1
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Brahmer JR, Long GV, Hamid O, Garon EB, Herbst RS, Andre T, Armand P, Bajorin D, Bellmunt J, Burtness B, Choueiri TK, Cohen EEW, Diaz LA, Shitara K, Kulkarni G, McDermott D, Shah M, Tabernero J, Vogel A, Zinzani PL, Jafari N, Bird S, Snyder E, Gause C, Bracco OL, Pietanza MC, Gruber T, Ribas A. Safety profile of pembrolizumab monotherapy based on an aggregate safety evaluation of 8937 patients. Eur J Cancer 2024; 199:113530. [PMID: 38295556 DOI: 10.1016/j.ejca.2024.113530] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Pembrolizumab has a manageable safety profile as described in its label, which was primarily based on 2799 patients who participated in clinical trials for melanoma or non-small cell lung cancer. Here, we evaluated the safety of pembrolizumab in a broader population of patients from 31 advanced cancer clinical trials across 19 cancer types. METHODS Safety was analyzed in patients who received at least one dose of pembrolizumab (200 mg every 3 weeks [Q3W], 10 mg/kg Q2W or Q3W, or 2 mg/kg Q3W). Adverse events (AEs) and immune-mediated AEs and infusion reactions were evaluated. RESULTS Safety data from 8937 patients in 31 trials of pembrolizumab monotherapy were pooled (median, seven administrations; range, 1-59). Median duration on treatment was 4.1 months (range, 0.03-40.1). AEs occurred in 96.6% of patients. Grade 3-5 AEs occurred in 50.6% of patients. AEs led to pembrolizumab discontinuation in 12.7% of patients and death in 5.9%. Immune-mediated AEs and infusion reactions occurred in 23.7% of patients (4.6% experienced multiple immune-mediated AEs/infusion reactions) and led to pembrolizumab discontinuation in 3.6% and death in 0.2%. Grade 3-5 immune-mediated AEs occurred in 6.3% of patients. Serious immune-mediated AEs and infusion reactions occurred in 6.0% of patients. Median time to immune-mediated AE onset was 85 days (range, 13-163). Of 2657 immune-mediated AEs, 22.3% were initially treated with prednisone ≥ 40 mg/day or equivalent, and 8.3% were initially treated with lower steroid doses. CONCLUSIONS This pooled analysis of 31 clinical trials showed that pembrolizumab has a consistent safety profile across indications.
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Affiliation(s)
- Julie R Brahmer
- Johns Hopkins Kimmel Cancer Center, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, 40 Rocklands Road North Sydney, Sydney, NSW 2060, Australia.
| | - Omid Hamid
- Cedars-Sinai The Angeles Clinic and Research Institute, 11800 Wilshire Blvd #300, Los Angeles, CA 90025, USA.
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
| | - Roy S Herbst
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Thierry Andre
- Sorbonne Université and Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, Paris 75012, France.
| | - Philippe Armand
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and IMIM Lab, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Barbara Burtness
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Ezra E W Cohen
- Moores Cancer Center, UC San Diego Health, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Luis A Diaz
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Kohei Shitara
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Chiba 277-8577, Japan.
| | - Girish Kulkarni
- Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON MG5 2C4, Canada.
| | - David McDermott
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02186, USA.
| | - Manish Shah
- Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA.
| | - Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Pg. de la Vall d'Hebron 119, Barcelona 08035, Spain.
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, Canada; Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada; Hannover Medical School, Hannover, Germany.
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | - Antoni Ribas
- David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd., Suite 200, Santa Monica, CA 90404, USA.
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2
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Vanguri RS, Smithy JW, Li Y, Zhuang M, Maher CA, Aleynick N, Peng X, Al-Ahmadie H, Funt SA, Rosenberg JE, Iyer G, Bajorin D, Mathews JC, Nadeem S, Panageas KS, Shen R, Callahan MK, Hollmann TJ. Integration of peripheral blood- and tissue-based biomarkers of response to immune checkpoint blockade in urothelial carcinoma. J Pathol 2023; 261:349-360. [PMID: 37667855 DOI: 10.1002/path.6197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
As predictive biomarkers of response to immune checkpoint inhibitors (ICIs) remain a major unmet clinical need in patients with urothelial carcinoma (UC), we sought to identify tissue-based immune biomarkers of clinical benefit to ICIs using multiplex immunofluorescence and to integrate these findings with previously identified peripheral blood biomarkers of response. Fifty-five pretreatment and 12 paired on-treatment UC specimens were identified from patients treated with nivolumab with or without ipilimumab. Whole tissue sections were stained with a 12-plex mIF panel, including CD8, PD-1/CD279, PD-L1/CD274, CD68, CD3, CD4, FoxP3, TCF1/7, Ki67, LAG-3, MHC-II/HLA-DR, and pancytokeratin+SOX10 to identify over three million cells. Immune tissue densities were compared to progression-free survival (PFS) and best overall response (BOR) by RECIST version 1.1. Correlation coefficients were calculated between tissue-based and circulating immune populations. The frequency of intratumoral CD3+ LAG-3+ cells was higher in responders compared to nonresponders (p = 0.0001). LAG-3+ cellular aggregates were associated with response, including CD3+ LAG-3+ in proximity to CD3+ (p = 0.01). Exploratory multivariate modeling showed an association between intratumoral CD3+ LAG-3+ cells and improved PFS independent of prognostic clinical factors (log HR -7.0; 95% confidence interval [CI] -12.7 to -1.4), as well as established biomarkers predictive of ICI response (log HR -5.0; 95% CI -9.8 to -0.2). Intratumoral LAG-3+ immune cell populations warrant further study as a predictive biomarker of clinical benefit to ICIs. Differences in LAG-3+ lymphocyte populations across the intratumoral and peripheral compartments may provide complementary information that could inform the future development of multimodal composite biomarkers of ICI response. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Rami S Vanguri
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James W Smithy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yanyun Li
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Mingqiang Zhuang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen A Maher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Nathaniel Aleynick
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiyu Peng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dean Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - James C Mathews
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Nadeem
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Travis J Hollmann
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Bristol Myers Squibb, Princeton, NJ, USA
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3
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Lyou Y, Rosenberg JE, Hoffman-Censits J, Quinn DI, Petrylak D, Galsky M, Vaishampayan U, De Giorgi U, Gupta S, Burris H, Rearden J, Li A, Xu C, Andresen C, Moran S, Daneshmand S, Bajorin D, Pal SK, Grivas P. Infigratinib in Early-Line and Salvage Therapy for FGFR3-Altered Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2021; 20:35-42. [PMID: 34782263 PMCID: PMC9460895 DOI: 10.1016/j.clgc.2021.10.004] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
The optimal sequencing of systemic treatments for metastatic urothelial cancer (mUC) is unknown. We assessed the efficacy of infigratinib, a fibroblast growth factor receptor (FGFR) 1 to 3 inhibitor, in 67 patients with FGFR3-altered mUC by line of therapy. Objective response rates were 31% (early-line setting) and 24% (≥2nd-line setting). Infigratinib has notable activity in mUC regardless of line of therapy.
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Affiliation(s)
- Yung Lyou
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Ugo De Giorgi
- lstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Sumati Gupta
- Huntsman Cancer Institute - University of Utah Health Care, Salt Lake City, UT
| | | | | | - Ai Li
- QED Therapeutics, Inc., San Francisco, CA
| | - Cindy Xu
- QED Therapeutics, Inc., San Francisco, CA
| | | | | | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center Institute of Urology, Los Angeles, CA
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA.
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4
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Francis JH, Harding JJ, Schram AM, Canestraro J, Haggag-Lindgren D, Heinemann M, Kriplani A, Jhaveri K, Voss MH, Bajorin D, Abou-Alfa GK, Iyer G, Drilon A, Rosenberg J, Abramson DH. Clinical and Morphologic Characteristics of Fibroblast Growth Factor Receptor Inhibitor-Associated Retinopathy. JAMA Ophthalmol 2021; 139:1126-1130. [PMID: 34473206 DOI: 10.1001/jamaophthalmol.2021.3331] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Fibroblast growth factor receptor (FGFR) 1 to 4 inhibitors are approved by the US Food and Drug Administration and suppress the mitogen-activated protein kinase (MAPK) pathway, with a potential for treatment-related retinopathy. To date, implications of FGFR inhibitor-associated ocular toxic effects are poorly described. Therefore, more detailed clinical descriptions of this ocular toxic effect could help explain visual symptoms while receiving drug therapy. Objective To describe the clinical and morphologic characteristics of serous retinal disturbances associated with FGFR inhibitors. Design, Setting, and Participants In this retrospective case series, 146 patients receiving FGFR inhibitors as cancer treatment at a single tertiary referral center were included. This study included 40 eyes of 20 patients with retinopathy by optical coherence tomography (OCT). OCTs were obtained on the remaining patients and the results were judged normal. Patients were recruited from March 2012 to January 2021. Main Outcomes and Measures Characteristics of treatment-emergent choroidal and retinal OCT abnormalities as compared with baseline OCT, associated with visual acuity at presentation and at fluid resolution. Results A total of 20 of 146 patients (13.7%) exhibited FGFR inhibitor-associated retinopathy. Of these 20 patients, 11 (55%) were female, and the median (range) age was 62.6 (42.7-86.0) years. The median (range; mean) time from medication start to initial subretinal fluid detection was 21 (5-125; 32) days. The median (interquartile range [IQR]) baseline logMAR best-corrected visual acuity (BCVA) was 0 (0-0.1). At fluid accumulation, 11 eyes had decreased vision: the median (IQR) subgroup baseline BCVA was 0 (0-0.1); and the median (IQR) BCVA change from baseline to accumulation was -0.1 (-0.2 to -0.1). For 26 eyes (65%) with follow-up, the subretinal fluid resolved without medical intervention or drug interruption in all but 1 patient. At fluid resolution, the median (IQR) BCVA was 0.1 (0-0.1), and the change in median (IQR) BCVA from baseline to fluid resolution was 0 (-0.03 to 0). No patient discontinued drug therapy on account of their retinopathy. Conclusions and Relevance FGFR inhibitors result in subretinal fluid foci similar to other drugs that inhibit the MAPK pathway. In this series, FGFR inhibitors did not cause irreversible loss of vision; the retinopathy was self-limited and did not require medical intervention. These results may explain visual symptoms while taking the drug, although the precise frequency or magnitude of this adverse effect cannot be determined with certainty from this retrospective investigation.
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Affiliation(s)
- Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill-Cornell Medical Center, New York, New York
| | - James J Harding
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison M Schram
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julia Canestraro
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Murk Heinemann
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill-Cornell Medical Center, New York, New York
| | - Anuja Kriplani
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Komal Jhaveri
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin H Voss
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dean Bajorin
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ghassan K Abou-Alfa
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gopa Iyer
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander Drilon
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Rosenberg
- Weill-Cornell Medical Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill-Cornell Medical Center, New York, New York
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5
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Mota JM, Teo MY, Whiting K, Li HA, Regazzi AM, Lee CH, Funt SA, Bajorin D, Ostrovnaya I, Iyer G, Rosenberg JE. Pretreatment Eosinophil Counts in Patients With Advanced or Metastatic Urothelial Carcinoma Treated With Anti-PD-1/PD-L1 Checkpoint Inhibitors. J Immunother 2021; 44:248-253. [PMID: 34081050 PMCID: PMC8373810 DOI: 10.1097/cji.0000000000000372] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023]
Abstract
Eosinophils influence antitumor immunity and may predict response to treatment with immune checkpoint inhibitors (ICIs). To examine the association between blood eosinophil counts and outcomes in patients with advanced or metastatic urothelial carcinoma (mUC) treated with ICIs, we identified 2 ICI-treated cohorts: discovery (n=60) and validation (n=111). Chemotherapy cohorts were used as comparators (first-line platinum-based chemotherapy, n=75; second-line or more pemetrexed, n=77). The primary endpoint was overall survival (OS). Secondary endpoints were time on treatment (ToT) and progression-free survival. Univariate and multivariate analyses were performed using Cox proportional hazard models. Associations between changes in eosinophil count at weeks 2/3 and 6 after the start of ICI treatment were analyzed using landmark analyses. Baseline characteristics of the ICI cohorts were similar. In the discovery cohort, an optimal cutoff for pretreatment eosinophil count was determined [Eos-Lo: <100 cells/µL; n=9 (15%); Eos-Hi: ≥100 cells/µL; n=51 (85%)]. Eos-Lo was associated with inferior outcomes [OS: hazard ratio (HR), 3.98; 95% confidence interval (CI), 1.85-8.56; P<0.013; ToT: HR, 2.45; 95% CI, 1.17-5.10; P=0.017]. This was confirmed in the validation cohort [Eos-Lo: n=17 (15%); Eos-Hi: n=94 (85%)] (OS: HR, 2.51; 95% CI, 1.31-4.80; P=0.006; ToT: HR, 2.22; 95% CI, 1.2-3.80; P=0.004), and remained significant after adjustment for other prognostic factors. Changes in eosinophil counts at weeks 2/3 and 6 were not clearly associated with outcomes. In chemotherapy cohorts, eosinophil counts were not associated with outcomes. In conclusion, low pretreatment eosinophil count was associated with poorer outcomes in patients with mUC treated with ICIs, and may represent a new predictive biomarker.
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Affiliation(s)
- Jose Mauricio Mota
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Min Yuen Teo
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Karissa Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Han A. Li
- Weill Cornell Medicine, New York, NY
| | | | - Chung-Han Lee
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Samuel A. Funt
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Dean Bajorin
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gopa Iyer
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Jonathan E. Rosenberg
- Genitourinary Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
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6
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Tsui DWY, Cheng ML, Shady M, Yang JL, Stephens D, Won H, Srinivasan P, Huberman K, Meng F, Jing X, Patel J, Hasan M, Johnson I, Gedvilaite E, Houck-Loomis B, Socci ND, Selcuklu SD, Seshan VE, Zhang H, Chakravarty D, Zehir A, Benayed R, Arcila M, Ladanyi M, Funt SA, Feldman DR, Li BT, Razavi P, Rosenberg J, Bajorin D, Iyer G, Abida W, Scher HI, Rathkopf D, Viale A, Berger MF, Solit DB. Tumor fraction-guided cell-free DNA profiling in metastatic solid tumor patients. Genome Med 2021; 13:96. [PMID: 34059130 PMCID: PMC8165771 DOI: 10.1186/s13073-021-00898-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cell-free DNA (cfDNA) profiling is increasingly used to guide cancer care, yet mutations are not always identified. The ability to detect somatic mutations in plasma depends on both assay sensitivity and the fraction of circulating DNA in plasma that is tumor-derived (i.e., cfDNA tumor fraction). We hypothesized that cfDNA tumor fraction could inform the interpretation of negative cfDNA results and guide the choice of subsequent assays of greater genomic breadth or depth. METHODS Plasma samples collected from 118 metastatic cancer patients were analyzed with cf-IMPACT, a modified version of the FDA-authorized MSK-IMPACT tumor test that can detect genomic alterations in 410 cancer-associated genes. Shallow whole genome sequencing (sWGS) was also performed in the same samples to estimate cfDNA tumor fraction based on genome-wide copy number alterations using z-score statistics. Plasma samples with no somatic alterations detected by cf-IMPACT were triaged based on sWGS-estimated tumor fraction for analysis with either a less comprehensive but more sensitive assay (MSK-ACCESS) or broader whole exome sequencing (WES). RESULTS cfDNA profiling using cf-IMPACT identified somatic mutations in 55/76 (72%) patients for whom MSK-IMPACT tumor profiling data were available. A significantly higher concordance of mutational profiles and tumor mutational burden (TMB) was observed between plasma and tumor profiling for plasma samples with a high tumor fraction (z-score≥5). In the 42 patients from whom tumor data was not available, cf-IMPACT identified mutations in 16/42 (38%). In total, cf-IMPACT analysis of plasma revealed mutations in 71/118 (60%) patients, with clinically actionable alterations identified in 30 (25%), including therapeutic targets of FDA-approved drugs. Of the 47 samples without alterations detected and low tumor fraction (z-score<5), 29 had sufficient material to be re-analyzed using a less comprehensive but more sensitive assay, MSK-ACCESS, which revealed somatic mutations in 14/29 (48%). Conversely, 5 patients without alterations detected by cf-IMPACT and with high tumor fraction (z-score≥5) were analyzed by WES, which identified mutational signatures and alterations in potential oncogenic drivers not covered by the cf-IMPACT panel. Overall, we identified mutations in 90/118 (76%) patients in the entire cohort using the three complementary plasma profiling approaches. CONCLUSIONS cfDNA tumor fraction can inform the interpretation of negative cfDNA results and guide the selection of subsequent sequencing platforms that are most likely to identify clinically-relevant genomic alterations.
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Affiliation(s)
- Dana W Y Tsui
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Weill Cornell Medical College, Weill Cornell University, New York, USA.
- Present Address: PetDx, Inc., La Jolla, USA.
| | - Michael L Cheng
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
- Present Address: Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Maha Shady
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Present Address: Graduate School of Arts and Sciences, Harvard University, Cambridge, USA
| | - Julie L Yang
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Dennis Stephens
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Helen Won
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Preethi Srinivasan
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Kety Huberman
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Fanli Meng
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Xiaohong Jing
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Present Address: NYU Langone Health, New York, USA
| | - Juber Patel
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Maysun Hasan
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ian Johnson
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Erika Gedvilaite
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Brian Houck-Loomis
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Nicholas D Socci
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - S Duygu Selcuklu
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Venkatraman E Seshan
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Hongxin Zhang
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Debyani Chakravarty
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bob T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jonathan Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dean Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Wassim Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Howard I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dana Rathkopf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Agnes Viale
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michael F Berger
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Weill Cornell Medical College, Weill Cornell University, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - David B Solit
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA.
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7
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Rosenberg JE, Ballman KA, Halabi S, Atherton PJ, Mortazavi A, Sweeney C, Stadler WM, Teply BA, Picus J, Tagawa ST, Katragadda S, Vaena D, Misleh J, Hoimes C, Plimack ER, Flaig TW, Dreicer R, Bajorin D, Hahn O, Small EJ, Morris MJ. Randomized Phase III Trial of Gemcitabine and Cisplatin With Bevacizumab or Placebo in Patients With Advanced Urothelial Carcinoma: Results of CALGB 90601 (Alliance). J Clin Oncol 2021; 39:2486-2496. [PMID: 33989025 DOI: 10.1200/jco.21.00286] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The combination of gemcitabine and cisplatin (GC) is a standard therapy for metastatic urothelial carcinoma. Based on data that angiogenesis plays a role in urothelial carcinoma growth and progression, a randomized placebo-controlled trial was performed with the primary objective of testing whether patients treated with GC and bevacizumab (GCB) have superior overall survival (OS) than patients treated with GC and placebo (GCP). PATIENTS AND METHODS Between July 2009 and December 2014, 506 patients with metastatic urothelial carcinoma without prior chemotherapy for metastatic disease and no neoadjuvant or adjuvant chemotherapy within 12 months were randomly assigned to receive either GCB or GCP. The primary end point was OS, with secondary end points of progression-free survival, objective response, and toxicity. RESULTS With a median follow-up of 76.3 months among alive patients, the median OS was 14.5 months for patients treated with GCB and 14.3 months for patients treated with GCP (hazard ratio for death = 0.87; 95% CI, 0.72 to 1.05; two-sided stratified log-rank P = .14). The median progression-free survival was 8.0 months for GCB and 6.7 months for GCP (hazard ratio = 0.77; 95% CI, 0.63 to 0.95; P = .016). The proportion of patients with grade 3 or greater adverse events did not differ significantly between both arms, although increased bevacizumab-related toxicities such as hypertension and proteinuria occurred in the bevacizumab-treated arm. CONCLUSION The addition of bevacizumab to GC did not result in improved OS. The observed median OS of about 14 months is consistent with prior phase III trials of cisplatin-based chemotherapy.
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Affiliation(s)
| | - Karla A Ballman
- Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY
| | - Susan Halabi
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke Cancer Institute-Biostatistics, Duke University, Durham, NC
| | | | - Amir Mortazavi
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Joel Picus
- Washington University School of Medicine, St Louis, MO
| | | | | | - Daniel Vaena
- University of Iowa/Holden Comprehensive Cancer Center, Iowa City, IA
| | - Jamal Misleh
- Christiana Care NCI Community Oncology Research Program, Newark, DE
| | - Christopher Hoimes
- Case Comprehensive Cancer Center at UH-Seidman, Cleveland, OH.,Duke University, Durham, NC
| | | | - Thomas W Flaig
- University of Colorado Denver School of Medicine, Aurora, CO
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Olwen Hahn
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Eric J Small
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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8
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Bolton KL, Ptashkin RN, Gao T, Braunstein L, Devlin SM, Kelly D, Patel M, Berthon A, Syed A, Yabe M, Coombs CC, Caltabellotta NM, Walsh M, Offit K, Stadler Z, Mandelker D, Schulman J, Patel A, Philip J, Bernard E, Gundem G, Ossa JEA, Levine M, Martinez JSM, Farnoud N, Glodzik D, Li S, Robson ME, Lee C, Pharoah PDP, Stopsack KH, Spitzer B, Mantha S, Fagin J, Boucai L, Gibson CJ, Ebert BL, Young AL, Druley T, Takahashi K, Gillis N, Ball M, Padron E, Hyman DM, Baselga J, Norton L, Gardos S, Klimek VM, Scher H, Bajorin D, Paraiso E, Benayed R, Arcila ME, Ladanyi M, Solit DB, Berger MF, Tallman M, Garcia-Closas M, Chatterjee N, Diaz LA, Levine RL, Morton LM, Zehir A, Papaemmanuil E. Cancer therapy shapes the fitness landscape of clonal hematopoiesis. Nat Genet 2020; 52:1219-1226. [PMID: 33106634 PMCID: PMC7891089 DOI: 10.1038/s41588-020-00710-0] [Citation(s) in RCA: 312] [Impact Index Per Article: 78.0] [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: 04/05/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023]
Abstract
Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/pharmacology
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/radiation effects
- Child
- Child, Preschool
- Clonal Evolution
- Clonal Hematopoiesis/drug effects
- Clonal Hematopoiesis/genetics
- Cohort Studies
- Female
- Genetic Fitness
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid/genetics
- Male
- Middle Aged
- Models, Biological
- Mutation
- Neoplasms/drug therapy
- Neoplasms/radiotherapy
- Neoplasms, Second Primary/genetics
- Selection, Genetic
- Young Adult
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Affiliation(s)
- Kelly L Bolton
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan N Ptashkin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teng Gao
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lior Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Kelly
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Minal Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonin Berthon
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aijazuddin Syed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariko Yabe
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine C Coombs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole M Caltabellotta
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mike Walsh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia Stadler
- Department of Medicine, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Schulman
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akshar Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Philip
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunes Gundem
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan E Arango Ossa
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Levine
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Noushin Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dominik Glodzik
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sonya Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul D P Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Konrad H Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon Mantha
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Boucai
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Young
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Todd Druley
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy Gillis
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Markus Ball
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
- Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Jose Baselga
- Research & Development, AstraZeneca, Milton, Cambridge, UK
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Stuart Gardos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Virginia M Klimek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Howard Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Dean Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Eder Paraiso
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Strategy & Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nilanjan Chatterjee
- Department of Biostatistics, Bloomberg School of Public Health Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Program in Precision Interception and Prevention, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Solid Tumor Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross L Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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Bellmunt J, de Wit R, Fradet Y, Climent M, Petrylak D, Lee JL, Fong L, Necchi A, Sternberg C, Grivas P, O’Donnell P, Powles T, Plimack E, Cristescu R, Lunceford J, Ma J, Rajasagi M, Godwin J, Moreno B, Bajorin D. 747P Association of TMB with efficacy of pembrolizumab (pembro) in patients (pts) with advanced urothelial cancer (UC): Results from KEYNOTE-045 and KEYNOTE-052. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Grivas P, Balar A, Vuky J, de Wit R, Vogelzang N, Choueiri T, Bajorin D, Castellano Gauna D, Gerritsen W, Gurney H, Quinn D, Culine S, Fradet Y, Saadatpour A, Loboda A, Ma J, Rajasagi M, Godwin J, Moreno B, Bellmunt J. 744P Association between gene expression signatures (sigs) and pembrolizumab (pembro) efficacy in patients (pts) with advanced urothelial cancer (UC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.816] [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: 11/16/2022] Open
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11
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Lyou Y, Grivas P, Rosenberg JE, Hoffman-Censits J, Quinn DI, P Petrylak D, Galsky M, Vaishampayan U, De Giorgi U, Gupta S, Burris H, Rearden J, Li A, Wang H, Reyes M, Moran S, Daneshmand S, Bajorin D, Pal SK. Hyperphosphatemia Secondary to the Selective Fibroblast Growth Factor Receptor 1-3 Inhibitor Infigratinib (BGJ398) Is Associated with Antitumor Efficacy in Fibroblast Growth Factor Receptor 3-altered Advanced/Metastatic Urothelial Carcinoma. Eur Urol 2020; 78:916-924. [PMID: 32847703 DOI: 10.1016/j.eururo.2020.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infigratinib (BGJ398) is a potent, selective fibroblast growth factor receptor (FGFR) 1-3 inhibitor with significant activity in metastatic urothelial carcinoma (mUC) bearing FGFR3 alterations. It can cause hyperphosphatemia due to the "on-target" class effect of FGFR1 inhibition. OBJECTIVE To investigate the relationship between hyperphosphatemia and treatment response in patients with mUC. INTERVENTION Oral infigratinib 125 mg/d for 21 d every 28 d. DESIGN, SETTING, AND PARTICIPANTS Data from patients treated with infigratinib in a phase I trial with platinum-refractory mUC and activating FGFR3 alterations were retrospectively analyzed for clinical efficacy in relation to serum hyperphosphatemia. The relationship between plasma infigratinib concentration and phosphorous levels was also assessed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical outcomes were compared in groups with/without hyperphosphatemia. RESULTS AND LIMITATIONS Of the 67 patients enrolled, 48 (71.6%) had hyperphosphatemia on one or more laboratory tests. Findings in patients with versus without hyperphosphatemia were the following: overall response rate 33.3% (95% confidence interval [CI] 20.4-48.4) versus 5.3% (95% CI 0.1-26.0); disease control rate 75.0% (95% CI 60.4-86.4) versus 36.8% (95% CI 16.3-61.6). This trend was maintained in a 1-mo landmark analysis. Pharmacokinetic/pharmacodynamic analysis showed that serum phosphorus levels and physiologic infigratinib concentrations were correlated positively. Key limitations include retrospective design, lack of comparator, and limited sample size. CONCLUSIONS This is the first published study to suggest that hyperphosphatemia caused by FGFR inhibitors, such as infigratinib, can be a surrogate biomarker for treatment response. These findings are consistent with other reported observations and will need to be validated further in a larger prospective trial. PATIENT SUMMARY Targeted therapy is a new paradigm in treating bladder cancer. In a study using infigratinib, a drug that targets mutations in a gene called fibroblast growth factor receptor 3 (FGFR3), we found that elevated levels of phosphorous were associated with greater clinical benefit. In the future, these data may help inform treatment strategies.
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Affiliation(s)
- Yung Lyou
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | | | | | - Ugo De Giorgi
- lstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sumati Gupta
- Huntsman Cancer Institute-University of Utah Health Care, Salt Lake City, UT, USA
| | | | | | - Ai Li
- QED Therapeutics, San Francisco, CA, USA
| | - Hao Wang
- QED Therapeutics, San Francisco, CA, USA
| | | | | | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center Department of Urology, Los Angeles, CA, USA
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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12
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Bolton KL, Ptashkin RN, Gao T, Braunstein L, Devlin SM, Patel M, Berthon A, Syed A, Yabe M, Coombs C, Caltabellotta NM, Walsh M, Offit K, Stadler Z, Lee C, Pharoah P, Stopsack KH, Spitzer B, Mantha S, Fagin J, Boucai L, Gibson CJ, Ebert B, Young AL, Druley T, Takahashi K, Gillis N, Ball M, Padron E, Hyman D, Baselga J, Norton L, Gardos S, Klimek V, Scher H, Bajorin D, Paraiso E, Benayed R, Arcilla M, Ladanyi M, Solit D, Berger M, Tallman M, Garcia-Closas M, Chatterjee N, Diaz L, Levine R, Morton L, Zehir A, Papaemmanuil E. Abstract 5703: Oncologic therapy shapes the fitness landscape of clonal hematopoiesis. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5703] [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
Recent studies among healthy individuals show evidence of somatic mutations in leukemia-associated genes, referred to as clonal hematopoiesis (CH). To determine the relationship between CH and oncologic therapy we collected sequential blood samples from 525 cancer patients (median sampling interval time = 23 months, range: 6-53 months) of whom 61% received cytotoxic therapy or external beam radiation therapy and 39% received either targeted/immunotherapy or were untreated. Samples were sequenced using deep targeted capture-based platforms. To determine whether CH mutational features were associated with tMN risk, we performed Cox proportional hazards regression on 9,549 cancer patients exposed to oncologic therapy of whom 75 cases developed tMN (median time to transformation=26 months). To further compare the genetic and clonal relationships between tMN and the proceeding CH, we analyzed 35 cases for which paired samples were available. We compared the growth rate of the variant allele fraction (VAF) of CH clones across treatment modalities and in untreated patients. A significant increase in the growth rate of CH mutations was seen in DDR genes among those receiving cytotoxic (p=0.03) or radiation therapy (p=0.02) during the follow-up period compared to patients who did not receive therapy. Similar growth rates among treated and untreated patients were seen for non-DDR CH genes such as DNMT3A. Increasing cumulative exposure to cytotoxic therapy (p=0.01) and external beam radiation therapy (2x10-8) resulted in higher growth rates for DDR CH mutations. Among 34 subjects with at least two CH mutations in which one mutation was in a DDR gene and one in a non-DDR gene, we studied competing clonal dynamics for multiple gene mutations within the same patient. The risk of tMN was positively associated with CH in a known myeloid neoplasm driver mutation (HR=6.9, p<10-6), and increased with the total number of mutations and clone size. The strongest associations were observed for mutations in TP53 and for CH with mutations in spliceosome genes (SRSF2, U2AF1 and SF3B1). Lower hemoglobin, lower platelet counts, lower neutrophil counts, higher red cell distribution width and higher mean corpuscular volume were all positively associated with increased tMN risk. Among 35 cases for which paired samples were available, in 19 patients (59%), we found evidence of at least one of these mutations at the time of pre-tMN sequencing and in 13 (41%), we identified two or more in the pre-tMN sample. In all cases the dominant clone at tMN transformation was defined by a mutation seen at CH Our serial sampling data provide clear evidence that oncologic therapy strongly selects for clones with mutations in the DDR genes and that these clones have limited competitive fitness, in the absence of cytotoxic or radiation therapy. We further validate the relevance of CH as a predictor and precursor of tMN in cancer patients. We show that CH mutations detected prior to tMN diagnosis were consistently part of the dominant clone at tMN diagnosis and demonstrate that oncologic therapy directly promotes clones with mutations in genes associated with chemo-resistant disease such as TP53.
Citation Format: Kelly L. Bolton, Ryan N. Ptashkin, Teng Gao, Lior Braunstein, Sean M. Devlin, Minal Patel, Antonin Berthon, Aijazuddin Syed, Mariko Yabe, Catherine Coombs, Nicole M. Caltabellotta, Mike Walsh, Ken Offit, Zsofia Stadler, Choonsik Lee, Paul Pharoah, Konrad H. Stopsack, Barbara Spitzer, Simon Mantha, James Fagin, Laura Boucai, Christopher J. Gibson, Benjamin Ebert, Andrew L. Young, Todd Druley, Koichi Takahashi, Nancy Gillis, Markus Ball, Eric Padron, David Hyman, Jose Baselga, Larry Norton, Stuart Gardos, Virginia Klimek, Howard Scher, Dean Bajorin, Eder Paraiso, Ryma Benayed, Maria Arcilla, Marc Ladanyi, David Solit, Michael Berger, Martin Tallman, Montserrat Garcia-Closas, Nilanjan Chatterjee, Luis Diaz, Ross Levine, Lindsay Morton, Ahmet Zehir, Elli Papaemmanuil. Oncologic therapy shapes the fitness landscape of clonal hematopoiesis [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 5703.
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Affiliation(s)
| | | | - Teng Gao
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Minal Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Mariko Yabe
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Mike Walsh
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ken Offit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Choonsik Lee
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Pharoah
- 3University of Cambridge, Cambridge, United Kingdom
| | | | | | - Simon Mantha
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Fagin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laura Boucai
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - David Hyman
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Baselga
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larry Norton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stuart Gardos
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Howard Scher
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean Bajorin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eder Paraiso
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryma Benayed
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Arcilla
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Solit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Luis Diaz
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross Levine
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ahmet Zehir
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Vuky J, Balar AV, Castellano D, O'Donnell PH, Grivas P, Bellmunt J, Powles T, Bajorin D, Hahn NM, Savage MJ, Fang X, Godwin JL, Frenkl TL, Homet Moreno B, de Wit R, Plimack ER. Long-Term Outcomes in KEYNOTE-052: Phase II Study Investigating First-Line Pembrolizumab in Cisplatin-Ineligible Patients With Locally Advanced or Metastatic Urothelial Cancer. J Clin Oncol 2020; 38:2658-2666. [PMID: 32552471 DOI: 10.1200/jco.19.01213] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The phase II single-arm KEYNOTE-052 study evaluated the efficacy and safety of first-line pembrolizumab for patients with locally advanced or metastatic cisplatin-ineligible urothelial carcinoma (UC). PATIENTS AND METHODS Three hundred seventy patients received pembrolizumab 200 mg intravenously every 3 weeks for up to 24 months. Positive tumor programmed death ligand 1 (PD-L1) expression was defined as combined positive score (CPS) ≥ 10. Response was assessed by independent central review every 9 weeks per RECIST v1.1. The primary end point was objective response rate (ORR). RESULTS At data cutoff (September 26, 2018), the minimum follow-up was 2 years since the last patient enrolled. ORR was 28.6% (95% CI, 24.1% to 33.5%); 33 patients (8.9%) and 73 patients (19.7%) achieved complete and partial response, respectively. The median duration of response was 30.1 months (95% CI, 18.1 months to not reached [NR]); responses lasted ≥ 12 and ≥ 24 months in 67% and 52% of patients, respectively. Forty patients with complete or partial response completed 2 years of study treatment, and 32 had ongoing response at completion. Median overall survival (OS) was 11.3 months (95% CI, 9.7 to 13.1 months), and 12- and 24-month OS rates were 46.9% and 31.2%, respectively. In patients with CPS ≥ 10, ORR was 47.3% (95% CI, 37.7% to 57.0%) and median OS was 18.5 months (95% CI, 12.2 to 28.5 months). In patients with lymph node-only disease, ORR was 49.0% (95% CI, 34.8% to 63.4%), and median OS was 27.0 months (12.4 months to NR). There were no new safety signals. CONCLUSION First-line pembrolizumab confers meaningful and durable clinical response in cisplatin-ineligible patients with advanced UC and is associated with prolonged OS, particularly with PD-L1 CPS ≥ 10 and lymph node-only disease.
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Affiliation(s)
| | - Arjun V Balar
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | | | | | - Joaquim Bellmunt
- Beth Israel Deaconess Medical Center/IMIM research Institute, Harvard Medical School, Boston, MA
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Noah M Hahn
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | - Ronald de Wit
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Pal SK, Bajorin D, Dizman N, Hoffman-Censits J, Quinn DI, Petrylak DP, Galsky MD, Vaishampayan U, De Giorgi U, Gupta S, Burris HA, Soifer HS, Li G, Wang H, Dambkowski CL, Moran S, Daneshmand S, Rosenberg JE. Infigratinib in upper tract urothelial carcinoma versus urothelial carcinoma of the bladder and its association with comprehensive genomic profiling and/or cell-free DNA results. Cancer 2020; 126:2597-2606. [PMID: 32208524 DOI: 10.1002/cncr.32806] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Infigratinib (BGJ398) is a potent and selective fibroblast grown factor receptor 1 to 3 (FGFR1-3) inhibitor with significant activity in patients with advanced or metastatic urothelial carcinoma bearing FGFR3 alterations. Given the distinct biologic characteristics of upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB), the authors examined whether infigratinib had varying activity in these settings. METHODS Eligible patients had metastatic urothelial carcinoma with activating FGFR3 mutations and/or fusions. Comprehensive genomic profiling was performed on formalin-fixed, paraffin-embedded tissues. Blood was collected for cell-free DNA analysis using a 600-gene panel. Patients received infigratinib at a dose of 125 mg orally daily (3 weeks on/1 week off) until disease progression or intolerable toxicity occurred. The overall response rate (ORR; partial response [PR] plus complete response [CR]) and disease control rate (DCR; CR plus PR plus stable disease [SD]) were characterized. RESULTS A total of 67 patients were enrolled; the majority (70.1%) had received ≥2 prior antineoplastic therapies. In 8 patients with UTUC, 1 CR and 3 PRs were observed (ORR, 50%); the remaining patients achieved a best response of SD (DCR, 100%). In patients with UCB, 13 PRs were observed (ORR, 22%), and 22 patients had a best response of SD (DCR, 59.3%). Notable differences in genomic alterations between patients with UTUC and those with UCB included higher frequencies of FGFR3-TACC3 fusions (12.5% vs 6.8%) and FGFR3 R248C mutations (50% vs 11.9%), and a lower frequency of FGFR3 S249C mutations (37.5% vs 59.3%). CONCLUSIONS Differences in the cumulative genomic profile were observed between patients with UTUC and those with UCB in the current FGFR3-restricted experience, underscoring the distinct biology of these diseases. These results support a planned phase 3 adjuvant study predominantly performed in this population.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Dean Bajorin
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jean Hoffman-Censits
- Departments of Medical Oncology and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David I Quinn
- University of Southern California Norris Comprehensive Cancer Center Keck School of Medicine at USC, Los Angeles, California
| | - Daniel P Petrylak
- Department of Medicine, Division of Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Matthew D Galsky
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, The Mount Sinai Hospital, New York, New York
| | - Ulka Vaishampayan
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Ugo De Giorgi
- Department of Medical Oncology, Scientific Institute of Romagna for the Study and Treatment of Cancer, IRCCS, Meldola, Italy
| | - Sumati Gupta
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Howard A Burris
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, Tennessee
| | - Harris S Soifer
- Department of Translational Medicine, QED Therapeutics Inc, San Francisco, California
| | - Gary Li
- Department of Translational Medicine, QED Therapeutics Inc, San Francisco, California
| | - Hao Wang
- Department of Biostatistics and Data Management, QED Therapeutics Inc, San Francisco, California
| | - Carl L Dambkowski
- Department of Strategy and Operations, QED Therapeutics Inc, San Francisco, California
| | - Susan Moran
- Department of Clinical Development, QED Therapeutics Inc, San Francisco, California
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Bolton K, Ptashkin R, Braunstein L, Gao T, Devlin SM, Kelly D, Coombs C, Patel M, Moarii M, Bernard E, Berthon A, Boucai L, Glodzik D, Martin A, Stadler Z, Walsh M, Mandelker D, Patel A, Schulman J, Gundem G, Syed A, Arcila M, Solit DB, Robson ME, Ladanyi M, Lee C, Philip J, Bajorin D, Garcia-Closas M, Gardos S, Hyman D, Tallman M, Yabe M, Offit K, Scher H, Klimek V, Diaz L, Chatterjee N, Berger MF, Morton L, Levine R, Zehir A, Papaemmanuil E. Abstract LB-304: Oncologic therapy for solid tumors alters the risk of clonal hematopoiesis. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-304] [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
Solid tumor patients often suffer from cytopenias and are at risk for therapy-related myeloid neoplasms (tMN). Somatic mutations in leukemia-associated genes can occur in normal healthy individuals, referred to as clonal hematopoiesis (CH). CH is associated with cytopenias, risk of leukemia and cardiovascular disease. We and others have shown that CH is frequent in cancer patients. Characterization of the relationship between exposure to specific oncologic regimens and CH and how these relate to cytopenias and tMN risk would inform treatment decisions and tMN prevention strategies.
To determine the relationship between CH and oncologic therapy we interrogated CH in a cohort of 9045 solid tumor patients. Subjects were sequenced using a targeted panel of cancer-associated mutations used to screen tumor samples against a blood control sample. Mutation detection was performed on blood-derived sequencing data using the matched tumor as a comparator and accounted for background sequencing error rates.
CH was identified in 23% of patients. In multivariate regression analyses adjusted by age, CH was more often found in current smokers (OR=1.20, 95%CI=1.07-1.35, p<0.001) and less often found in Asians compared to Whites (OR=0.72, 95%CI=0.56-0.89, p<0.001). Smoking was associated with CH mutations in ASXL1 (OR=3.75, 95%CI=2.73-5.17, p<0.001). There was a higher proportion of patients with CH among those who had received chemotherapy (OR=1.14, 95%CI=1.02-1.26, p=0.02) and those who had received external beam radiation therapy (OR=1.45, 95%CI=1.28-1.63, p<0.001) prior to blood collection. Mutations in the DNA repair/cell cycle pathway (including TP53, PPM1D and CHEK2) were more common among patients who received chemotherapy and radiation therapy prior to IMPACT testing compared to those who were treatment naïve (p<0.001). Exposure to prior cytotoxic chemotherapy (OR=1.20, 95%CI=1.02-1.30; p=0.007) and radiation therapy (OR=1.6, 95%CI=1.4-1.9, p<0.001) was associated with having CH while exposure to immunotherapy and targeted therapy was not. Increasing cumulative dose of chemotherapy overall and cytotoxic therapy was associated with a higher likelihood of CH (p=0.015 and p=0.007 respectively). There was evidence of specific gene, treatment and dosage effects. To further examine the relationship between oncologic therapy and clonal evolution of CH, we collected 375 sequential samples at least 18 months apart. T mean change in VAF of CH mutations per year was found to increase by 0.17% in patients who did not receive further therapy during the follow-up time and 0.49% in those who were exposed to cytotoxic chemotherapy. A subset of patients with CH were consented to germline testing for cancer predisposition genes (N=6368). We observe a higher rate of CH among patients with a germline mutation in the cell cycle/DNA repair pathway (i.e. TP53) when compared to patients without germline mutations (OR=3.7, 95% CI: 1.35-9.35, p-value=0.01).
CH is frequent in solid tumor patients and can be reliably detected when a matched tumor normal targeted gene sequencing approach is performed. Beyond age, CH is strongly associated with race, smoking and importantly prior exposure to oncologic therapy with evidence of specific treatment effects. Screening of CH in cancer cohorts is critical to the development of future clinical guidelines and risk-adapted prevention strategies for tMN.
Note: This abstract was not presented at the meeting.
Citation Format: Kelly Bolton, Ryan Ptashkin, Lior Braunstein, Teng Gao, Sean M. Devlin, Daniel Kelly, Catherine Coombs, Minal Patel, Matahi Moarii, Elsa Bernard, Antonin Berthon, Laura Boucai, Dominik Glodzik, Axel Martin, Zsofia Stadler, Michael Walsh, Diana Mandelker, Akshar Patel, Jessica Schulman, Gunes Gundem, Aijazuddin Syed, Maria Arcila, David B. Solit, Mark E. Robson, Marc Ladanyi, Choonsik Lee, John Philip, Dean Bajorin, Montserrat Garcia-Closas, Stuart Gardos, David Hyman, Martin Tallman, Mariko Yabe, Kenneth Offit, Howard Scher, Virginia Klimek, Luis Diaz, Nilanjan Chatterjee, Michael F. Berger, Lindsay Morton, Ross Levine, Ahmet Zehir, Elli Papaemmanuil. Oncologic therapy for solid tumors alters the risk of clonal hematopoiesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-304.
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Affiliation(s)
- Kelly Bolton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan Ptashkin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Teng Gao
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Daniel Kelly
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Minal Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Elsa Bernard
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Laura Boucai
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Axel Martin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Michael Walsh
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Akshar Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Gunes Gundem
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Maria Arcila
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Marc Ladanyi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John Philip
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean Bajorin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Stuart Gardos
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Hyman
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mariko Yabe
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Offit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Howard Scher
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Luis Diaz
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ross Levine
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Zehir
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Kollmeier M, Zelefsky M, McBride S, Debonis D, Lochansingh S, Varghese M, Bochner B, Rosenberg J, Bajorin D. A Phase I Trial of Dose-Escalated Image-Guided, Intensity Modulated Radiation Therapy in Combination with Concurrent Gemcitabine Chemotherapy for Node-Negative, Muscle-Invasive Bladder Cancer (MIBC). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.352] [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: 11/29/2022]
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Audenet F, Isharwal S, Cha E, Donoghue M, Pietzak E, Sfakianos J, Bagrodia A, Dalbagni G, Donahue T, Rosenberg J, Bajorin D, Arcila M, Berger M, Taylor B, Al-Ahmadie H, Iyer G, Bochner B, Coleman J, Solit D. Classification phylogénétique des récidives vésicales après tumeur de la voie excrétrice urinaire supérieure. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.133] [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: 11/25/2022]
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Audenet F, Isharwal S, Cha E, Donoghue M, Pietzak E, Sfakianos J, Bagrodia A, Dalbagni G, Donahue T, Rosenberg J, Bajorin D, Arcila M, Berger M, Taylor B, Al-Ahmadie H, Iyer G, Bochner B, Coleman J, Solit D. Spécificités moléculaires des tumeurs de la voie excrétrice urinaire supérieure. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.132] [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: 11/24/2022]
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Latham A, Srinivasan P, Kemel Y, Shia J, Bandlamudi C, Mandelker D, Middha S, Hechtman J, Zehir A, Dubard-Gault M, Tran C, Stewart C, Sheehan M, Penson A, DeLair D, Yaeger R, Vijai J, Mukherjee S, Galle J, Dickson MA, Janjigian Y, O'Reilly EM, Segal N, Saltz LB, Reidy-Lagunes D, Varghese AM, Bajorin D, Carlo MI, Cadoo K, Walsh MF, Weiser M, Aguilar JG, Klimstra DS, Diaz LA, Baselga J, Zhang L, Ladanyi M, Hyman DM, Solit DB, Robson ME, Taylor BS, Offit K, Berger MF, Stadler ZK. Microsatellite Instability Is Associated With the Presence of Lynch Syndrome Pan-Cancer. J Clin Oncol 2018; 37:286-295. [PMID: 30376427 DOI: 10.1200/jco.18.00283] [Citation(s) in RCA: 358] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Microsatellite instability (MSI) and/or mismatch repair deficiency (MMR-D) testing has traditionally been performed in patients with colorectal (CRC) and endometrial cancer (EC) to screen for Lynch syndrome (LS)-associated cancer predisposition. The recent success of immunotherapy in high-frequency MSI (MSI-H) and/or MMR-D tumors now supports testing for MSI in all advanced solid tumors. The extent to which LS accounts for MSI-H across heterogeneous tumor types is unknown. Here, we establish the prevalence of LS across solid tumors according to MSI status. METHODS MSI status was determined using targeted next-generation sequencing, with tumors classified as MSI-H, MSI-indeterminate, or microsatellite-stable. Matched germline DNA was analyzed for mutations in LS-associated mismatch repair genes ( MLH1, MSH2, MSH6, PMS2, EPCAM). In patients with LS with MSI-H/I tumors, immunohistochemical staining for MMR-D was assessed. RESULTS Among 15,045 unique patients (more than 50 cancer types), LS was identified in 16.3% (53 of 326), 1.9% (13 of 699), and 0.3% (37 of 14,020) of patients with MSI-H, MSI-indeterminate, and microsatellite-stable tumors, respectively ( P < .001). Among patients with LS with MSI-H/I tumors, 50% (33 of 66) had tumors other than CRC/EC, including urothelial, prostate, pancreas, adrenocortical, small bowel, sarcoma, mesothelioma, melanoma, gastric, and germ cell tumors. In these patients with non-CRC/EC tumors, 45% (15 of 33) did not meet LS genetic testing criteria on the basis of personal/family history. Immunohistochemical staining of LS-positive MSI-H/I tumors demonstrated MMR-D in 98.2% (56 of 57) of available cases. CONCLUSION MSI-H/MMR-D is predictive of LS across a much broader tumor spectrum than currently appreciated. Given implications for cancer surveillance and prevention measures in affected families, these data support germline genetic assessment for LS for patients with an MSI-H/MMR-D tumor, regardless of cancer type or family cancer history.
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Affiliation(s)
- Alicia Latham
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yelena Kemel
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sumit Middha
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ahmet Zehir
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Rona Yaeger
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Joseph Vijai
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jesse Galle
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark A Dickson
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Yelena Janjigian
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Eileen M O'Reilly
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Neil Segal
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Leonard B Saltz
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Diane Reidy-Lagunes
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Anna M Varghese
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Dean Bajorin
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Maria I Carlo
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Karen Cadoo
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Michael F Walsh
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Martin Weiser
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Julio Garcia Aguilar
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | | | - Luis A Diaz
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Jose Baselga
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Liying Zhang
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Hyman
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - David B Solit
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Mark E Robson
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | | | - Kenneth Offit
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael F Berger
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Zsofia K Stadler
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
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20
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Bellmunt J, de Wit R, Vaughn D, Fradet Y, Lee J, Fong L, Vogelzang N, Climent M, Petrylak D, Choueiri T, Necchi A, Gerritsen W, Gurney H, Quinn D, Culine S, Sternberg C, Jensen E, Frenkl T, Perini R, Bajorin D. Impact of prognostic factors and risk groups on overall survival (OS) in patients treated with pembrolizumab vs investigator’s choice chemotherapy for advanced urothelial cancer (UC): Post hoc analysis of KEYNOTE-045. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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de Wit R, Kulkarni G, Uchio E, Singer E, Krieger L, Grivas P, Bajorin D, Seo H, Mourey L, Kamat A, Nishiyama H, Kapadia E, Nam K, Frenkl T, Balar A. Pembrolizumab for high-risk (HR) non–muscle invasive bladder cancer (NMIBC) unresponsive to bacillus Calmette-Guérin (BCG): Phase II KEYNOTE-057 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Li Q, Damish AW, Frazier Z, Liu D, Reznichenko E, Kamburov A, Bell A, Zhao H, Jordan EJ, Gao SP, Ma J, Abbosh PH, Bellmunt J, Plimack ER, Lazaro JB, Solit DB, Bajorin D, Rosenberg JE, D'Andrea AD, Riaz N, Van Allen EM, Iyer G, Mouw KW. ERCC2 Helicase Domain Mutations Confer Nucleotide Excision Repair Deficiency and Drive Cisplatin Sensitivity in Muscle-Invasive Bladder Cancer. Clin Cancer Res 2018; 25:977-988. [PMID: 29980530 DOI: 10.1158/1078-0432.ccr-18-1001] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/04/2018] [Accepted: 07/02/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE DNA-damaging agents comprise the backbone of systemic treatment for many tumor types; however, few reliable predictive biomarkers are available to guide use of these agents. In muscle-invasive bladder cancer (MIBC), cisplatin-based chemotherapy improves survival, yet response varies widely among patients. Here, we sought to define the role of the nucleotide excision repair (NER) gene ERCC2 as a biomarker predictive of response to cisplatin in MIBC. EXPERIMENTAL DESIGN Somatic missense mutations in ERCC2 are associated with improved response to cisplatin-based chemotherapy; however, clinically identified ERCC2 mutations are distributed throughout the gene, and the impact of individual ERCC2 variants on NER capacity and cisplatin sensitivity is unknown. We developed a microscopy-based NER assay to profile ERCC2 mutations observed retrospectively in prior studies and prospectively within the context of an institution-wide tumor profiling initiative. In addition, we created the first ERCC2-deficient bladder cancer preclinical model for studying the impact of ERCC2 loss of function. RESULTS We used our functional assay to test the NER capacity of clinically observed ERCC2 mutations and found that most ERCC2 helicase domain mutations cannot support NER. Furthermore, we show that introducing an ERCC2 mutation into a bladder cancer cell line abrogates NER activity and is sufficient to drive cisplatin sensitivity in an orthotopic xenograft model. CONCLUSIONS Our data support a direct role for ERCC2 mutations in driving cisplatin response, define the functional landscape of ERCC2 mutations in bladder cancer, and provide an opportunity to apply combined genomic and functional approaches to prospectively guide therapy decisions in bladder cancer.See related commentary by Grivas, p. 907.
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Affiliation(s)
- Qiang Li
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Alexis W Damish
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Zoë Frazier
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - David Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizaveta Reznichenko
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Atanas Kamburov
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Drug Discovery, Bayer AG, Berlin, Germany
| | - Andrew Bell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Huiyong Zhao
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emmet J Jordan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Paul Gao
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer Ma
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip H Abbosh
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Urology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Joaquim Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth R Plimack
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jean-Bernard Lazaro
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, Cornell University, New York, New York
| | - Dean Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan D D'Andrea
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, Massachusetts.,Ludwig Center at Harvard, Boston, Massachusetts
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts. .,Ludwig Center at Harvard, Boston, Massachusetts
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Isharwal S, Audenet F, Drill E, Ostrovnaya I, Pietzak E, Al-Ahmadie H, Cha E, Donahue T, Yuen Teo M, Funt S, Arcila M, Berger M, Rosenberg J, Bajorin D, Dalbagni G, Bochner B, Solit D, Iyer G. MP54-04 NEXT GENERATION SEQUENCING OF UROTHELIAL BLADDER CANCER: MEMORIAL SLOAN KETTERING CANCER CENTER EXPERIENCE IN 454 PATIENTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1695] [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: 12/01/2022]
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24
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Mano R, Dinatale R, Becerra M, Carver B, Sharp D, Feldman D, Funt S, Bajorin D, Motzer R, Bosl G, Sheinfeld J. MP37-09 LATE RELAPSE OF TESTICULAR CANCER – UPDATE OF THE MSKCC EXPERIENCE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1215] [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: 11/30/2022]
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25
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Castellano D, Grivas P, Plimack E, Balar A, O’Donnell P, Bellmunt J, Powles T, Hahn N, De Wit R, Bajorin D, Ellison M, Frenkl T, Keefe S, Vuky J. Pembrolizumab (pembro) as first-line therapy in elderly patients (pts) with poor performance status with cisplatin-ineligible advanced urothelial cancer (UC): Results from Keynote-052. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)30938-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Dowling CM, Assel M, Musser JE, Meeks JJ, Sjoberg DD, Bosl G, Motzer R, Bajorin D, Feldman D, Carver BS, Sheinfeld J. Clinical Outcome of Retroperitoneal Lymph Node Dissection after Chemotherapy in Patients with Pure Embryonal Carcinoma in the Orchiectomy Specimen. Urology 2018; 114:133-138. [PMID: 29410311 DOI: 10.1016/j.urology.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the pathologic findings and clinical outcome of patients with pure embryonal carcinoma (EC) of the testis who were diagnosed with testis cancer from January 1989 to January 2013 who underwent an orchiectomy, cisplatin-based chemotherapy and a postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). METHODS We compared those patients with 100% EC with those with mixed nonseminomatous germ cell tumor pathology who underwent a PC-RPLND. RESULTS Of 1105 patients who underwent a PC-RPLND, 145 had pure EC. Twenty-six percent of patients presented with metastatic disease outside the retroperitoneum. Patients with mixed histologies tended to have worse International Germ Cell Cancer Collaborative Group risk compared to those with EC at orchiectomy (P = .037). Histology at PC-RPLND revealed fibrosis or necrosis in 76%, mature teratoma in 19% and viable cancer in 4%. Over one-third of the patients had a residual mass of <1 cm prior to RPLND; of whom 15% harbored mature teratoma in PC-RPLND histology. The Kaplan-Meier estimated probability of recurrence at 5 years of follow-up was 3.1% (95% CI 1.2%, 8.0%) for EC histology, 7.3% lower than mixed histology. For cancer-specific mortality, the Kaplan-Meier estimated probability at 5 years was 4.6% (95% CI 3.3%, 6.3%) and 1.7% (95% CI 0.4%, 6.8%) for mixed and pure EC histologies, respectively. CONCLUSION Approximately 20% of patients with pure EC had teratoma at PC-RPLND. We have shown that those with a maximum node size of <1 cm should not be precluded from RPLND.
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Affiliation(s)
- Catherine M Dowling
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY
| | - John E Musser
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Joshua J Meeks
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY
| | - George Bosl
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Robert Motzer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Dean Bajorin
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Darren Feldman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Brett S Carver
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY.
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Balar AV, Castellano D, O'Donnell PH, Grivas P, Vuky J, Powles T, Plimack ER, Hahn NM, de Wit R, Pang L, Savage MJ, Perini RF, Keefe SM, Bajorin D, Bellmunt J. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol 2017; 18:1483-1492. [PMID: 28967485 DOI: 10.1016/s1470-2045(17)30616-2] [Citation(s) in RCA: 886] [Impact Index Per Article: 126.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND More than half of all patients with advanced urothelial cancer cannot receive standard, first-line cisplatin-based chemotherapy because of renal dysfunction, poor performance status, or other comorbidities. We assessed the activity and safety of first-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer. METHODS In this multicentre, single-arm, phase 2 study (KEYNOTE-052), cisplatin-ineligible patients with advanced urothelial cancer who had not been previously treated with systemic chemotherapy were recruited from 91 academic medical centres in 20 countries. Enrolled patients received intravenous pembrolizumab 200 mg every 3 weeks. The primary endpoint was objective response (the proportion of patients who achieved complete or partial response) in all patients and by PD-L1 expression status according to the Response Evaluation Criteria in Solid Tumors, version 1.1, as assessed by independent central review. PD-L1 expression was assessed in tumour and inflammatory cells from tumour biopsies provided at study entry. Activity and safety were analysed in all patients who received at least one dose of pembrolizumab (all-patients-treated population). This study is registered with ClinicalTrials.gov, number NCT02335424, and follow-up is ongoing. FINDINGS Between Feb 24, 2015, and Aug 8, 2016, 374 patients were enrolled and 370 patients received at least one dose of pembrolizumab. 89 (24%, 95% CI 20-29) of 370 patients had a centrally assessed objective response, and as of Sept 1, 2016 (data cutoff), 74 (83%) of 89 responses were ongoing. Median follow-up was 5 months (IQR 3·0-8·6). A PD-L1-expression cutoff of 10% was associated with a higher frequency of response to pembrolizumab; 42 (38%, 95% CI 29-48) of 110 patients with a combined positive score of 10% or more had a centrally assessed objective response. The most common grade 3 or 4 treatment-related adverse events were fatigue (eight [2%] of 370 patients), alkaline phosphatase increase (five [1%]), colitis, and muscle weakness (both four [1%]). 36 (10%) of 370 patients had a serious treatment-related adverse event. 17 (5%) of 370 patients died from non-treatment-related adverse events associated with death, and one patient died from treatment-related adverse events (myositis in addition to grade 3 thyroiditis, grade 3 hepatitis, grade 3 pneumonia, and grade 4 myocarditis). INTERPRETATION First-line pembrolizumab has antitumour activity and acceptable tolerability in cisplatin-ineligible patients with urothelial cancer, most of whom were elderly, had poor prognostic factors, or had serious comorbidities. In view of this result, pembrolizumab has become a new treatment option for patients who are cisplatin-ineligible or not suitable candidates for chemotherapy. Pembrolizumab in the first-line setting is being further assessed in the phase 3 KEYNOTE-361 trial (ClinicalTrials.gov, NCT02335424). FUNDING Merck & Co.
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Affiliation(s)
- Arjun V Balar
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, USA.
| | | | | | - Petros Grivas
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Noah M Hahn
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | | | | | | | | | | | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Petrylak D, Vogelzang N, Fradet Y, Bajorin D, de Wit R, Vaughn D, Lee JL, Fong L, Climent M, Necchi A, Gerritsen W, Gurney H, Quinn D, Culine S, Sternberg C, Jensen E, Puhlmann M, Perini R, Bellmunt J, Choueiri T. Subgroup analyses from KEYNOTE-045: Pembrolizumab (pembro) versus individual investigator’s choice of chemotherapy (paclitaxel, docetaxel, or vinflunine) in recurrent, advanced urothelial cancer (uc). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Grivas P, Plimack E, Balar A, Castellano D, O'Donnell P, Bellmunt J, Powles T, Hahn N, de Wit R, Bajorin D, Ellison M, Frenkl T, Keefe S, Vuky J. Pembrolizumab (pembro) as first-line therapy in cisplatin-ineligible advanced urothelial cancer (UC): Outcomes from KEYNOTE-052 in senior patients (pts) with poor performance status. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Bajorin D, Galsky M, Gschwend J, Tomita Y, Azrilevich A, Witjes F. A Phase III, randomized, double-blind, multicenter study of adjuvant nivolumab vs placebo in patients (pts) with high-risk invasive urothelial carcinoma (UC; CheckMate 274). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kopp RP, Chevinsky M, Bernstein M, Bosl G, Motzer R, Bajorin D, Feldman D, Carver BS, Sheinfeld J. Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy. Urology 2017; 103:154-160. [PMID: 27816603 PMCID: PMC5546215 DOI: 10.1016/j.urology.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the incidence, presentation, management, and relapse of a large population of bilateral testicular germ cell tumors (TGCT) from a single institution. PATIENTS AND METHODS We identified bilateral TGCT diagnosed between January 1989 and February 2014. We categorized synchronous and metachronous TGCT, noting time between first and second TGCT, histology (seminoma vs nonseminoma [NSGCT]), stage, and treatments. Kaplan-Meier survival estimates characterized relapse. RESULTS Of 5132 patients with TGCT, 128 (2.5%) had bilateral TGCT. Bilateral TGCT increased over time-1.7% in 1989-1994 up to 3.8% in 2010 to February 2014. The 35 (27%) synchronous cases of TGCT had 20 (57%) concordant seminoma, 5 (14%) concordant NSGCT, and 10 (29%) discordant NSGCT. The 93 (73%) metachronous cases had median time interval to second TGCT of 73 months (range: 5 months-28.6 years). Compared with first TGCT, 39 (42%) had discordant histology, 29 (31%) had concordant seminoma, and 25 (27%) had concordant NSGCT. Stage at first tumor was statistically similar to second TGCT (second stage I, II, II in 69%, 22%, 10%). Increasing duration between first and second TGCT was not associated with higher stage (II or III) at second TGCT (P = .09). Treatment at first tumor was not associated with stage at second tumor. Relapse following bilateral diagnosis was 16.8% (95% confidence interval 10.5%-26.2%) at 5 years. CONCLUSION Incidence of bilateral TGCT increased with >25% of metachronous TGCT presenting ≥10 years after first TGCT; possible causes include increased survivorship and referral bias. Stage was statistically similar at first and second tumor; stage at second tumor was not associated with time interval between tumors or prior treatment modality at first tumor.
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Affiliation(s)
- Ryan P Kopp
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Michael Chevinsky
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melanie Bernstein
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - George Bosl
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Motzer
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean Bajorin
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren Feldman
- Genitourinary Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brett S Carver
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Pietzak E, Bagrodia A, Al-Ahmadie H, Herr H, Zabor E, Barron D, Li Q, Audenet F, Funt S, Zehir A, Arcila M, Baez P, Berger M, Schultz N, Solit D, Bajorin D, Rosenberg J, Cha E, Bochner B, Iyer G. MP58-02 GENOMIC DIFFERENCES BETWEEN “PRIMARY” AND “SECONDARY” MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR NEOADJUVANT CHEMOTHERAPY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pietzak E, Cha E, Bagrodia A, Drill E, Iyer G, Baez P, Isharwal S, Li Q, Zehir A, Arcila M, Berger M, Schultz N, Ostrovnaya I, Rosenberg J, Bajorin D, Dalbagni G, Al-Ahmadie H, Solit D, Bochner B. PD48-11 NEXT GENERATION SEQUENCING OF NON-MUSCLE INVASIVE BLADDER CANCER REVEALS POTENTIAL BIOMARKERS AND RATIONAL THERAPEUTIC TARGETS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2359] [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: 11/16/2022]
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Powles T, Bellmunt J, Castellano D, O’Donnell P, Grivas P, Vuky J, Plimack E, Hahn N, Balar A, Pang L, Savage M, Perini R, Keefe S, Bajorin D, De Wit R. Pembrolizumab produces clinically meaningful responses as first-line therapy in cisplatin-ineligible advanced urothelial cancer: Results from subgroup analyses of KEYNOTE-052. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30236-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lundqvist A, van Hoef V, Zhang X, Wennerberg E, Lorent J, Witt K, Sanz LM, Liang S, Murray S, Larsson O, Kiessling R, Mao Y, Sidhom JW, Bessell CA, Havel J, Schneck J, Chan TA, Sachsenmeier E, Woods D, Berglund A, Ramakrishnan R, Sodre A, Weber J, Zappasodi R, Li Y, Qi J, Wong P, Sirard C, Postow M, Newman W, Koon H, Velcheti V, Callahan MK, Wolchok JD, Merghoub T, Lum LG, Choi M, Thakur A, Deol A, Dyson G, Shields A, Haymaker C, Uemura M, Murthy R, James M, Wang D, Brevard J, Monaghan C, Swann S, Geib J, Cornfeld M, Chunduru S, Agrawal S, Yee C, Wargo J, Patel SP, Amaria R, Tawbi H, Glitza I, Woodman S, Hwu WJ, Davies MA, Hwu P, Overwijk WW, Bernatchez C, Diab A, Massarelli E, Segal NH, Ribrag V, Melero I, Gangadhar TC, Urba W, Schadendorf D, Ferris RL, Houot R, Morschhauser F, Logan T, Luke JJ, Sharfman W, Barlesi F, Ott PA, Mansi L, Kummar S, Salles G, Carpio C, Meier R, Krishnan S, McDonald D, Maurer M, Gu X, Neely J, Suryawanshi S, Levy R, Khushalani N, Wu J, Zhang J, Basher F, 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Ehrmann JM, Taylor KA, Korman AJ, Graziano RF, Page D, Sanchez K, Ballesteros-Merino C, Martel M, Bifulco C, Urba W, Fox B, Patel SP, De Macedo MP, Qin Y, Reuben A, Spencer C, Guindani M, Bassett R, Wargo J, Racolta A, Kelly B, Jones T, Polaske N, Theiss N, Robida M, Meridew J, Habensus I, Zhang L, Pestic-Dragovich L, Tang L, Sullivan RJ, Logan T, Khushalani N, Margolin K, Koon H, Olencki T, Hutson T, Curti B, Roder J, Blackmon S, Roder H, Stewart J, Amin A, Ernstoff MS, Clark JI, Atkins MB, Kaufman HL, Sosman J, Weber J, McDermott DF, Weber J, Kluger H, Halaban R, Snzol M, Roder H, Roder J, Asmellash S, Steingrimsson A, Blackmon S, Sullivan RJ, Wang C, Roman K, Clement A, Downing S, Hoyt C, Harder N, Schmidt G, Schoenmeyer R, Brieu N, Yigitsoy M, Madonna G, Botti G, Grimaldi A, Ascierto PA, Huss R, Athelogou M, Hessel H, Harder N, Buchner A, Schmidt G, Stief C, Huss R, Binnig G, Kirchner T, Sellappan S, Thyparambil S, Schwartz S, Cecchi F, Nguyen A, Vaske C. 31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016): part one. J Immunother Cancer 2016. [PMCID: PMC5123387 DOI: 10.1186/s40425-016-0172-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Wit R, Kamat A, Bellmunt J, Choueiri T, Nam K, De Santis M, Dreicer R, Hahn N, Perini R, Siefker-Radtke A, Sonpavde G, Witjes J, Keefe S, Bajorin D. Pembrolizumab in patients with Bacillus Calmette Guérin (BCG)-unresponsive, high-risk non–muscle-invasive bladder cancer (NMIBC): Phase 2 KEYNOTE-057 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Balar A, Bellmunt J, O'Donnell P, Castellano D, Grivas P, Vuky J, Powles T, Plimack E, Hahn N, de Wit R, Pang L, Savage M, Perini R, Keefe S, Bajorin D. Pembrolizumab (pembro) as first-line therapy for advanced/unresectable or metastatic urothelial cancer: Preliminary results from the phase 2 KEYNOTE-052 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.25] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rosenberg JE, Hoffman-Censits J, Powles T, van der Heijden MS, Balar AV, Necchi A, Dawson N, O'Donnell PH, Balmanoukian A, Loriot Y, Srinivas S, Retz MM, Grivas P, Joseph RW, Galsky MD, Fleming MT, Petrylak DP, Perez-Gracia JL, Burris HA, Castellano D, Canil C, Bellmunt J, Bajorin D, Nickles D, Bourgon R, Frampton GM, Cui N, Mariathasan S, Abidoye O, Fine GD, Dreicer R. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet 2016; 387:1909-20. [PMID: 26952546 PMCID: PMC5480242 DOI: 10.1016/s0140-6736(16)00561-4] [Citation(s) in RCA: 2688] [Impact Index Per Article: 336.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with metastatic urothelial carcinoma have few treatment options after failure of platinum-based chemotherapy. In this trial, we assessed treatment with atezolizumab, an engineered humanised immunoglobulin G1 monoclonal antibody that binds selectively to programmed death ligand 1 (PD-L1), in this patient population. METHODS For this multicentre, single-arm, two-cohort, phase 2 trial, patients (aged ≥18 years) with inoperable locally advanced or metastatic urothelial carcinoma whose disease had progressed after previous platinum-based chemotherapy were enrolled from 70 major academic medical centres and community oncology practices in Europe and North America. Key inclusion criteria for enrolment were Eastern Cooperative Oncology Group performance status of 0 or 1, measurable disease defined by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), adequate haematological and end-organ function, and no autoimmune disease or active infections. Formalin-fixed paraffin-embedded tumour specimens with sufficient viable tumour content were needed from all patients before enrolment. Patients received treatment with intravenous atezolizumab (1200 mg, given every 3 weeks). PD-L1 expression on tumour-infiltrating immune cells (ICs) was assessed prospectively by immunohistochemistry. The co-primary endpoints were the independent review facility-assessed objective response rate according to RECIST v1.1 and the investigator-assessed objective response rate according to immune-modified RECIST, analysed by intention to treat. A hierarchical testing procedure was used to assess whether the objective response rate was significantly higher than the historical control rate of 10% at an α level of 0·05. This study is registered with ClinicalTrials.gov, number NCT02108652. FINDINGS Between May 13, 2014, and Nov 19, 2014, 486 patients were screened and 315 patients were enrolled into the study. Of these patients, 310 received atezolizumab treatment (five enrolled patients later did not meet eligibility criteria and were not dosed with study drug). The PD-L1 expression status on infiltrating immune cells (ICs) in the tumour microenvironment was defined by the percentage of PD-L1-positive immune cells: IC0 (<1%), IC1 (≥1% but <5%), and IC2/3 (≥5%). The primary analysis (data cutoff May 5, 2015) showed that compared with a historical control overall response rate of 10%, treatment with atezolizumab resulted in a significantly improved RECIST v1.1 objective response rate for each prespecified immune cell group (IC2/3: 27% [95% CI 19-37], p<0·0001; IC1/2/3: 18% [13-24], p=0·0004) and in all patients (15% [11-20], p=0·0058). With longer follow-up (data cutoff Sept 14, 2015), by independent review, objective response rates were 26% (95% CI 18-36) in the IC2/3 group, 18% (13-24) in the IC1/2/3 group, and 15% (11-19) overall in all 310 patients. With a median follow-up of 11·7 months (95% CI 11·4-12·2), ongoing responses were recorded in 38 (84%) of 45 responders. Exploratory analyses showed The Cancer Genome Atlas (TCGA) subtypes and mutation load to be independently predictive for response to atezolizumab. Grade 3-4 treatment-related adverse events, of which fatigue was the most common (five patients [2%]), occurred in 50 (16%) of 310 treated patients. Grade 3-4 immune-mediated adverse events occurred in 15 (5%) of 310 treated patients, with pneumonitis, increased aspartate aminotransferase, increased alanine aminotransferase, rash, and dyspnoea being the most common. No treatment-related deaths occurred during the study. INTERPRETATION Atezolizumab showed durable activity and good tolerability in this patient population. Increased levels of PD-L1 expression on immune cells were associated with increased response. This report is the first to show the association of TCGA subtypes with response to immune checkpoint inhibition and to show the importance of mutation load as a biomarker of response to this class of agents in advanced urothelial carcinoma. FUNDING F Hoffmann-La Roche Ltd.
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Affiliation(s)
- Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Tom Powles
- Barts Cancer Institute ECMC, Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK
| | | | - Arjun V Balar
- Genitourinary Cancers Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nancy Dawson
- Medstar Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Peter H O'Donnell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Yohann Loriot
- Department of Cancer Medicine, Gustave-Roussy Cancer Campus, Villejuif, University of Paris Sud, Paris, France
| | - Sandy Srinivas
- Division of Oncology/Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Margitta M Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petros Grivas
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard W Joseph
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew D Galsky
- Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Mark T Fleming
- Virginia Oncology Associates, US Oncology Research, Norfolk, VA, USA
| | | | - Jose Luis Perez-Gracia
- Department of Oncology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Navarre, Spain
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN, USA; Tennessee Oncology, Nashville, TN, USA
| | - Daniel Castellano
- Medical Oncology Department, Genitourinary Oncology Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Joaquim Bellmunt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dean Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Na Cui
- Genentech Inc, 1 DNA Way, South San Francisco, CA, USA
| | | | | | - Gregg D Fine
- Genentech Inc, 1 DNA Way, South San Francisco, CA, USA
| | - Robert Dreicer
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Bagrodia A, Sukhu R, Winer A, Vacchio M, Levy E, Lee B, Donahue T, Cha E, Assel M, Sjoberg D, Vickers A, Rosenberg J, Bajorin D, Dalbagni G, Bochner B. MP06-01 INCIDENCE AND IMPACT OF VENOUS THROMBOEMBOLISM IN RADICAL CYSTECTOMY PATIENTS UNDERGOING PRE-OPERATIVE CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bagrodia A, Lee B, Lee W, Cha E, Sfakianos J, Gao P, Zabor E, Ostrovnaya I, Kaffenberger S, Eng J, Berger M, Bajorin D, Schultz N, Sheinfeld J, Bosl G, Al-Ahmadie H, Solit D, Feldman D. MP81-15 GENETIC BASIS FOR CISPLATIN RESISTANCE IN PATIENTS WITH ADVANCED GERM CELL TUMORS (GCT). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pietzak E, Cha E, Zabor E, Li Q, Solit D, Rosenberg J, Bajorin D, Bochner B, Herr H, Iyer G. PI-01 PROGRESSION FROM NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) TO MUSCLE INVASION IS ASSOCIATED WITH LOWER RESPONSE RATES TO NEOADJUVANT CHEMOTHERAPY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee B, Jordan E, Won H, Bagrodia A, Desai N, Bajorin D, Rosenberg J, Bochner B, Kim W, Berger M, Solit D, Al-Ahmadie H, Iyer G. MP88-13 MUTATIONAL LANDSCAPE OF PRIMARY BLADDER AND URACHAL ADENOCARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bagrodia A, Kaffenberger S, Lee B, Lee W, Cha E, Sfakianos J, Gao P, Zabor E, Ostrovnaya I, Eng J, Berger M, Bajorin D, Schultz N, Sheinfeld J, Bosl G, Al-Ahmadie H, Solit D, Feldman D. PD34-04 ACTIONABLE TARGETS IN PATIENTS WITH CISPLATIN-RESISTANT ADVANCED GERM CELL TUMORS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Figueroa JD, Middlebrooks CD, Banday AR, Ye Y, Garcia-Closas M, Chatterjee N, Koutros S, Kiemeney LA, Rafnar T, Bishop T, Furberg H, Matullo G, Golka K, Gago-Dominguez M, Taylor JA, Fletcher T, Siddiq A, Cortessis VK, Kooperberg C, Cussenot O, Benhamou S, Prescott J, Porru S, Dinney CP, Malats N, Baris D, Purdue MP, Jacobs EJ, Albanes D, Wang Z, Chung CC, Vermeulen SH, Aben KK, Galesloot TE, Thorleifsson G, Sulem P, Stefansson K, Kiltie AE, Harland M, Teo M, Offit K, Vijai J, Bajorin D, Kopp R, Fiorito G, Guarrera S, Sacerdote C, Selinski S, Hengstler JG, Gerullis H, Ovsiannikov D, Blaszkewicz M, Castelao JE, Calaza M, Martinez ME, Cordeiro P, Xu Z, Panduri V, Kumar R, Gurzau E, Koppova K, Bueno-De-Mesquita HB, Ljungberg B, Clavel-Chapelon F, Weiderpass E, Krogh V, Dorronsoro M, Travis RC, Tjønneland A, Brennan P, Chang-Claude J, Riboli E, Conti D, Stern MC, Pike MC, Van Den Berg D, Yuan JM, Hohensee C, Jeppson RP, Cancel-Tassin G, Roupret M, Comperat E, Turman C, De Vivo I, Giovannucci E, Hunter DJ, Kraft P, Lindstrom S, Carta A, Pavanello S, Arici C, Mastrangelo G, Kamat AM, Zhang L, Gong Y, Pu X, Hutchinson A, Burdett L, Wheeler WA, Karagas MR, Johnson A, Schned A, Monawar Hosain GM, Schwenn M, Kogevinas M, Tardón A, Serra C, Carrato A, García-Closas R, Lloreta J, Andriole G, Grubb R, Black A, Diver WR, Gapstur SM, Weinstein S, Virtamo J, Haiman CA, Landi MT, Caporaso NE, Fraumeni JF, Vineis P, Wu X, Chanock SJ, Silverman DT, Prokunina-Olsson L, Rothman N. Identification of a novel susceptibility locus at 13q34 and refinement of the 20p12.2 region as a multi-signal locus associated with bladder cancer risk in individuals of European ancestry. Hum Mol Genet 2016; 25:1203-14. [PMID: 26732427 PMCID: PMC4817084 DOI: 10.1093/hmg/ddv492] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/12/2015] [Accepted: 11/26/2015] [Indexed: 12/21/2022] Open
Abstract
Candidate gene and genome-wide association studies (GWAS) have identified 15 independent genomic regions associated with bladder cancer risk. In search for additional susceptibility variants, we followed up on four promising single-nucleotide polymorphisms (SNPs) that had not achieved genome-wide significance in 6911 cases and 11 814 controls (rs6104690, rs4510656, rs5003154 and rs4907479, P < 1 × 10(-6)), using additional data from existing GWAS datasets and targeted genotyping for studies that did not have GWAS data. In a combined analysis, which included data on up to 15 058 cases and 286 270 controls, two SNPs achieved genome-wide statistical significance: rs6104690 in a gene desert at 20p12.2 (P = 2.19 × 10(-11)) and rs4907479 within the MCF2L gene at 13q34 (P = 3.3 × 10(-10)). Imputation and fine-mapping analyses were performed in these two regions for a subset of 5551 bladder cancer cases and 10 242 controls. Analyses at the 13q34 region suggest a single signal marked by rs4907479. In contrast, we detected two signals in the 20p12.2 region-the first signal is marked by rs6104690, and the second signal is marked by two moderately correlated SNPs (r(2) = 0.53), rs6108803 and the previously reported rs62185668. The second 20p12.2 signal is more strongly associated with the risk of muscle-invasive (T2-T4 stage) compared with non-muscle-invasive (Ta, T1 stage) bladder cancer (case-case P ≤ 0.02 for both rs62185668 and rs6108803). Functional analyses are needed to explore the biological mechanisms underlying these novel genetic associations with risk for bladder cancer.
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Affiliation(s)
- Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA, Usher Institute of Population Health Sciences and Informatics, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,
| | - Candace D Middlebrooks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - A Rouf Banday
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Yuanqing Ye
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA, Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, Turin, Italy, Human Genetics Foundation, Turin, Italy
| | - Klaus Golka
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jack A Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Epigenetic and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, NC, USA
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Victoria K Cortessis
- Department of Preventive Medicine, USC Keck School of Medicine, Department of Obstetrics and Gynecology, Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Olivier Cussenot
- Department of Urology, Tenon, Centre de Recherche sur les Pathologies Prostatiques, Paris, France, UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
| | - Simone Benhamou
- Institut national de la sante et de la recherche medicale, U946, Foundation Jean Dausset Centre d'Etude du Polymorphisme Humain (CEPH), Paris, France, Centre National de la Receherche Scientifique, UMR8200, Institut Gustave-Roussy, Villejuif, France
| | - Jennifer Prescott
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Department of Epidemiology
| | - Stefano Porru
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Colin P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Dalsu Baris
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Zhaoming Wang
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD, USA
| | - Charles C Chung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA, Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sita H Vermeulen
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K Aben
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tessel E Galesloot
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Kari Stefansson
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anne E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford OX3 7DQ, UK
| | | | - Mark Teo
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | | | | | - Dean Bajorin
- Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - Ryan Kopp
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giovanni Fiorito
- Department of Medical Sciences, University of Turin, Turin, Italy, Human Genetics Foundation, Turin, Italy
| | - Simonetta Guarrera
- Department of Medical Sciences, University of Turin, Turin, Italy, Human Genetics Foundation, Turin, Italy
| | | | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany, Department of Urology, Lukasklinik Neuss, Germany
| | | | - Meinolf Blaszkewicz
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Jose Esteban Castelao
- Oncology and Genetics Unit, Complejo Hospitalario, Instituto de Investigacion Biomedica (IBI) Orense-Pontevedra-Vigo, Xerencia de Xestion Integrada de Vigo-SERGAS, Vigo, Spain
| | - Manuel Calaza
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Galicia, Spain
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Patricia Cordeiro
- Department of Urology, Complejo Hospitalario, University of Santiago de Compostela, Servicio Galego de Saude (SERGAS), Santiago de Compostela, Spain
| | - Zongli Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS)
| | - Vijayalakshmi Panduri
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Epigenetic and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, NC, USA
| | - Rajiv Kumar
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg; University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - H Bas Bueno-De-Mesquita
- School of Public Health, Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, Umea, Sweden
| | - Françoise Clavel-Chapelon
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif F-94805, France, Université Paris Sud, UMRS 1018, Villejuif F-94805, France, Institut Gustave Roussy, Villejuif F-94805, France
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway, Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Miren Dorronsoro
- Health Department, BioDonostia Research Institute, Basque Region, Spain, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ruth C Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Paul Brennan
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg; University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - David Conti
- School of Public Health, Department of Obstetrics and Gynecology
| | - Marianna C Stern
- School of Public Health, Department of Obstetrics and Gynecology
| | | | | | - Jian-Min Yuan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Chancellor Hohensee
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca P Jeppson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Geraldine Cancel-Tassin
- Centre de Recherche sur les Pathologies Prostatiques, Paris, France, UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
| | - Morgan Roupret
- Department of Urology, Pitié-Salpétrière, Centre de Recherche sur les Pathologies Prostatiques, Paris, France, UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
| | - Eva Comperat
- Department of Pathology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris (APHP), Paris, France, Centre de Recherche sur les Pathologies Prostatiques, Paris, France, UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
| | | | - Immaculata De Vivo
- Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Department of Epidemiology, Department of Nutrition
| | - David J Hunter
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Department of Epidemiology, Department of Nutrition, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Peter Kraft
- Department of Epidemiology, Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | | | - Angela Carta
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Sofia Pavanello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Cecilia Arici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Liren Zhang
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Yilei Gong
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Xia Pu
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Hutchinson
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD, USA
| | - Laurie Burdett
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD, USA
| | | | | | | | - Alan Schned
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | | | - Manolis Kogevinas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, Municipal Institute of Medical Research, (IMIM-Hospital del Mar), Barcelona, Spain, National School of Public Health, Athens, Greece
| | - Adonina Tardón
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | - Consol Serra
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain, Municipal Institute of Medical Research, (IMIM-Hospital del Mar), Barcelona, Spain, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Reina García-Closas
- Unidad de Investigación, Hospital Universitario de Canarias, La Laguna, Spain
| | - Josep Lloreta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gerald Andriole
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA and
| | - Robert Grubb
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA and
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Stephanie Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jarmo Virtamo
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Joseph F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Paolo Vineis
- Human Genetics Foundation, Turin, Italy, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Xifeng Wu
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Debra T Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Lin CC, Bruinooge SS, Kirkwood MK, Hershman DL, Jemal A, Guadagnolo BA, Yu JB, Hopkins S, Goldstein M, Bajorin D, Giordano SH, Kosty M, Arnone A, Hanley A, Stevens S, Olsen C. Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer. Int J Radiat Oncol Biol Phys 2015; 94:719-28. [PMID: 26972644 DOI: 10.1016/j.ijrobp.2015.12.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/18/2015] [Accepted: 12/10/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT. METHODS AND MATERIALS A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics. RESULTS Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of <12.5 miles, patients diagnosed at a reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, P<.001; ≥250 miles, adjusted odds ratio 0.46; P=.002), all else being equal. The density level of radiation oncologists was not significantly associated with the receipt of RT. Patients who were female, nonwhite, and aged ≥50 years and had comorbidities were less likely to receive RT (P<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at a reporting facility, and resided in Midwest had an increased the likelihood of receipt of RT (P<.05). CONCLUSIONS An increased travel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care.
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Affiliation(s)
| | | | | | | | | | | | - James B Yu
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Anna Arnone
- American Society for Radiation Oncology, Fairfax, Virginia
| | - Amy Hanley
- American Society of Clinical Oncology, Alexandria, Virginia
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Desai N, Iyer G, Cha E, Scott S, Hreiki J, Sfakianos J, Bagrodia A, Bochner B, Rosenberg J, Bajorin D, Berger M, Kollmeier M, Al-Ahmadie H, Solit D. Deleterious Alterations in DNA Damage Response Genes Are Associated With Improved Outcome in Muscle-Invasive Bladder Cancer Patients Treated With Radiation-Based Bladder Preservation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lin C, Bruinooge S, Kirkwood K, Hershman D, Jemal A, Yu J, Guadagnolo B, Hopkins S, Goldstein M, Bajorin D, Giordano S, Kosty M, Arnone A, Hanley A, Stevens S, Olsen C. Association Between Geographic Access and Receipt of Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1484] [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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48
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Jordan E, Won H, Toubaji A, Bagrodia A, Desai N, Bajorin D, Rosenberg J, Bochner B, Kim W, Berger M, Solit D, Al-Ahmadie H, Iyer G. 2650 Assessment of genomic alterations in bladder adenocarcinoma and urachal adenocarcinoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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49
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Lin CC, Bruinooge SS, Kirkwood MK, Olsen C, Jemal A, Bajorin D, Giordano SH, Goldstein M, Guadagnolo BA, Kosty M, Hopkins S, Yu JB, Arnone A, Hanley A, Stevens S, Hershman DL. Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance. J Clin Oncol 2015; 33:3177-85. [PMID: 26304878 DOI: 10.1200/jco.2015.61.1558] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy. PATIENTS AND METHODS Patients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics. RESULTS Of 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P=.009) or ≥250 miles (OR, 0.36; P<.001) had decreased likelihood of receiving adjuvant chemotherapy. Density level of oncologists was not statistically associated with receipt of adjuvant chemotherapy (low v high density: OR, 0.98; P=.77). When stratifying analyses by insurance status, non-privately insured patients who resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy (OR, 0.85; P=.03). CONCLUSION Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.
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Affiliation(s)
- Chun Chieh Lin
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
| | - Suanna S Bruinooge
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - M Kelsey Kirkwood
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Christine Olsen
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Ahmedin Jemal
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Dean Bajorin
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Sharon H Giordano
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Michael Goldstein
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - B Ashleigh Guadagnolo
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Michael Kosty
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Shane Hopkins
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - James B Yu
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Anna Arnone
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Amy Hanley
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Stephanie Stevens
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
| | - Dawn L Hershman
- Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT
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Hanrahan AJ, Hyman DM, Sfakianos J, Jones A, Ramirez R, Johnsen H, Iyer G, Al-Ahmadie HA, Bajorin D, Bochner BH, Coleman JA, Rosenberg JE, Berger MF, Chandarlapaty S, Baselga J, Solit DB. Abstract 1101: Functional genomics of HER2 and HER3 mutations and response to neratinib. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1101] [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
Selective kinase inhibitors, such as erolotinib and lapatinib, and monoclonal antibodies, such as cetuximab, trastuzumab and pertuzumab, targeting EGFR and ERBB2 have elicited significant response rates in lung cancer patients harboring mutant EGFR alleles and breast cancer patients whose tumors harbor gene amplification of ERBB2. To date, only a small number of ERBB2 and ERBB3 mutations have been reported and biologically characterized. Moreover, the therapeutic impact of ERBB2 or ERBB3 mutant alleles and their value as an actionable target in patients has not been validated. While ERBB2 itself cannot bind ligand, it is a potent receptor that integrates growth signals via homo- or heterodimerization with other ERBB family members.
Genomic alterations increase ERBB2 kinase activity by constitutively activating the kinase domain, enabling ligand-independent receptor activation, by promoting enhanced dimerization or other mechanisms that have yet to be elucidated. Although ERBB3 has limited inherent kinase activity and cannot homodimerize, ligand stimulation promotes dimerization with active kinases like ERBB2 and EGFR that can phosphorylate ERBB2 which then promotes transformation.
Thus genomic alterations in ERBB3 may be a key means of promoting oncogenic signaling despite the protein lacking robust enzymatic activity. We performed an analysis of ∼100 large-scale next generation sequencing datasets newly generated by our group (bladder), our institution (MSKCC-IMPACT), or found in recently published repositories (The Cancer Genome Atlas (TCGA), Broad, Genentech, Sanger, etc) to characterize the distribution and spectrum of mutations in the ERBB2 and ERBB3 genes. Data generated suggests that ERBB2 and ERBB3 mutations are highly prevalent in bladder cancer (each ∼10%), and recurrent, but with less frequency (<5%), in stomach, breast, colon and lung cancers. Hotspots include mutation of S310F and a cluster of residues in the kinase domain in ERBB2 and the V104M mutation in ERBB3. Preliminary analysis of ∼300 tumors demonstrated that ERBB2 and ERBB3 mutations present in a typically in a mutually exclusive pattern suggesting that these may be driver events with overlapping biologic effects. Generation and expression of several of these ERBB2 and ERBB3 mutants induced receptor activation, cell transformation and tumor growth in isogenic cell line and xenograft models. Treatment with the dual EGFR/HER2 inhibitor, neratinib, in isogenic cell lines abrogated colony formation in soft agar and receptor activation and downstream signaling. We hope to correlate the in vitro potency of specific ERBB2 and ERBB3 mutations with drug response in patients on ongoing or future clinical trials of targeted ERBB therapies and determine the whether lineage, subclonality and co-altered genes, if present, predict for drug resistance.
Citation Format: Aphrothiti J. Hanrahan, David M. Hyman, John Sfakianos, Alexis Jones, Ricardo Ramirez, Hannah Johnsen, Gopakumar Iyer, Hikmat A. Al-Ahmadie, Dean Bajorin, Bernard H. Bochner, Jonathan A. Coleman, Jonathan E. Rosenberg, Michael F. Berger, Sarat Chandarlapaty, Jose Baselga, David B. Solit. Functional genomics of HER2 and HER3 mutations and response to neratinib. [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 1101. doi:10.1158/1538-7445.AM2015-1101
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Affiliation(s)
| | | | | | - Alexis Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
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