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Stamp R, Cohn D, Hel-Or H, Sandler W. Kinect-ing the Dots: Using Motion-Capture Technology to Distinguish Sign Language Linguistic From Gestural Expressions. Lang Speech 2024; 67:255-276. [PMID: 37313985 DOI: 10.1177/00238309231169502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Just as vocalization proceeds in a continuous stream in speech, so too do movements of the hands, face, and body in sign languages. Here, we use motion-capture technology to distinguish lexical signs in sign language from other common types of expression in the signing stream. One type of expression is constructed action, the enactment of (aspects of) referents and events by (parts of) the body. Another is classifier constructions, the manual representation of analogue and gradient motions and locations simultaneously with specified referent morphemes. The term signing is commonly used for all of these, but we show that not all visual signals in sign languages are of the same type. In this study of Israeli Sign Language, we use motion capture to show that the motion of lexical signs differs significantly along several kinematic parameters from that of the two other modes of expression: constructed action and the classifier forms. In so doing, we show how motion-capture technology can help to define the universal linguistic category "word," and to distinguish it from the expressive gestural elements that are commonly found across sign languages.
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Affiliation(s)
- Rose Stamp
- Department of English Literature and Linguistics, Bar-Ilan University, Israel
| | | | - Hagit Hel-Or
- Department of Computer Science, University of Haifa, Israel
| | - Wendy Sandler
- Sign Language Research Lab, University of Haifa, Israel
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Liu Z, Lee K, Cohn D, Zhang M, Ai L, Li M, Zhang X, Jun T, Higashi MK, Pan Q, Oh W, Stolovitzky G, Schadt E, Wang X, Li SD. Analysis of real-world data to investigate evolving treatment sequencing patterns in advanced non-small cell lung cancers and their impact on survival. J Thorac Dis 2023; 15:2438-2449. [PMID: 37324065 PMCID: PMC10267939 DOI: 10.21037/jtd-22-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/10/2023] [Indexed: 08/11/2023]
Abstract
Background Although optimal sequencing of systemic therapy in cancer care is critical to achieving maximal clinical benefit, there is a lack of analysis of treatment sequencing in advanced non-small cell lung cancer (aNSCLC) in real-world settings. Methods A retrospective cohort study of 13,340 lung cancer patients within the Mount Sinai Health System (MSHS) was performed. Systemic therapy data of aNSCLC in 2,106 patients was the starting point in our analysis to investigate how treatment sequencing has evolved, the impact of sequencing patterns on clinical outcomes, and the effectiveness of 2nd line chemotherapy after patients progressed on immune checkpoint inhibitor (ICI)-based therapy as the 1st line of therapy (LOT). Results There is a significant shift to more ICI-based therapy and multiple lines of targeted therapy after 2015. We compared clinical outcomes of two patient populations with different treatment sequencing patterns, with the 1st group receiving chemotherapy as the 1st LOT followed by ICI-based treatment, and the 2nd group treated in the opposite order receiving a 1st line ICI-containing regimen followed by a 2nd line chemotherapy. No statistically significant difference in overall survival (OS) was observed between the two groups [group 2 vs. group 1, adjusted hazard ratio (aHR) =1.36, P=0.39]. We assessed the efficacy of the 2nd line chemotherapy in three patient populations given either 1st line ICI single agent, 1st line ICI-chemotherapy combination, or 1st line chemotherapy alone, there was no statistically significant difference in time-to-next treatment (TTNT) and in OS among the three patient groups. Conclusions Analysis of real-world data has shown two treatment sequencing patterns in aNSCLC, ICI followed by chemotherapy or chemotherapy followed by ICI, achieved similar clinical benefit. The chemotherapies routinely used following platinum doublet 1st LOT, is effective as the 2nd line option after ICI-chemotherapy combination in the 1st line setting.
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Affiliation(s)
- Zongzhi Liu
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | | | - David Cohn
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | | | - Lei Ai
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | - Minghao Li
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | | | - Tomi Jun
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | | | - Qi Pan
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | - William Oh
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eric Schadt
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyan Wang
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
| | - Shuyu D. Li
- Sema4 Mount Sinai Genomic Inc., Stamford, CT, USA
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You B, Purdy C, Copeland LJ, Swisher EM, Bookman MA, Fleming G, Coleman R, Randall LM, Tewari KS, Monk BJ, Mannel RS, Walker JL, Cappuccini F, Cohn D, Muzaffar M, Mutch D, Wahner-Hendrickson A, Martin L, Colomban O, Burger RA. Identification of Patients With Ovarian Cancer Experiencing the Highest Benefit From Bevacizumab in the First-Line Setting on the Basis of Their Tumor-Intrinsic Chemosensitivity (KELIM): The GOG-0218 Validation Study. J Clin Oncol 2022; 40:3965-3974. [PMID: 36252167 PMCID: PMC9746742 DOI: 10.1200/jco.22.01207] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/30/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In patients with high-grade ovarian cancer, predictors of bevacizumab efficacy in first-line setting are needed. In the ICON-7 trial, a poor tumor intrinsic chemosensitivity (defined by unfavorable modeled cancer antigen-125 [CA-125] ELIMination rate constant K [KELIM] score) was a predictive biomarker. Only the patients with high-risk disease (suboptimally resected stage III, or stage IV) exhibiting unfavorable KELIM score < 1.0 had overall survival (OS) benefit from bevacizumab (median: 29.7 v 20.6 months; hazard ratio [HR], 0.78). An external validation study in the GOG-0218 trial was performed. METHODS In GOG-0218, 1,873 patients were treated with carboplatin-paclitaxel ± concurrent-maintenance bevacizumab/placebo. Patient KELIM values were calculated with CA-125 kinetics during the first 100 chemotherapy days by the Lyon University team. The association between KELIM score (favorable ≥ 1.0, or unfavorable < 1.0) and bevacizumab benefit for progression-free survival (PFS)/OS was independently assessed by NGR-GOG using univariate/multivariate analyses. RESULTS KELIM was assessable in 1,662 patients with ≥ 3 CA-125 available values. An unfavorable KELIM score was associated with bevacizumab benefit compared with placebo (PFS: HR, 0.70; 95% CI, 0.59 to 0.82; OS: HR, 0.87; 95% CI, 0.73 to 1.03), whereas a favorable KELIM was not (PFS: HR, 0.96; 95% CI, 0.79 to 1.17; OS: HR, 1.11; 95% CI, 0.89 to 1.39). The highest benefit was observed in patients with a high-risk disease exhibiting unfavorable KELIM, for PFS (median: 9.1 v 5.6 months; HR, 0.64; 95% CI, 0.53 to 0.78), and for OS (median: 35.1 v 29.1 months; HR, 0.79; 95% CI, 0.65 to 0.97). CONCLUSION This GOG-0218 trial investigation validates ICON-7 findings about the association between poor tumor chemosensitivity and benefit from concurrent-maintenance bevacizumab, suggesting that bevacizumab may mainly be effective in patients with poorly chemosensitive disease. Bevacizumab may be prioritized in patients with a high-risk and poorly chemosensitive disease to improve their PFS/OS (patient KELIM score calculator available on the Biomarker Kinetics website).
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Affiliation(s)
- Benoit You
- Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EMR UCBL/HCL 3738, Lyon, France GINECO, Paris, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, GINECO-GINEGEPS, Lyon, France
| | - Christopher Purdy
- Clinical Trial Development Division, Biostatistics and Bioinformatics Department, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Elizabeth M. Swisher
- Division of Gynecologic Oncology, Department of Ob/Gyn, University of Washington, Seattle, WA
| | - Michael A. Bookman
- Director, Gynecologic Oncology Therapeutics, Kaiser Permanente Northern California, San Francisco, CA
| | - Gini Fleming
- Hematology and Oncology, The University of Chicago Medicine, Chicago, IL
| | - Robert Coleman
- Chief Scientific Officer, US Oncology Research, The Woodlands, TX
| | - Leslie M. Randall
- Division of Gynecologic Oncology, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | | | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ
| | | | | | | | - David Cohn
- The Ohio State University, James Cancer Hospital, Columbus, OH
| | | | - David Mutch
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | - Lainie Martin
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Mersana Therapeutics, Cambridge, MA
| | - Olivier Colomban
- Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EMR UCBL/HCL 3738, Lyon, France GINECO, Paris, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, GINECO-GINEGEPS, Lyon, France
| | - Robert A. Burger
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Mersana Therapeutics, Cambridge, MA
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Duong LT, Clark S, Pickarski M, Giezek H, Cohn D, Massaad R, Stoch SA. Effects of odanacatib on bone-turnover markers in osteoporotic postmenopausal women: a post hoc analysis of the LOFT study. Osteoporos Int 2022; 33:2165-2175. [PMID: 35711006 DOI: 10.1007/s00198-022-06406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED This post hoc analysis and modeling study examined the mechanism of action of odanacatib using a statistical model to explain sCTx response in ODN-treated patients as a function of other bone-turnover biomarkers that, with other observed biomarker changes, showed that odanacatib persistently inhibited osteoclastic bone removal activity without preventing osteoclastogenesis. INTRODUCTION Odanacatib (ODN) is an oral selective cathepsin K (CatK) inhibitor, previously in development for osteoporosis treatment. A post hoc analysis examined ODN's mechanism of action on bone-turnover biomarkers. METHODS A subset of patients who completed 60 months' treatment in the Long-Term Odanacatib Fracture Trial (LOFT; NCT00529373) (N = 112 [57 ODN, 55 placebo]) were evaluated. Serum (s) and urine (u) samples were assayed at baseline and months 6-60 for 10 known bone-remodeling biomarkers: sCTx, uαα- and uββCTx/Cr, uNTx/Cr, sNTx, uDPD/Cr, sICTP, sTRAP5b, sPINP, and sBSAP. Because the CrossLaps® CTx assay identifies the CTx peptide as well as larger molecular weight CTx-containing peptides, including ICTP, a best-fit model was developed to explain the transient sCTx reduction in ODN-treated patients. RESULTS ODN persistently reduced the bone-resorption markers sNTx, uNTx/Cr, uαα- and uββCTx/Cr, and uDPD/Cr, and gradually increased the target-engagement marker sICTP and osteoclast number (sTRAP5b), versus placebo from baseline to month 60. sCTx was transiently reduced with ODN within 12 months, returning to baseline by month 48. Modeling suggested that sCTx changes in the ODN group were primarily due to increased accumulation of larger CTx species, including sICTP. The bone-formation markers sPINP and sBSAP showed partial reductions, versus placebo, in the first 6 months but approached baseline by months 48-60. CONCLUSION Observed changes in bone-turnover biomarkers support the persistent efficacy of ODN in direct inhibition of osteoclastic bone-resorption activity, without inhibition of osteoclastogenesis. Long-term evaluation also underscores the unique mechanism of ODN on osteoclastic collagen processing and subsequently osteoblastic bone formation. TRIAL REGISTRATION NCT00529373.
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Affiliation(s)
| | - S Clark
- Merck & Co., Inc., Rahway, NJ, USA.
| | | | - H Giezek
- MSD Europe Inc., Brussels, Belgium
| | - D Cohn
- Merck & Co., Inc., Rahway, NJ, USA
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Wagner V, Dorayappan KDP, Cosgrove C, Cohn D, Karuppaiyah S. Circulating exosomal TMEM205 protein expression for early prediction of platinum-resistance in high grade serous ovarian cancer (255). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01477-9] [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: 11/04/2022]
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Calo CA, Barrington DA, Brown M, Gonzalez L, Baek J, Huffman A, Benedict J, Backes F, Chambers L, Cohn D, Copeland L, Cosgrove C, Nagel C, O'Malley D, Bixel K. High pre-treatment neutrophil-to-lymphocyte ratio as a prognostic marker for worse survival in patients with recurrent/metastatic cervical cancer treated with immune checkpoint inhibitors. Gynecol Oncol Rep 2022; 42:101040. [PMID: 35855965 PMCID: PMC9287632 DOI: 10.1016/j.gore.2022.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio was predictive of OS in cervical cancer patients treated with PD-1/PD-L1 inhibitors. For those with a NLR < 8 the probability of survival at one year was 57% compared to 26% for those with NLR ≥ 8. No significant association between NLR and progression free survival or response to treatment was noted. Assessment of ORR was limited due to 5/14 patients in the NLR ≥ 8 group passing before assessment of disease response. NLR holds promise as a predictive marker for survival in this population and warrants further evaluation.
Objective To evaluate the association between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and survival outcomes among patients with recurrent/metastatic cervical cancer treated with PD-1/PD-L1 inhibitors. Methods A retrospective analysis of patients with recurrent/metastatic cervical cancer treated with PD-1/PD-L1 inhibitors from 2016 to 2021 was conducted. Progression free survival (PFS) and overall survival (OS) outcomes were assessed for patients stratified by NLR (<8 vs ≥ 8) utilizing Kaplan-Meier method. Univariable analysis was performed to compare baseline characteristics between the two groups. Results A total of 49 patients were included in analysis. A majority of patients had squamous cell histology (57%), were PD-L1 positive (55%), received ≤ 1 prior lines of systemic therapy (57%), and had distant metastatic disease at the time of treatment (69%). The groups were well-balanced with respect to age, race, histology, smoking status, PD-L1 positivity, prior lines of treatment (≤1 vs > 1), prior radiation therapy, ECOG performance status, and disease distribution for patients with a NLR < 8 (n = 35) compared to those with a NLR ≥ 8 (n = 14). A pre-treatment NLR of < 8 was associated with improved survival (p < 0.01), with 57% (95% CI: 41%, 78%) probability of survival at one year compared to 26% (95% CI: 10%, 66%) for those with NLR ≥ 8. No statistically significant differences in probability of PFS at 1 year were seen between NLR < 8 compared to those with NLR ≥ 8 (p = 0.70). Conclusions Pre-treatment NLR may hold prognostic value for patients with metastatic/recurrent cervical cancer treated with PD-1/PD-L1 inhibitors, with NLR < 8 associated with improved survival.
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Affiliation(s)
- Corinne A. Calo
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
- Corresponding author at: 320 W 10th Ave, M210 Starling Loving Hall, Columbus, OH 43210, United States.
| | - David A. Barrington
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Morgan Brown
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
| | - Lynette Gonzalez
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Jae Baek
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Allison Huffman
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Jason Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Floor Backes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Laura Chambers
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - David Cohn
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Larry Copeland
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Casey Cosgrove
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Christa Nagel
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - David O'Malley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Kristin Bixel
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
- James Cancer Hospital, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
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Barrington D, Levine M, Meade C, Cohn D, Felix A. Equity vs. variety: Demographic and facility factors are associated with variation in adjuvant treatment for stage IB grade 3 endometrioid endometrial cancer (193). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01420-2] [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: 11/04/2022]
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Wagner V, Piver R, Levine M, Backes F, Cohn D, Copeland L, Cosgrove C, Fowler J, Nagel C, O’Malley D, Bixel K. Using machine learning to predict venous thromboembolism in patients with uterine cancer (081). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01306-3] [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: 11/04/2022]
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Barrington D, Riedinger C, Haight P, Tubbs C, Cohn D. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer: a cost-effectiveness analysis (025). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01243-4] [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: 11/04/2022]
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Lee K, Cohn D, Liu Z, Ai L, Paek H, Jin L, Raja K, Li M, Zhang X, Jun T, Higashi M, Oh W, Calay ES, Savic R, Ghosh K, Kasarskis A, Mullaney T, Pan Q, Schadt E, Wang X. Phenotypic and endotypic features of COPD associated with lung cancer development. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13563 Background: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with multiple phenotypes and endotypes and associated with lung cancer development. In this study, we analyzed the clinical features of COPD including various phenotypic and endotypic features from the electronic health records (EHR) as the potential risk factors for lung cancer development in a large cohort of COPD patients. Methods: We identified a COPD cohort based on electronic Medical Records and Genomics (eMERGE) network COPD cohort identification algorithms with minor modifications from the Mount Sinai Data Warehouse (2000-2020) and followed the patients on the first diagnosis of lung cancer. The development of lung cancer in COPD patients was confirmed by manual chart review. We retrieved the clinical features from EHRs and conducted Kaplan Meier (KM) analysis and multivariable Cox-regression modeling for hazard ratio (HR) analysis. Results: We found that 3.8 % of COPD patients (824 out of 21,658) developed lung cancer. While COPD patients with emphysema and smoking history (former or current) showed an increased risk of lung cancer onset, patients with concurrent asthma and corticosteroid (ICS) inhalation history showed a reduced risk of lung cancer onset (adjusted HR in Table). Interestingly, COPD patients with higher eosinophil counts showed late onset of lung cancer (>300 cells/ul, cancer rate at 5y=2.4%, p=< 0.002; 150-300 cells/ul, cancer rate at 5y=2.9%, p=0.003) when compared to patients with low eosinophils count (<150 cells/ul, cancer rate at 5y=3.4%) in a KM analysis. A multivariable analysis adjusted for age, gender, race, smoking status, COPD sub-phenotypes, severe exacerbation history, and ICS inhalation history showed a significantly lower risk of lung cancer in COPD patients with higher eosinophils count (150-300 cells/ul; HR: 0.82, 95% CI: 0.69-0.97, p=0.021 and >300 cells/ul; HR:0.72, 95% CI: 0.57-0.89, p=0.003) when compared to those with low eosinophils count (<150 cells/ul). Conclusions: Our study shows that many phenotypic and endotypic features of COPD are differentially associated with lung cancer development. High eosinophil levels, ICS usage, and concurrent asthma in COPD patients may reduce the risk of lung cancer development. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - William Oh
- Icahn School of Medicine at Mount Sinai, New York, NY
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Arendt V, Mabud T, Cohn D, Jeon G, An X, Fu J, Kuo W, Hofmann L. Abstract No. 152 Outcomes following IVC stent placement across the renal veins. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.233] [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] Open
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Reinbolt R, Heuser E, Hrnicek A, Stucke T, Bicknell J, Gilmore D, Cohn D. QIM22-202: Cancer Diagnostic Center: A Response to the COVID-19 Pandemic to Improve Access to Diagnostic Testing. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raquel Reinbolt
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Erin Heuser
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Amanda Hrnicek
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Tori Stucke
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Julie Bicknell
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Dareth Gilmore
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - David Cohn
- 1The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
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Cohn D, Fijen L, Riedl M, Bordone L, Alexander V, Schneider E, Newman K. A020 A PHASE 2 STUDY EVALUATING AN ANTISENSE OLIGONUCLEOTIDE TO PREKALLIKREIN IN PATIENTS WITH HEREDITARY ANGIOEDEMA. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levine MD, Pearlman R, Hampel H, Cosgrove C, Cohn D, Chassen A, Suarez A, Barrington DA, McElroy JP, Waggoner S, Nakayama J, Billingsley C, Resnick K, Andrews S, Singh S, Jenison E, Clements A, Neff R, Goodfellow PJ. Up-Front Multigene Panel Testing for Cancer Susceptibility in Patients With Newly Diagnosed Endometrial Cancer: A Multicenter Prospective Study. JCO Precis Oncol 2021; 5:1588-1602. [PMID: 34994648 PMCID: PMC9848552 DOI: 10.1200/po.21.00249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Clinical utility of up-front multigene panel testing (MGPT) is directly related to the frequency of pathogenic variants (PVs) in the population screened and how genetic findings can be used to guide treatment decision making and cancer prevention efforts. The benefit of MGPT for many common malignancies remains to be determined. In this study, we evaluated up-front MGPT in unselected patients with endometrial cancer (EC) to determine the frequency of PVs in cancer susceptibility genes. METHODS Patients with EC were prospectively enrolled at nine Ohio institutions from October 1, 2017, to December 31, 2020. Nine hundred and sixty-one patients with newly diagnosed EC underwent clinical germline MGPT for 47 cancer susceptibility genes. In addition to estimating the prevalence of germline PVs, the number of individuals identified with Lynch syndrome (LS) was compared between MGPT and tumor-based screening. RESULTS Likely pathogenic variants or PVs were identified in 97 of 961 women (10.1%). LS was diagnosed in 29 of 961 patients (3%; 95% CI, 2.1 to 4.3), with PVs in PMS2 most frequent. MGPT revealed nine patients with LS in addition to the 20 identified through routine tumor-based screening. BRCA1 and BRCA2 PVs were found in 1% (10 of 961; 95% CI, 0.6 to 1.9) of patients and that group was significantly enriched for type II ECs. CONCLUSION This prospective, multicenter study revealed potentially actionable germline variants in 10% of unselected women with newly diagnosed EC, supporting the use of up-front MGPT for all EC patients. The discovery that BRCA1 or BRCA2 heterozygotes frequently had type II cancers points to therapeutic opportunities for women with aggressive histologic EC subtypes.
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Affiliation(s)
- Monica D. Levine
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Rachel Pearlman
- Division of Human Genetics, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - Heather Hampel
- Division of Human Genetics, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - Casey Cosgrove
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - David Cohn
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Alexis Chassen
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Adrian Suarez
- Department of Pathology, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - David A. Barrington
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Joseph P. McElroy
- Center for Biostatistics, Department of
Biomedical Informatics, The Ohio State University College of Medicine, Columbus,
OH
| | - Steven Waggoner
- Division of Gynecologic Oncology,
University Hospitals Seidman Cancer Center, Cleveland, OH
| | - John Nakayama
- Division of Gynecologic Oncology,
University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Kim Resnick
- Division of Gynecologic Oncology,
MetroHealth, Cleveland, OH
| | | | - Sareena Singh
- Division of Gynecologic Oncology, Aultman
Hospital, Canton, OH
| | - Eric Jenison
- Division of Gynecologic Oncology, Mercy
Toledo, Toledo, OH
| | - Aine Clements
- Division of Gynecologic Oncology,
OhioHealth, Columbus, OH
| | - Robert Neff
- Division of Gynecologic Oncology,
TriHealth, Cincinnati, OH
| | - Paul J. Goodfellow
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH,Paul J. Goodfellow, PhD, The Ohio State University Comprehensive
Cancer Center, 460 West 12th Ave, Room 808 BRT, Columbus, OH 43210; e-mail:
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15
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Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Huh WK, Lurain Iii JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Sisodia R, Tillmanns T, Ueda S, Urban R, Wyse E, McMillian NR, Motter AD. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw 2021; 18:660-666. [PMID: 32502976 DOI: 10.6004/jnccn.2020.0027] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Cervical Cancer provide recommendations for diagnostic workup, staging, and treatment of patients with the disease. These NCCN Guidelines Insights focus on recent updates to the guidelines, including changes to first- and second-line systemic therapy recommendations for patients with recurrent or metastatic disease, and emerging evidence on a new histopathologic classification system for HPV-related endocervical adenocarcinoma.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- 8The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | - John R Lurain Iii
- 17Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - David Mutch
- 19Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - Todd Tillmanns
- 25St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Stefanie Ueda
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | - Renata Urban
- 27Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
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16
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Barrington D, Calo C, Haight P, Cohn D. Don't lose your pants*: Telehealth strategies for maintaining revenue streams in a gynecologic oncology practice during a global pandemic *(Pants recommended for all televisits). Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Vetter M, Vetter M, Cohn D, ager KY, Fowler J. Professional fulfillment and burnout among physicians at a large NCI-designated Comprehensive Cancer Center. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00667-3] [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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18
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Barrington D, Calhoun C, Haight P, Tubbs C, Cohn D, Bixel K. Lenvatinib plus pembrolizumab in advanced recurrent endometrial cancer: a cost-effectiveness analysis. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00710-1] [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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19
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Vetter M, Vetter M, Cohn D, Yeager K, Fowler J. Utility of the Stanford Professional Fulfillment Index as a single survey instrument to assess holistic physician wellbeing. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01272-5] [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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20
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Castaneda A, Graves S, Suarez A, Cohn D, O'Malley D, Copeland L, Fowler J, Backes F, Bixel K, Cosgrove C. Incidence of ovarian metastasis in neuroendocrine tumors of the cervix. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01005-2] [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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21
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Nixon A, Liu J, Xiong N, Hurwitz HI, Lyu J, Liu Y, Starr M, Brady J, Swisher E, Owzar K, Wenham R, Hendrickson AW, Armstrong D, Chan N, Cohn D, Lee JM, Penson R, Cristea M, Gaillard S, Abbruzzese J, Matsuo K, Olawaiye A, Kohn E, Ivy SP, Secord AA. Blood-based biomarkers in patients with platinum-sensitive and resistant ovarian cancer treated with olaparib and cediranib: results from the UM9825 trial. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Barrington D, Sinnott J, Nixon D, Doll K, Donneyong M, Cohn D, Felix A. More than treatment refusal: an NCDB analysis of the impact of endometrial cancer treatment refusal on racial survival disparities. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00738-1] [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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23
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Abu-Rustum NR, Yashar CM, Bradley K, Campos SM, Chino J, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Diver E, Fisher CM, Frederick P, Gaffney DK, George S, Giuntoli R, Han E, Howitt B, Huh WK, Lea J, Mariani A, Mutch D, Nekhlyudov L, Podoll M, Remmenga SW, Reynolds RK, Salani R, Sisodia R, Soliman P, Tanner E, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Motter AD. NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021. J Natl Compr Canc Netw 2021; 19:888-895. [PMID: 34416706 DOI: 10.6004/jnccn.2021.0038] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The NCCN Guidelines for Uterine Neoplasms provide recommendations for diagnostic workup, clinical staging, and treatment options for patients with endometrial cancer or uterine sarcoma. These NCCN Guidelines Insights focus on the recent addition of molecular profiling information to aid in accurate diagnosis, classification, and treatment of uterine sarcomas.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | | | - Edward Tanner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Renata Urban
- Fred Hutchinson Cancer Research CenterSeattle Cancer Care Alliance
| | | | | | - Kristine Zanotti
- Case Comprehensive Cancer CenterUniversity Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; and
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24
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Mimica X, Meneses M, Ferrer P, Caglevic C, Cohn D, Lavin M, Marin L, Contreras F. Clinical characterization and treatment of head and neck mucosal melanoma: a Chilean experience. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:273-280. [PMID: 34088652 DOI: 10.1016/j.oooo.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Head and neck mucosal melanoma (HNMM) is a rare disease with a poor prognosis. The aim of this research was to analyze clinical characteristics and prognostic factors in a Latin American cohort. STUDY DESIGN A retrospective chart review of patients with HNMM treated between 2008 and 2019 was conducted. Demographic characteristics, tumor characteristics, surgical treatment, adjuvant therapy, and oncologic outcomes were recorded. RESULTS Twenty HNMMs were identified; 60% were in men. The most frequent primary location was the nasal cavity (10; 50%). Regional disease was uncommon and limited to the oral cavity. The median overall survival was 29 months; the 3- and 5-year overall survival rates were 37.2% and 26.6%, respectively. Univariate analysis revealed that predictors of a worse overall survival were paranasal location (hazard ratio [HR], 4.61; 95% confidence interval [CI], 1.61-18.40; P = .030), positive lymph nodes (HR, 6.00; 95% CI, 1.30-27.7; P = .022), positive margins (HR, 4.32; 95% CI, 1.08-17.2; P = .039), bone invasion (HR, 3.27;95% CI, 1.05-10.1; P = .041), and lymphovascular invasion (HR, 3.82; CI, 1.03-14.2; P = .045). Three-year recurrence-free survival was 17.3%, and most of the recurrences were with distant disease. CONCLUSIONS HNMM is an infrequent disease with an aggressive behavior. Survival outcomes are related to location of the primary disease, regional spread, lymphovascular invasion, and bone invasion.
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Affiliation(s)
- Ximena Mimica
- Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Manuel Meneses
- Pathology Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Pedro Ferrer
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Christian Caglevic
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile; Head and Neck Medical Oncology Service, Department of Medicine, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - David Cohn
- Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Matias Lavin
- Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Marin
- Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Felipe Contreras
- Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile.
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25
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Koivisto CS, Melodie P, Santosh B, Ngoi S, Nahhas GJ, Liu B, Torres A, Gallagher J, Snchez-Hodge R, Zeinner V, Cohn D, Backes F, Goodfellow P, Chamberlin H, Leone G. Abstract 627: Evaluating the efficacy of enzalutamide and the development of resistance in a preclinical mouse model of type-I endometrial carcinoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-627] [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
Androgen Receptor (AR) signaling is a critical driver of hormone-dependent prostate cancer and has also been proposed to have biological activity in female hormone-dependent cancers, including type I endometrial carcinoma (EMC). In this study, we evaluated the preclinical efficacy of a third-generation AR antagonist, enzalutamide, in a genetic mouse model of EMC, Sprr2f-Cre;Ptenfl/fl. In this model, ablation of Pten in the uterine epithelium leads to localized and distant malignant disease as observed in human EMC. We hypothesized that administering enzalutamide through the diet would temporarily decrease the incidence of invasive and metastatic carcinoma, while prolonged administration would result in development of resistance. Short-term treatment with enzalutamide reduced overall tumor burden through increased apoptosis but failed to prevent progression of invasive and metastatic disease suggesting that AR signaling may have biphasic, oncogenic and tumor suppressive roles in EMC. Enzalutamide treatment increased Progesterone Receptor (PR) expression within both stromal and tumor cell compartments. Prolonged administration of enzalutamide decreased apoptosis, increased tumor burden and resulted in the clonal expansion of tumor cells expressing high levels of p53 protein, suggestive of acquired Trp53 mutations. In conclusion, we show that enzalutamide induces apoptosis in EMC but has limited efficacy overall as a single agent. Induction of PR, a negative regulator of endometrial proliferation, suggests that adding progestin therapy to enzalutamide administration may further decrease tumor burden and result in a prolonged response.
Citation Format: Christopher Steven Koivisto, Parrish Melodie, Bonala Santosh, Soo Ngoi, Georges J. Nahhas, Bei Liu, Adrian Torres, James Gallagher, Rebekah Snchez-Hodge, Victor Zeinner, David Cohn, Floor Backes, Paul Goodfellow, Helen Chamberlin, Gustavo Leone. Evaluating the efficacy of enzalutamide and the development of resistance in a preclinical mouse model of type-I endometrial carcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 627.
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Affiliation(s)
| | | | | | - Soo Ngoi
- 1Medical University of South Carolina, Charleston, SC
| | | | - Bei Liu
- 1Medical University of South Carolina, Charleston, SC
| | | | | | | | | | - David Cohn
- 2The Ohio State University, Columbus, OH
| | | | | | | | - Gustavo Leone
- 1Medical University of South Carolina, Charleston, SC
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26
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Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Clark R, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:64-84. [PMID: 30659131 DOI: 10.6004/jnccn.2019.0001] [Citation(s) in RCA: 576] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cervical cancer is a malignant epithelial tumor that forms in the uterine cervix. Most cases of cervical cancer are preventable through human papilloma virus (HPV) vaccination, routine screening, and treatment of precancerous lesions. However, due to inadequate screening protocols in many regions of the world, cervical cancer remains the fourth-most common cancer in women globally. The complete NCCN Guidelines for Cervical Cancer provide recommendations for the diagnosis, evaluation, and treatment of cervical cancer. This manuscript discusses guiding principles for the workup, staging, and treatment of early stage and locally advanced cervical cancer, as well as evidence for these recommendations. For recommendations regarding treatment of recurrent or metastatic disease, please see the full guidelines on NCCN.org.
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27
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Mabud T, Cohn D, Fu J, Arendt V, Souffrant A, Perera N, Hofmann L. 3:27 PM Abstract No. 85 In-stent restenosis after lower extremity venous stent placement: a large retrospective single-center analysis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Bixel K, Vetter M, Davidson B, Berchuck A, Cohn D, Copeland L, Fowler JM, Havrilesky L, Lee PS, O'Malley DM, Salani R, Valea F, Alvarez Secord A, Backes F. Intraperitoneal chemotherapy following neoadjuvant chemotherapy and optimal interval tumor reductive surgery for advanced ovarian cancer. Gynecol Oncol 2020; 156:530-534. [PMID: 31937450 DOI: 10.1016/j.ygyno.2019.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intraperitoneal (IP) chemotherapy following neoadjuvant chemotherapy (NACT) and interval tumor reductive surgery (TRS) for advanced ovarian cancer is feasible, however, the impact on disease outcomes remains unclear. We compare outcomes of patients treated with IP chemotherapy versus intravenous (IV) chemotherapy following NACT and interval TRS. METHODS In this retrospective review, patients with advanced ovarian cancer were included if they received NACT followed by optimal interval TRS between 1/2004 and 4/2017. Patients were excluded if they had an ECOG PS >1, received >6 cycles of NACT or postoperative chemotherapy, and/or received bevacizumab during primary therapy. Primary outcomes were progression free survival (PFS) and overall survival (OS). RESULTS There were 134 patients included in this study, 37 (28%) received IP and 97 (72%) received IV chemotherapy postoperatively. Patients in the IV group were older (median 66.3 vs 59.7 years, p = 0.0039) though there were no differences in BMI, race, BRCA status, stage, or histology. Median PFS was 3 months longer in the IP group (14.5 versus 11.5 months, p = 0.028) however there was no significant difference in OS. On univariate analysis, increasing number of NACT cycles (HR 1.914, 95% CI 1.024-3.497) and residual disease at completion of TRS (HR 1.541, 95% CI 1.042-2.248) were associated with decreased PFS; IP chemotherapy was associated with increased PFS (HR 0.633, 95% CI 0.414-0.944). These associations remained on multivariate analysis. Toxicity was comparable between the groups. CONCLUSIONS IP after NACT and optimal interval TRS was associated with in improved PFS compared to IV chemotherapy without significant differences in toxicity.
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Affiliation(s)
- K Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America.
| | - M Vetter
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - B Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - A Berchuck
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - D Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - L Copeland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - J M Fowler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - L Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - P S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - D M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - R Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
| | - F Valea
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - A Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America
| | - F Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research institute, Columbus, OH, United States of America
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Srivastava AK, Cui T, Banerjee A, Han C, Cai S, Liu L, Wu D, Cui R, Li Z, Zhang X, Xie G, Karuppalyah S, Karpf A, Liu J, Cohn D, Wang QE. Abstract GMM-017: UPREGULATION OF MIR-328 CONTRIBUTES TO OVARIAN CANCER STEM CELL MAINTENANCE BY DOWNREGULATING DDB2. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-gmm-017] [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
Cancer stem cells (CSCs) are a particular subpopulation of cells that are characterized by self renewal, differentiation and enhanced tumorigenicity. They are responsible for tumor metastasis, relapse and development of drug resistance. Thus, eradication of CSCs is essential for improved patient prognosis. Micro RNAs are a group of small non-coding, endogenous RNAs that are found to regulate cancer stem cell characteristics by binding to mRNA in a sequence specific manner. In ovarian cancers, a wide array of Micro RNAs have been found to show differential expression of which miR328-3p deserves special mention. In this study, a Micro RNA Nanostring profile analysis reveals a significant upregulation of miR-328-3p in ovarian cancer stem cells isolated from both ovarian cancer cell lines and primary ovarian tumors as compared to their corresponding bulk cells. Moreover, it was found that inhibition of miR-328 limited the CSC population in ovarian cancer cells whereas overexpression of miR-328 enriched the CSC population, thus accounting for miR-328 as an onco-miRNA. The upregulation of miR-328 not only increased the percentage of ALDH+ cells in ovarian cancer bulk cells, but also increased the tumorigenicity and sphere formation ability. This was supported by the orthotopic ovarian xenograft assay. Further investigation revealed that reduced phosphorylation of Erk in ovarian cancer stem cells owing to reduced levels of Reactive Oxygen species (ROS) could be a prospective mechanism behind elevated miR328 expression and maintenance of CSC characteristics. Inhibition of phosphorylated Erk expression in ovarian cancer bulk cells by use of commercially available Erk inhibitor, U0126, led to a significant increase in miR328 expression. Simultaneously, upregulation of phosphorylated Erk in ovarian cancer stem cells not only reduced miR328 expression, but also displayed a significant reduction in expression of cancer stem cell markers (Oct4, Sox2, Nanog), sphere formation ability and tumorigenesis. We obtained a similar trend of results on regulating the expression of pErk by use of Reactive Oxygen Species to ovarian cancer cells. These data further helped us confirm our speculation that reduced ROS promotes the maintenance of CSCs characteristics through inactivation of Erk signalling pathway. Besides, we also identified DDB2 as a direct target of miR328. Our previous findings demonstrate that DDB2 is able to limit ovarian CSC population by disrupting their self renewal capacity. Thus, we conclude that elevated miR328 in ovarian CSCs, resulting from inactivated Erk1/2 activity, is responsible for maintenance of stemness by inhibition of DDB2 expression. Targeting miR-328 could therefore be a novel therapeutic strategy to eradicate CSCs in ovarian cancer.
Citation Format: Amit Kumar Srivastava, Tiantian Cui, Ananya Banerjee, Chunhua Han, Shurui Cai, Lu Liu, Dayong Wu1, Ri Cui, Zaibo Li, Xiaoli Zhang, Guozhen Xie, Selvendiran Karuppalyah, Adam Karpf, Jinsong Liu, David Cohn, Qi-En Wang. UPREGULATION OF MIR-328 CONTRIBUTES TO OVARIAN CANCER STEM CELL MAINTENANCE BY DOWNREGULATING DDB2 [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr GMM-017.
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Affiliation(s)
| | | | | | | | | | - Lu Liu
- 1Department of Radiology,
| | | | - Ri Cui
- 2Department of Cancer Biology and Genetics,
| | | | | | | | | | - Adam Karpf
- 6Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE,
| | - Jinsong Liu
- 7Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Cohn
- 5Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH,
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Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Sisodia R, Tillmanns T, Ueda S, Wyse E, McMillian NR, Scavone J. Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:1374-1391. [PMID: 31693991 DOI: 10.6004/jnccn.2019.0053] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | | | - John R Lurain
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - Todd Tillmanns
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
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Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, George S, Han E, Higgins S, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:170-199. [PMID: 29439178 DOI: 10.6004/jnccn.2018.0006] [Citation(s) in RCA: 407] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometrial carcinoma is a malignant epithelial tumor that forms in the inner lining, or endometrium, of the uterus. Endometrial carcinoma is the most common gynecologic malignancy. Approximately two-thirds of endometrial carcinoma cases are diagnosed with disease confined to the uterus. The complete NCCN Guidelines for Uterine Neoplasms provide recommendations for the diagnosis, evaluation, and treatment of endometrial cancer and uterine sarcoma. This manuscript discusses guiding principles for the diagnosis, staging, and treatment of early-stage endometrial carcinoma as well as evidence for these recommendations.
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Cohn D, Mahdavinia M. NOT YOUR AVERAGE CASE OF ANGIOEDEMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.272] [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: 11/27/2022]
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Felix A, Cohn D, Brasky T, Mutch D, Creasman W, Thaker P, Walker J, Moore R, Lele S, Guntupalli S, Downs L, Nagel C, Boggess J, Pearl M, Ioffe O, Deng W, Randall M, Brinton L. Abstract A85: Receipt of adjuvant endometrial carcinoma treatment according to race: An NRG Oncology/Gynecologic Oncology Group 210 Study. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Black women diagnosed with endometrial cancer (EC) experience worse outcomes compared with white women. Differences in receipt of treatment are postulated to contribute to this disparity. While underuse of surgical treatment among black women is well documented, we know less about racial differences in adjuvant treatment. We therefore examined receipt of adjuvant treatment among black and white women in the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study, a large prospective cohort of women with EC who received uniform surgical treatment but varying adjuvant therapy regimens.
Methods: Our analysis included 615 black and 4,283 white women with EC who underwent either an abdominal hysterectomy or laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection. At study enrollment, women completed a questionnaire that assessed race as well as risk factors for EC. Tumor characteristics were available from surgical pathology reports and a centralized review by pathologists with expertise in gynecologic cancers. Adjuvant treatment was documented at the time of the postoperative clinical visits and was categorized as none (54.3%), radiotherapy only (16.5%), chemotherapy only (n=15.2%), and radiotherapy and chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between race and receipt of adjuvant therapy in the overall study population and stratified by tumor subtype (combination of histology and grade) adjusted for age, income, education, and stage.
Results: Black compared with white women had higher odds of receiving combination radiotherapy and chemotherapy compared to no adjuvant therapy (OR=1.35, 95% CI=1.01-1.79) but no difference in receipt of radiotherapy only (OR=0.95, 95% CI=0.72-1.25) or chemotherapy only (OR=0.88 (0.64-1.20) was observed. In tumor-subtype stratified models, black women diagnosed with low-grade endometrioid (OR=2.04, 95% CI=1.06-3.93) or serous tumors (OR=1.81, 95% CI=1.07-3.08) had higher odds of receiving radiotherapy and chemotherapy than white women, but race was not associated with receipt of radiotherapy and chemotherapy for women with high-grade endometrioid, carcinosarcoma, mixed-cell, or clear-cell tumors. Moreover, the tumor-subtype stratified analyses revealed no racial differences in receipt of radiotherapy-only or chemotherapy-only regimens.
Conclusions: In this study of women with EC who received uniform surgical treatment, we observed racial differences in receipt of some adjuvant treatment regimens but not others. Among women with indolent (i.e., low-grade endometrioid) or aggressive (i.e., serous) tumors, black women had higher odds of receiving radiotherapy and chemotherapy compared to white women. Radiotherapy and chemotherapy treatment is potentially contraindicated for women with indolent tumors, which suggests a need to understand the reasons why clinicians might overprescribe these therapies for black women. Overall, our results suggest racial differences in receipt of radiotherapy and chemotherapy, but not for other regimens.
Citation Format: Ashley Felix, David Cohn, Theodore Brasky, David Mutch, William Creasman, Premal Thaker, Joan Walker, Richard Moore, Shashikant Lele, Saketh Guntupalli, Levi Downs, Christa Nagel, John Boggess, Michael Pearl, Olga Ioffe, Wei Deng, Marcus Randall, Louise Brinton. Receipt of adjuvant endometrial carcinoma treatment according to race: An NRG Oncology/Gynecologic Oncology Group 210 Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A85.
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Affiliation(s)
| | - David Cohn
- 1The Ohio State University, Columbus, OH,
| | | | - David Mutch
- 2Washington University School of Medicine, St. Louis, MO,
| | | | - Premal Thaker
- 2Washington University School of Medicine, St. Louis, MO,
| | | | - Richard Moore
- 5Women and Infants Hospital/Brown University, Providence, RI,
| | | | | | - Levi Downs
- 8University of Minnesota, Minneapolis, MN,
| | | | - John Boggess
- 10University of North Carolina, Chapel Hill, NC,
| | - Michael Pearl
- 11State University of New York at Stony Brook, Stony Brook, NY,
| | - Olga Ioffe
- 12University of Maryland, College Park, MD,
| | - Wei Deng
- 6Roswell Park Cancer Institute, Buffalo, NY,
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Arendt V, Cohn D, An X, Jeon G, Hofmann L. 3:36 PM Abstract No. 355 Vein diameters and time to restenosis: an analysis of over 3500 imaging studies. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.394] [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: 10/17/2022] Open
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Reposar A, Eifler A, Hoogi A, Arendt V, Cohn D, Rubin D, Hofmann L. Abstract No. 638 Automated quantitative measurements of disease severity in patients with May-Thurner syndrome. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.683] [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: 10/17/2022] Open
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Cohn D, Arendt V, Jeon G, An X, Kuo W, Sze D, Rubin D, Hofmann L. 3:54 PM Abstract No. 357 Venous stenting above versus below the inguinal ligament: 20-year experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.396] [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: 10/17/2022] Open
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Koh WJ, Greer BE, Abu-Rustum NR, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA, Dizon DS, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Higgins S, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Valea FA, Wyse E, Yashar CM, McMillian N, Scavone J. Vulvar Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:92-120. [PMID: 28040721 DOI: 10.6004/jnccn.2017.0008] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vulvar cancer is a rare gynecologic malignancy. Ninety percent of vulvar cancers are predominantly squamous cell carcinomas (SCCs), which can arise through human papilloma virus (HPV)-dependent and HPV-independent pathways. The NCCN Vulvar Cancer panel is an interdisciplinary group of representatives from NCCN Member Institutions consisting of specialists in gynecological oncology, medical oncology, radiation oncology, and pathology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vulvar Cancer provide an evidence- and consensus-based approach for the management of patients with vulvar SCC. This manuscript discusses the recommendations outlined in the NCCN Guidelines for diagnosis, staging, treatment, and follow-up.
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Wenzel L, Mukamel D, Osann K, Havrilesky L, Sparks L, Lipscomb J, Wright AA, Walker J, Alvarez R, Van Le L, Robison K, Bristow R, Morgan R, Rimel BJ, Ladd H, Hsieh S, Wahi A, Cohn D. Rationale and study protocol for the Patient-Centered Outcome Aid (PCOA) randomized controlled trial: A personalized decision tool for newly diagnosed ovarian cancer patients. Contemp Clin Trials 2017; 57:29-36. [PMID: 28330753 PMCID: PMC6198815 DOI: 10.1016/j.cct.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 01/23/2023]
Affiliation(s)
- L Wenzel
- University of California, Irvine, United States.
| | - D Mukamel
- University of California, Irvine, United States
| | - K Osann
- University of California, Irvine, United States
| | | | - L Sparks
- Chapman University, United States
| | | | - A A Wright
- Dana Farber Cancer Institute, United States
| | - J Walker
- University of Oklahoma, United States
| | - R Alvarez
- Vanderbilt University, United States
| | - L Van Le
- University of North Carolina at Chapel Hill, United States
| | | | - R Bristow
- University of California, Irvine, United States
| | | | | | - H Ladd
- University of California, Irvine, United States
| | - S Hsieh
- University of California, Irvine, United States
| | - A Wahi
- University of California, Irvine, United States
| | - D Cohn
- Ohio State University, United States
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Knobloch TJ, Oghumu S, Sears M, Zhang Z, Ogbemudia B, Perrault J, Cohn D, DeGraffinreid CR, Lu B, Peng J, Hade EM, Schiano MA, Calhoun BC, McBee W, Lesnock J, Gallion H, Pollock J, Ruffin MT, Weghorst CM, Paskett ED. Abstract B57: Inherited alterations of Transforming Growth Factor Beta signaling components in Appalachian Cervical Cancers. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Invasive cancer of the uterine cervix (ICC) is a leading cause of cancer death in women worldwide. ICC incidence and mortality rates are especially high among women from Appalachia. In addition to lifestyle and social-behavioral factors and HPV infections, hereditary predispositions may mediate cervical cancer risk. Polymorphic alleles within the Transforming Growth Factor Beta (TGFB) signaling cascade, an important regulator of epithelial cell growth, have been implicated in modifying cancer susceptibility. The contributions of these factors within a gene-environment model have not been well characterized in Appalachian ICC patients. Hypothesis: High-risk genomic variants of TGFB signaling pathway components will be overrepresented in Appalachian women diagnosed with ICC compared to their healthy Appalachian counterparts. Methods: A case-control study was conducted with 163 cases, women diagnosed with ICC, and 842 controls, women with normal Pap tests from Appalachia Ohio, West Virginia, and Kentucky. Inclusion criteria were (i) women residing in Appalachian counties who were ≥18 years, (ii) spoke English, (ii) not cognitively impaired, (iii) able to provide informed consent. Three distinct groups were considered, representing (i) prevalent invasive cervical cancer cases, (ii) newly diagnosed invasive cervical cancer cases, and (iii) healthy controls. Targeted genomic variance analysis of 9 SNPs (rs1800469, rs1800470, rs3917200, rs7034462, rs11568785, rs868, rs1042522, rs750749, rs1800566) and a polymorphic repeat variant was conducted on blood DNA. Behavioral and environmental factors were collected using a comprehensive, self-administered questionnaire completed at the time of enrollment. Characteristics between cases and controls were compared by a two sample t-test, assuming unequal variance for continuous variables and by Fisher's exact test for categorical variables. Associations between disease status, polymorphism and behavioral or environmental characteristics were estimated via multivariable logistic regression. Results: Never smokers with TGFB1 rs1800469 overdominant allele types A/A-G/G had 0.4 (95% CI: 0.22-0.73, p=0.003) times the odds of cervical cancer compared to never smokers with A/G genotype. This effect was not observed in ever smokers (interaction p=0.02). While there was a suggestion of an increased risk of cervical cancer for never smokers with TGFB1 rs1800469 recessive A/G-A/A genotypes compared to G/G non9A genotype CD83 dominant T/T compared to C/C-C/T, or overdominant C/C -T/T compared to C/T alleles, there were no strong interaction effects identified. The effect of dominant TP53 rs1042522 allele type (C/C C/G versus G/G) differed by smoking status. There was a significant 3-fold increase in the odds of cervical cancer (aOR: 3.1, 95% CI: 1.1-8.5, p=0.03) for never smokers with TP53 rs1042522 G/G compared to never smokers with C/C-C/G genotypes. A similar increase was not observed in ever-smokers (smoking status by genotype interaction effect p=0.02). In codominant types, there was a similar increased adjusted odds (aOR: 3.65, 95% CI: 1.21-11.0, p=0.021) of cervical cancer for never smokers with G/G genotypes compared to never smokers with C/G genotypes. This effect was not observed in ever smokers (interaction effect p=0.06). Conclusions: Genetic susceptibility may contribute to the overall cervical cancer risk associated with the Appalachian population, especially among non-smokers. Inclusion of additional demographic and social-behavioral features, as well as other genetic events, may further define this evolving cervical cancer risk model.
Citation Format: Thomas J. Knobloch, Steve Oghumu, Marta Sears, Zhaoxia Zhang, Blessing Ogbemudia, Joe Perrault, David Cohn, Cecilia R. DeGraffinreid, Bo Lu, Juan Peng, Erinn M. Hade, Michael A. Schiano, Byron C. Calhoun, William McBee, Jr., Jamie Lesnock, Holly Gallion, Jondavid Pollock, Mack T. Ruffin, IV, Christopher M. Weghorst, Electra D. Paskett. Inherited alterations of Transforming Growth Factor Beta signaling components in Appalachian Cervical Cancers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B57.
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Affiliation(s)
| | | | | | | | | | | | - David Cohn
- 1The Ohio State University, Columbus, OH,
| | | | - Bo Lu
- 1The Ohio State University, Columbus, OH,
| | - Juan Peng
- 1The Ohio State University, Columbus, OH,
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Felix AS, Brasky T, Cohn D, McMeekin S, Mutch D, William C, Thaker P, Walker J, Moore R, Lele S, Guntupalli S, Downs L, Nagel C, Boggess J, Pearl M, Ioffe O, Park K, Ali S, Brinton L. Abstract C44: Endometrial carcinoma recurrence in black and white women in the NRG Oncology/Gynecologic Oncology Group 210 trial. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-c44] [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] Open
Abstract
Abstract
BACKGROUND: Black women diagnosed with endometrial carcinoma have a higher risk of recurrence compared with white women. Higher recurrence risk among black women is due, in part, to a greater frequency of aggressive tumor characteristics including non-endometrioid histologies and advanced stage tumors. The risk of recurrence for black and white women within distinct tumor groupings has not been well-examined due to low numbers of black women and under-representation of aggressive histologic subtypes in single institution studies. Therefore, we examined the association between self-reported race and recurrence risk stratified by histologic subtype in the NRG Oncology/Gynecology Oncology Group (GOG) 210, a prospective observational study that enrolled 6,124 newly diagnosed endometrial carcinoma patients between 2003 and 2011.
METHODS: We restricted this analysis to 618 black and 4,316 white women with endometrial carcinoma. At study enrollment, women completed a questionnaire that assessed risk factors for gynecologic cancers. Recurrence, defined as evidence of disease following complete response to primary therapy, was abstracted from medical records. Tumor characteristics were available from surgical pathology reports and a centralized review by pathologists with expertise in gynecologic cancers. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between race (black vs. white) and recurrence risk in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed epithelial, carcinosarcoma, clear cell) and adjusted for stage (I, II, III, IV), age at diagnosis (continuous), and adjuvant therapy (none, chemotherapy, radiation, chemotherapy and radiation, unknown). We also examined income ($20,000-$39,999, $40,000-$69,999, ≥$70,000) and education (high school/GED, some college/technical school, college graduate/beyond) as potential mediators of the association between race and endometrial carcinoma recurrence risk using the Baron-Kenny method. Median follow-up time was 5 years.
RESULTS: Black women were more frequently diagnosed with non-endometrioid (52.9% vs. 31.8%) and advanced stage (Stage III or IV: 29.0% vs. 21.1%) tumors compared with white women. Recurrence was documented in 26% of black and 17% of white endometrial carcinoma patients. In histologic subtype-stratified models adjusted for stage, age, and adjuvant therapy, a higher risk of recurrence was noted in black women with low-grade endometrioid (HR=1.65, 95% CI=1.07-2.54), mixed epithelial (HR=1.75, 95% CI=1.13-2.71), or carcinosarcomas (HR=1.55, 95% CI=1.03-2.31) compared with white women. No significant race-recurrence relationships were observed among women diagnosed with high-grade endometrioid, serous, or clear cell tumors. After adjustment for income and education, the association of black race and recurrence risk remained elevated, but was not statistically significant: low-grade endometrioid (HR=1.52, 95% CI=0.97-2.38), mixed epithelial (HR=1.56, 95% CI=0.98-2.50), and carcinosarcoma (HR=1.48, 95% CI=0.98-2.25). Further, neither income nor education were significantly associated with recurrence risk in the multivariable models.
CONCLUSIONS: Our study provides evidence that racial disparities in endometrial carcinoma recurrence risk vary by histologic subtype. Socioeconomic factors do not explain black-white differences in endometrial carcinoma recurrence risk. Future studies exploring the role of biological factors and post-diagnosis surveillance contributing to racial differences in endometrial carcinoma recurrence are warranted.
Citation Format: Ashley S. Felix, Theodore Brasky, David Cohn, Scott McMeekin, David Mutch, Creasman William, Premal Thaker, Joan Walker, Richard Moore, Shashikant Lele, Saketh Guntupalli, Levi Downs, Christa Nagel, John Boggess, Michael Pearl, Olga Ioffe, Kay Park, Shamshad Ali, Louise Brinton. Endometrial carcinoma recurrence in black and white women in the NRG Oncology/Gynecologic Oncology Group 210 trial. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C44.
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Affiliation(s)
| | | | - David Cohn
- 1The Ohio State University, Columbus, OH,
| | | | - David Mutch
- 3Washington University School of Medicine, St. Louis,
| | | | - Premal Thaker
- 3Washington University School of Medicine, St. Louis,
| | | | - Richard Moore
- 5Women and Infants Hospital/Brown University, Providence,
| | | | | | | | | | | | - Michael Pearl
- 11State University of New York at Stonybrook, Stonybrook,
| | | | - Kay Park
- 13Memorial Sloan Kettering Cancer Center, New York,
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Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Cho KR, Chu C, Cohn D, Crispens MA, Dizon DS, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, George S, Han E, Higgins S, Huh WK, Lurain JR, Mariani A, Mutch D, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Valea FA, Yashar CM, McMillian NR, Scavone JL. Uterine Sarcoma, Version 1.2016: Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw 2016; 13:1321-31. [PMID: 26553763 DOI: 10.6004/jnccn.2015.0162] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The NCCN Guidelines for Uterine Neoplasms provide interdisciplinary recommendations for treating endometrial carcinoma and uterine sarcomas. These NCCN Guidelines Insights summarize the NCCN Uterine Neoplasms Panel's 2016 discussions and major guideline updates for treating uterine sarcomas. During this most recent update, the panel updated the mesenchymal tumor classification to correspond with recent updates to the WHO tumor classification system. Additionally, the panel revised its systemic therapy recommendations to reflect new data and collective clinical experience. These NCCN Guidelines Insights elaborate on the rationale behind these recent changes.
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Affiliation(s)
- Wui-Jin Koh
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Benjamin E Greer
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Nadeem R Abu-Rustum
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Sachin M Apte
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Susana M Campos
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Kathleen R Cho
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Christina Chu
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - David Cohn
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Marta Ann Crispens
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Don S Dizon
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Oliver Dorigo
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Patricia J Eifel
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Christine M Fisher
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Peter Frederick
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - David K Gaffney
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Suzanne George
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Ernest Han
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Susan Higgins
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Warner K Huh
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - John R Lurain
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Andrea Mariani
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - David Mutch
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Amanda Nickles Fader
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Steven W Remmenga
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - R Kevin Reynolds
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Todd Tillmanns
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Fidel A Valea
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Catheryn M Yashar
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Nicole R McMillian
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
| | - Jillian L Scavone
- From Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; University of Washington/Seattle Cancer Care Alliance; Memorial Sloan Kettering Cancer Center; Moffitt Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Fox Chase Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital Cancer Center; Stanford Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Huntsman Cancer Institute at the University of Utah; City of Hope Comprehensive Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred & Pamela Buffet Cancer Center at The Nebraska Medical Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; UC San Diego Moores Cancer Center; and National Comprehensive Cancer Network
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Saini U, Wallbillich J, Riley MR, Fowler JM, Wanner R, Lester J, Karlan B, Goodfellow P, Suarez A, Cohn D, Selvendiran K. Abstract LB-130: STAT3/PIAS3 as “early signature” gene pathways in the development of ovarian high grade serous carcinoma from the fallopian tube. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-130] [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
Objectives: Our recent studies in human samples have demonstrated constitutive activation of STAT3 Tyr705 and loss of protein inhibitor of activated STAT3 (PIAS3) in STICs in the fallopian tubes and advanced HGSC tissues. The goal of this current study is to identify and elucidate the molecular mechanisms leading to the initiation and development of HGSC through STAT3 activation and low levels or absence of PIAS3 in the fallopian tube (FT).
Methods: Human tissues–benign normal FTs, STICs (without ovarian cancer) and HGSC—were evaluated for expression of STAT3/PIAS3 (as compared with their known TP53 signature) and their target proliferation genes. Isolated primary fallopian tubal serous epithelial carcinoma (FTSEC) cells from FT and immortalized FT cells were also utilized and were evaluated with real time PCR, IHC, ICC, western blots, cloning and orthotopic mouse models.
Results: We observed high-level expression of pSTAT3 Tyr705, and decreased levels of PIAS3, in dysplastic areas of FT obtained from patients with and without cancer and advanced stage HGSC (as compared to high PIAS3 low pSTAT3 expression in normal benign FT). In addition, FT cells transfected with a STAT3 overexpression construct showed translocation of pSTAT3 and c-Myc into the nucleus. Further, the in vivo experiments demonstrated that the overexpression of STAT3 in FTSECs promoted tumor progression and metastasis, mimicking the clinical disease observed in patients with HGSC. In contrast, STAT3 knockdown in ovarian cancer cells was associated with reduced tumor growth and metastasis in vivo.
Conclusions: The STAT3 pathway may play a critical role in the development of STIC lesions and their progression to HGSC. We will further screen more FT samples and number of human tissues from various stages of HGSC along with an in vivo mouse model of HGSC in order to establish the oncogenic role of STAT3 and expression levels of PIAS3 in ovarian HGSC. Our current and future findings offer an opportunity to address the clinically important questions that are critical for cancer prevention and early detection in deadly HGSC.
Citation Format: Uksha Saini, John Wallbillich, Maria Riley Riley, John M. Fowler, Ross Wanner, Jenny Lester, Beth Karlan, Paul Goodfellow, Adrian Suarez, David Cohn, Karuppaiyah Selvendiran. STAT3/PIAS3 as “early signature” gene pathways in the development of ovarian high grade serous carcinoma from the fallopian tube. [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 LB-130.
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Naidu S, Saini U, ElNaggar AC, Bid HK, Wanner R, Bixel K, Suarez AA, Bolyard C, Kaur B, Goodfellow PJ, Kuppusamy P, Cohn D, Selvendiran K. Abstract 1720: HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1720] [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
The lack of an efficient pre-clinical model predicting a drug's clinical response before it enters into clinical trials is a major reason behind the limited success or complete failure of most of the traditional anti-cancer compounds. In this study, we evaluate our novel, safe and selective STAT3 inhibitor HO-3867 for its anti-cancer efficacy/bio-availability using a pre-clinical relevant, orthotopic ovarian tumor model and ex-vivo human tumor tissue culture. Treatment with HO-3867 (100PPM) significantly suppressed ovarian tumor growth and metastasis when compared to the standard Cisplatin (4mg/kg). A substantial amount of HO-3867 was detected in the ovarian tumor tissues and quantified using EPR spectroscopy. Markers specific to cell proliferation (Ki-67, Cyclin D1), angiogenesis (VEGF and Kinase array) and apoptosis (caspase-3 activity) were significantly altered by treatment with HO-3867. In vivo histopathological evaluation of internal organs collected from treated tumor mice revealed no evidence of toxicity specific to HO-3867. Normal and malignant tissues were collected and TUNEL/8-OHdG staining revealed selective induction of apoptosis limited to neoplastic cells and concomitant increase in reactive oxygen species within the orthotopic tumor. Suppression of STAT3 and its downstream target proteins (cell proliferative, anti-apoptotic and angiogenic) was confirmed with proteomic array. HO-3867 treated samples had significantly reduced vessel formation (∼4 times) as compared to the untreated control as is evident by in vivo Matrigel assay. HO-3867 was also found to have cytotoxic effects in ex vivo culture of freshly collected human tumor samples, including patients with chemotherapy resistant form of the disease. Overall, these results highlight the clinical anti-cancer potential of HO-3867 using a relevant preclinical orthotopic ovarian tumor model, and provide a rationale for the inclusion of ex vivo patient tumor slice culture in oncologic drug development processes.
Citation Format: Shan Naidu, Uksha Saini, Adam C. ElNaggar, Hemant K. Bid, Ross Wanner, Kristin Bixel, Adrian A. Suarez, Chelsea Bolyard, Balveen Kaur, Paul J. Goodfellow, Periannan Kuppusamy, David Cohn, Karuppaiyah Selvendiran. HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1720. doi:10.1158/1538-7445.AM2015-1720
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Bixel KL, Saini U, Fowler J, Rajendran S, Wanner R, Matsumura N, Hideg K, Konishi I, Cohn D, Karrupaiyah S. Abstract 5405: Targeting STAT3 as a novel therapy for ovarian clear cell carcinoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-5405] [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
Objective: Advanced ovarian clear cell carcinoma (OCCC) carries a very poor prognosis in large part secondary to the high rate of resistance to standard platinum and taxane chemotherapy. STAT3 expression and activation has been shown to regulate tumor progression in various human cancers though has not been well studied in OCCC. Preliminary work in our lab has demonstrated constitutive activation of STAT3 (pSTAT3Tyr705 or pSTAT3727) in OCCC cell lines as well as human OCCC tumor tissue samples. Significantly, pSTAT3 is expressed in the absence of other forms of activated STAT (pSTAT1,2,6). Based on our preliminary data, we hypothesized that use of a novel STAT3 inhibitor, HO-3867, would be an effective agent against OCCC cell lines in vitro and in vivo using a novel orthotopic mouse model.
Methods: Five OCCC cell lines (JHOC, OVISE, OVTOKO, RMGV, and ES2) were treated with HO-3867, cisplatin, or paclitaxel alone and/or in combination. Protein expression in tumor tissue and cell lines was determined by western blot (WB) and RT PCR was used to analyze RNA expression levels. MTT assay, BrdU assay, ANNEXIN V kit and flow cytometry were used to analyze cell viability, proliferation, apoptosis and cell cycle arrest. We use a novel orthotopic murine model using an ovarian bursal injection which was developed in our laboratory and has demonstrated primary ovarian tumor development and peritoneal carcinomatosis.
Results: Treatment with HO-3867 decreased expression of pSTAT3 while total STAT3 remained constant. Treatment with cisplatin or paclitaxel resulted in a relative increase in pSTAT3. The inhibitory effect of HO-3867 on cell proliferation is associated with G2/M phase cell cycle arrest and apoptosis (>45%) within 24 hours of treatment. Treatment with HO-3867 resulted in a decrease in BCL2 and cleavage of caspase 3, caspase 7, and PARP confirming induction of apoptosis after treatment with HO-3867. Treatment with cisplatin or paclitaxel was less effective at decreasing cell viability, reducing proliferation, and inducing apoptosis. In vivo experiments using the orthotopic murine model are ongoing.
Conclusion: HO-3867, a novel STAT3 inhibitor, appears to be efficacious against OCCC in vitro as compared to standard chemotherapeutics. Further investigation into this novel therapy is warranted given the generally poor response of OCCC to our standard chemotherapy regimens. Experiments to investigate the efficacy of HO-3867 in OCCC in vivo are underway.
Citation Format: Kristin L. Bixel, Uksha Saini, Jack Fowler, Sneja Rajendran, Ross Wanner, Noriomi Matsumura, Kalman Hideg, Ikuo Konishi, David Cohn, Selvendiran Karrupaiyah. Targeting STAT3 as a novel therapy for ovarian clear cell carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5405. doi:10.1158/1538-7445.AM2015-5405
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Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Cho KR, Chu C, Cohn D, Crispens MA, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mutch D, Fader AN, Remmenga SW, Reynolds RK, Teng N, Tillmanns T, Valea FA, Yashar CM, McMillian NR, Scavone JL. Cervical Cancer, Version 2.2015. J Natl Compr Canc Netw 2015; 13:395-404; quiz 404. [DOI: 10.6004/jnccn.2015.0055] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Chan J, Cho KR, Cohn D, Crispens MA, DuPont N, Eifel PJ, Fader AN, Fisher CM, Gaffney DK, George S, Han E, Huh WK, Lurain JR, Martin L, Mutch D, Remmenga SW, Reynolds RK, Small W, Teng N, Tillmanns T, Valea FA, McMillian N, Hughes M. Uterine Neoplasms, Version 1.2014. J Natl Compr Canc Netw 2014; 12:248-80. [DOI: 10.6004/jnccn.2014.0025] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liang M, Rosen M, Rath K, Clements A, Backes F, Eisenhauer E, Salani R, O'Malley D, Fowler J, Cohn D. Predicting patients requiring prolonged hospitalization after robotic surgery for the management of endometrial cancer: An opportunity for improvement. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.008] [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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Clements A, Backes F, Rath K, McCann G, Cohn D, Fowler J, Copeland L, Salani R, Eisenhauer E, O’Malley D. Are postmenopausal women with body mass indices <30 with grade 1 endometrial cancer more likely than their obese counterparts to have advanced or recurrent disease? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.246] [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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Billingsley C, Cohn D, Crim A, O’Malley D, Havrilesky L. Is it reasonable to administer pegfilgrastim on day 1 of a myelosuppressive chemotherapy regimen? A cost-utility analysis. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.201] [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: 11/27/2022]
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Brinton L, Felix A, Sherman M, Zaino R, McMeekin D, Creasman W, Mutch D, Cohn D, Walker J, Moore R. Etiologic heterogeneity in endometrial cancer: Evidence from a Gyneco- logic Oncology Group trial. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.143] [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: 11/28/2022]
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