phase III trials in HER2-negative mBC (AVADO), gastric cancer (AVAGAST), and pancreatic cancer (AViTA). This led to initiation of the MERiDiAN trial evaluating pVEGF-A prospectively in patients (pts) receiving 1st-line paclitaxel ± BEV in HER2-negative mBC. Potential predictive value was also noted for pVEGFR-2 in AVADO, AViTA, and in early BC in BEATRICE. We report prespecified pVEGF-A and pVEGFR-2 analyses in TANIA.
METHODS: TANIA is an open-label randomized phase III trial evaluating the addition of BEV (15 mg/kg q3w or 10 mg/kg q2w) to the investigator’s choice of chemotherapy (CT) in pts with HER2-negative mBC who experience disease progression (PD) on/after 1st-line BEV-containing therapy. Allocation to BEV or no BEV is continued with 3rd-line therapy after 2nd PD (ie no crossover permitted). The primary endpoint is PFS from randomization to 2nd-line PD/death. Pts consenting to the optional biomarker substudy provided 6 mL plasma samples in EDTA before drug administration at randomization, at wks 7 and 13, every 12 wks thereafter, and at 2nd PD. pVEGF-A and shedded pVEGFR-2 were measured using the IMPACT assay (v2.03). The median concentration for each marker before 2nd-line treatment was prespecified as the cut-off between low (≤ median) and high (> median) biomarker subgroups. 2nd-line PFS was analyzed in each subgroup.
RESULTS: The PFS benefit from BEV seen in the ITT population (N=494; stratified hazard ratio [HR] 0.75, 95% CI 0.61–0.93) was observed consistently within subgroups of the biomarker population (N=312). However, there was no differential BEV effect according to pVEGF-A or shedded pVEGFR-2 concentrations. The stratified HR for PFS was 0.69 (95% CI 0.46–1.04) in pts with low pVEGF-A (≤1010.6 pg/mL [median]) and 0.80 (95% CI 0.54–1.18) in pts with high pVEGF-A (interaction p=0.47). As all pts had received prior BEV, unlike earlier trials showing a potential predictive effect of pVEGF-A, we explored pVEGF-A concentrations according to BEV-free interval. The BEV-free interval was ≤12 wks in 117/150 pts (78%) in the CT arm and 136/162 pts (84%) in the BEV+CT arm. Median pVEGF-A was much lower in the subgroup of 59 pts with a BEV-free interval >12 wks (45.1 pg/mL) than in pts with a BEV-free interval ≤12 wks (1135.3 pg/mL). Analyses of 2nd-line PFS according to shedded pVEGFR-2 concentration showed stratified PFS HRs of 0.68 (95% CI 0.45–1.02) for low pVEGFR-2 (≤9.6 ng/mL [median]) and 0.90 (95% CI 0.60–1.34) for high pVEGFR-2 (interaction p=0.49).
CONCLUSIONS: The potential predictive effect of pVEGF-A in AVADO was not observed in TANIA, although high pVEGF-A concentrations in pts recently treated with BEV complicate interpretation. pVEGF-A is being evaluated prospectively in BEV-naïve pts in the ongoing MERiDiAN trial. Shedded pVEGFR-2 showed no predictive effect in TANIA and the suggested trend was in the opposite direction to the effect seen in AVADO and BEATRICE. Further analyses are planned to evaluate the impact of gene expression, cell-free DNA, protein expression, and DNA mutations on treatment effect in TANIA.
Citation Format: Javier Cortes, Eduard Vrdoljak, Fabio Puglisi, Norbert Marschner, Joseph Gligorov, Christoph Zielinski, Cristian Villanueva, Gilles Romieu, István Lang, Eva Ciruelos, Corinne Veyret, Andrea Fontana, Mikkel Oestergaard, Sabine de Ducla, Ulrich Freudensprung, Gunter von Minckwitz. Plasma (p) biomarker results from the TANIA trial evaluating continued or reintroduced bevacizumab (BEV) after 1st-line BEV for HER2-negative metastatic breast cancer (mBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-08.
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Snodgrass W, Villanueva C, Gargollo P, Jacobs M. New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder. J Pediatr Urol 2014; 10:906-10. [PMID: 24680474 DOI: 10.1016/j.jpurol.2014.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence. MATERIALS AND METHODS Consecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually. RESULTS There were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet). CONCLUSIONS Upper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.
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Affiliation(s)
- W Snodgrass
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
| | - C Villanueva
- University of Nebraska Medical Center, 988102 Nebraska Medical Center, Omaha, NE 68196-8102, USA.
| | - P Gargollo
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
| | - M Jacobs
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
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von Minckwitz G, Puglisi F, Cortes J, Vrdoljak E, Marschner N, Zielinski C, Villanueva C, Romieu G, Lang I, Ciruelos E, De Laurentiis M, Veyret C, de Ducla S, Freudensprung U, Srock S, Gligorov J. Bevacizumab plus chemotherapy versus chemotherapy alone as second-line treatment for patients with HER2-negative locally recurrent or metastatic breast cancer after first-line treatment with bevacizumab plus chemotherapy (TANIA): an open-label, randomised phase 3 trial. Lancet Oncol 2014; 15:1269-78. [PMID: 25273342 DOI: 10.1016/s1470-2045(14)70439-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [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: 01/28/2023]
Abstract
BACKGROUND Combining bevacizumab with first-line or second-line chemotherapy improves progression-free survival in HER2-negative locally recurrent or metastatic breast cancer. We assessed the efficacy and safety of further bevacizumab therapy in patients with locally recurrent or metastatic breast cancer whose disease had progressed after treatment with bevacizumab plus chemotherapy. METHODS In this open-label, randomised, phase 3 trial, we recruited patients who had HER2-negative locally recurrent or metastatic breast cancer that had progressed after receiving 12 weeks or more of first-line bevacizumab plus chemotherapy from 118 centres in 12 countries. Patients were randomly assigned (1:1) by use of a central interactive voice response system using a block randomisation schedule (block size four) stratified by hormone receptor status, first-line progression-free survival, selected chemotherapy, and lactate dehydrogenase concentration, to receive second-line single-agent chemotherapy either alone or with bevacizumab (15 mg/kg every 3 weeks or 10 mg/kg every 2 weeks). Second-line therapy was continued until disease progression, unacceptable toxicity, or consent withdrawal. At progression, patients randomly assigned to chemotherapy alone received third-line chemotherapy without bevacizumab; those randomly assigned to bevacizumab continued bevacizumab with third-line chemotherapy. The primary endpoint was progression-free survival from randomisation to second-line progression or death in the intention-to-treat population. This trial is ongoing, and registered with ClinicalTrials.gov, number NCT01250379. FINDINGS Between Feb 17, 2011, and April 3, 2013, 494 patients were randomly assigned to treatment (247 in each group). The median duration of follow-up at the time of this prespecified primary progression-free survival analysis was 15·9 months (IQR 9·1-21·7) in the chemotherapy-alone group and 16·1 months (10·6-22·7) in the combination group. Progression-free survival was significantly longer for those patients treated with bevacizumab plus chemotherapy than for those with chemotherapy alone (median: 6·3 months [95% CI 5·4-7·2] vs 4·2 months [3·9-4·7], respectively, stratified hazard ratio [HR] 0·75 [95% CI 0·61-0·93], two-sided stratified log-rank p=0·0068). The most common grade 3 or more adverse events were hypertension (33 [13%] of 245 patients receiving bevacizumab plus chemotherapy vs 17 [7%] of 238 patients receiving chemotherapy alone), neutropenia (29 [12%] vs 20 [8%]), and hand-foot syndrome (27 [11%] vs 25 [11%]). Grade 3 proteinuria occurred in 17 (7%) of 245 patients receiving combination therapy and one (<1%) of 238 patients receiving chemotherapy alone. Serious adverse events were reported in 61 (25%) of 245 patients receiving bevacizumab plus chemotherapy versus 44 (18%) of 238 patients receiving chemotherapy alone. INTERPRETATION These results suggest that continued VEGF inhibition with further bevacizumab is a valid treatment option for patients with locally recurrent or metastatic HER2-negative breast cancer whose disease was stabilised or responded to first-line bevacizumab with chemotherapy. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, and University Women's Hospital, Frankfurt, Germany.
| | | | - Javier Cortes
- Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eduard Vrdoljak
- Center of Oncology, University Hospital Split, Split, Croatia
| | | | - Christoph Zielinski
- Department of Medicine I and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Central European Cooperative Oncology Group, Vienna, Austria
| | | | - Gilles Romieu
- Institut du Cancer Montpellier, Val d'Aurelle, France
| | - István Lang
- National Institute of Oncology, Budapest, Hungary
| | - Eva Ciruelos
- Hospital Universitario 12 Octubre, Madrid, Spain
| | | | | | | | | | | | - Joseph Gligorov
- Assistance-Publique Hôpitaux de Paris-Tenon, Institut Universitaire de Cancerologie Université Pierre et Marie Curie, Sorbonne Université, Paris, France
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