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Poland SG, Guth AA, Feinberg JA, Ebina W, Chiu E, Levine J, Gonzalez LM, Muggia F. Basal cell carcinoma after breast radiation: An uncommon disease with varying clinical presentations. Current Problems in Cancer: Case Reports 2021. [DOI: 10.1016/j.cpccr.2021.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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2
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Safra T, Waissengrin B, Gerber D, Bernstein-Molho R, Klorin G, Salman L, Josephy D, Chen-Shtoyerman R, Bruchim I, Frey MK, Pothuri B, Muggia F. Breast cancer incidence in BRCA mutation carriers with ovarian cancer: A longitudal observational study. Gynecol Oncol 2021; 162:715-719. [PMID: 34172288 DOI: 10.1016/j.ygyno.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We evaluated the incidence of breast cancer and overall survival in a multi-center cohort of ovarian cancer patients carrying BRCA1/2 mutations in order to assess risks and formulate optimal preventive interventions and/or surveillance. METHODS Medical records of 502 BRCA1/2 mutation carriers diagnosed with ovarian cancer between 2000 and 2018 at 7 medical centers in Israel and one in New York were retrospectively analyzed for breast cancer diagnosis. Data included demographics, type of BRCA mutations, surveillance methods, timing of breast cancer diagnosis, and family history of cancer. RESULTS The median age at diagnosis of ovarian cancer was 55.8 years (range, 23.9-90.1). A third (31.5%) had a family history of breast cancer and 17.1% of ovarian cancer. Most patients (67.3%) were Ashkenazi Jews, 72.9% were BRCA1 carriers. Breast cancer preceded ovarian cancer in 17.5% and was diagnosed after ovarian cancer in 6.2%; an additional 2.2% had a synchronous presentation. Median time to breast cancer diagnosis after ovarian cancer was 46.0 months (range, 11-168). Of those diagnosed with both breast cancer and ovarian cancer (n = 31), 83.9% and 16.1% harbored BRCA1 and BRCA2 mutations, respectively. No deaths from breast cancer were recorded. Overall survival did not differ statistically between patients with an ovarian cancer diagnosis only and those diagnosed with breast cancer after ovarian cancer. CONCLUSION The low incidence of breast cancer after ovarian cancer in women carrying BRCA1/2 mutations suggests that routine breast surveillance, rather than risk-reducing surgical interventions, may be sufficient in ovarian cancer survivors.
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Affiliation(s)
- Tamar Safra
- New York University Cancer Institute, New York, ,NY, United States of America; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
| | | | - Deanna Gerber
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Rinat Bernstein-Molho
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Chaim Sheba Medical Center, Breast Cancer Center, Oncology Institute, Ramat Gan, Israel
| | - Geula Klorin
- Rambam Health Care Campus, Haifa, Israel; Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel
| | | | - Dana Josephy
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Meir Medical Center, Kfar Saba, Israel
| | - Rakefet Chen-Shtoyerman
- The Oncogenetic Clinic, The Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Israel; Ariel University, Ariel, Israel
| | - Ilan Bruchim
- Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel; Hillel Yaffe Medical Center, Hadera, Israel
| | - Melissa K Frey
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Bhavana Pothuri
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Franco Muggia
- New York University Cancer Institute, New York, ,NY, United States of America
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Muggia F, Bonetti A. History of intraperitoneal platinum drug delivery for ovarian cancer and its future applications. CDR 2021; 4:453-462. [PMID: 35582028 PMCID: PMC9019271 DOI: 10.20517/cdr.2020.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 11/15/2022]
Abstract
Intraperitoneal (IP) delivery of cisplatin was developed in the 1970s based on a strong pharmacologic rationale and rodent models. Its advantage over intravenous (IV) administration was supported initially by observational studies in treating recurrent ovarian cancer and eventually by better outcomes from IP vs. IV cisplatin in randomized studies in patients undergoing optimal surgical debulking at diagnosis. In the past two decades, with the introduction of novel anticancer interventions (such as taxanes, bevacizumab, inhibitors of DNA repair, and immune check point inhibitors), advantages of IP drug delivery are less clear and concerns are raised on cisplatin's therapeutic index. The discovery of BRCA genes and their key role in DNA repair, on the other hand, have strengthened the rationale for IP drug delivery: high grade serous cancers arising in the Mullerian epithelium in association with hereditary or somatic BRCA function inactivation are linked to peritoneal spread of cells that - while initially sensitive - are prone to emergence of platinum resistance. Therefore, selection of patients based on genomic features and focusing on the better tolerated IP carboplatin are ongoing. Recent examples of leveraging the peritoneal route include (1) targeting the cell membrane copper transport receptor - that is shared by platinums - by the combination of the proteasome inhibitor bortezomib and IP carboplatin; and (2) enhancing IP 5-fluoro-2-deoxyuridine cytotoxicity when coupled with PARP inhibition.
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Affiliation(s)
- Franco Muggia
- Department of Medical Oncology, New York University Langone Health, New York, NY 10016, USA
- Correspondence Address: Dr. Franco Muggia, Department of Medical Oncology, New York University Langone Health, Perlmutter Cancer Center at NYU Langone Medical Center, 160 East 34th street, New York, NY 10016, USA. E-mail:
| | - Andrea Bonetti
- Department of Medical Oncology, Mater Salutis Hospital, AULSS 9 of the Veneto Region, Legnago (VR) 37121, Italy
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Muggia F. Weekly Carboplatin and Paclitaxel for Ovarian Cancer: The "Finer Points". Oncologist 2020; 26:1-3. [PMID: 33098242 DOI: 10.1002/onco.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/06/2020] [Indexed: 11/06/2022] Open
Abstract
First-line ovarian cancer platinum doublet is paclitaxel-carboplatin. Superiority of weekly paclitaxel schedules has not been confirmed; however, a novel schedule with both drugs given weekly (days 1, 8, 15) followed by a 2-week break may be advantageous to some.
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Affiliation(s)
- Franco Muggia
- Perlmutter Cancer Center of the NYU Langone Medical Center, New York, New York, USA
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Moiseyenko A, Muggia F, Condamine T, Pulini J, Janik JE, Cho DC. Sequential therapy with INCAGN01949 followed by ipilimumab and nivolumab in two patients with advanced ovarian carcinoma. Gynecol Oncol Rep 2020; 34:100655. [PMID: 33083509 PMCID: PMC7554352 DOI: 10.1016/j.gore.2020.100655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 01/16/2023] Open
Abstract
Agonistic antibodies against OX40 are in active clinical development. Pre-clinical studies suggest sequential therapy is superior to combinational. We report two cases of ovarian cancer treated with OX40 followed by PD-1/CTLA4 Ab. Both experienced unusually deep and durable responses. The cases support further investigation of the relevance of sequential immunotherapy.
Agonists of the co-stimulatory molecule OX40 (CD134) are in clinical assessment alone and in combination with other immunotherapies. Recent pre-clinical studies have suggested that concurrent administration of OX40 agonists with anti-PD1 therapy is detrimental to the efficacy of such combinations and maximal efficacy may require sequential administration of the OX40 agonist followed by anti-PD1 therapy. In this report, we detail two patients with advanced ovarian carcinoma were treated with INCAGN01949, an agonistic OX40 Ab, as part of a clinical trial until disease progression. Both patients then received the combination of ipilimumab and nivolumab and experienced unusually deep and durable responses. These cases support the hypothesis raised in pre-clinical studies and highlight the potential relevance of sequence in combinational immunotherapy.
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Affiliation(s)
- Andrey Moiseyenko
- Perlmutter Cancer Center at NYU Langone Medical Center, United States
| | - Franco Muggia
- Perlmutter Cancer Center at NYU Langone Medical Center, United States
| | | | | | | | - Daniel C Cho
- Perlmutter Cancer Center at NYU Langone Medical Center, United States
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Granina E, Fehniger J, Kondziolka D, Silverman J, Downey A, Placantonakis D, Muggia F. Endometrial adenocarcinoma presenting as a suprasellar mass: lessons to be learned. Ecancermedicalscience 2020; 14:1083. [PMID: 32863877 PMCID: PMC7434505 DOI: 10.3332/ecancer.2020.1083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
A 66-year-old woman with a history of stage IA mixed endometrioid and serous endometrial cancer presented to our centre with 2 weeks of worsening headaches nearly 4 years after her initial surgery. At admission, she manifested bitemporal hemianopsia, difficulty walking and clinical and laboratory findings of panhypopituitarism, including diabetes insipidus. Magnetic resonance imaging of the brain revealed a 2.7 cm sellar/suprasellar mass compressing the optic chiasm and infiltrating the pituitary stalk. Computerised tomography documented mediastinal, lung, adrenal and liver involvement, including a 2.5 cm palpable left supraclavicular node that on excisional biopsy demonstrated metastatic endometrial adenocarcinoma. Due to the advanced stage of her cancer as well as the presence of multiple metastases, including lung and hepatic metastases causing post-obstructive pneumonia and coagulopathy, the sellar/suprasellar mass was treated with fractionated radiosurgery rather than surgical excision.
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Affiliation(s)
- Evgenia Granina
- Department of Internal Medicine, NYU Langone Health, New York, NY 10016, USA
| | - Julia Fehniger
- Department of Gynecologic Oncology, NYU Langone Health, New York, NY 10016, USA
| | | | - Joshua Silverman
- Department of Radiation Oncology, NYU Langone Health, New York, NY 10016, USA
| | - Andrea Downey
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | | | - Franco Muggia
- Department of Medical Oncology, NYU Langone Health, New York, NY 10016, USA
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Novik Y, Klar N, Zamora S, Kwa M, Speyer J, Oratz R, Muggia F, Meyers M, Hochman T, Goldberg J, Adams S. 129P Phase II study of pembrolizumab and nab-paclitaxel in HER2-negative metastatic breast cancer: Hormone receptor-positive cohort. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Pothuri B, Brodsky AL, Sparano JA, Blank SV, Kim M, Hershman DL, Tiersten A, Kiesel BF, Beumer JH, Liebes L, Muggia F. Phase I and pharmacokinetic study of veliparib, a PARP inhibitor, and pegylated liposomal doxorubicin (PLD) in recurrent gynecologic cancer and triple negative breast cancer with long-term follow-up. Cancer Chemother Pharmacol 2020; 85:741-751. [PMID: 32055930 DOI: 10.1007/s00280-020-04030-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Poly(ADP-ribosyl) polymerases (PARPs) are nuclear enzymes with roles in DNA damage recognition and repair. PARP1 inhibition enhances the effects of DNA-damaging agents like doxorubicin. We sought to determine the recommended phase two dose (RP2D) of veliparib with pegylated liposomal doxorubicin (PLD) in breast and recurrent gynecologic cancer patients. METHODS Veliparib and PLD were administered in a standard phase 1, 3 + 3 dose-escalation design starting at 50 mg veliparib BID on days 1-14 with PLD 40 mg/mg2 on day 1 of a 28-day cycle. Dose escalation proceeded in two strata: A (prior PLD exposure) and B (no prior PLD exposure). Patients underwent limited pharmacokinetic (PK) sampling; an expansion PK cohort was added. RESULTS 44 patients with recurrent ovarian or triple negative breast cancer were enrolled. Median age 56 years; 23 patients BRCA mutation carriers; median prior regimens four. Patients received a median of four cycles of veliparib/PLD. Grade 3/4 toxicities were observed in 10% of patients. Antitumor activity was observed in both sporadic and BRCA-deficient cancers. Two BRCA mutation carriers had complete responses. Two BRCA patients developed oral squamous cell cancers after completing this regimen. PLD exposure was observed to be higher when veliparib doses were > 200 mg BID. CONCLUSIONS The RP2D is 200 mg veliparib BID on days 1-14 with 40 mg/m2 PLD on day 1 of a 28-day cycle. Anti-tumor activity was seen in both strata. However, given development of long-term squamous cell cancers and the PK interaction observed, efforts should focus on other targeted combinations to improve efficacy.
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Affiliation(s)
- Bhavana Pothuri
- NYU Langone Health, Division of Gynecologic Oncology, New York University School of Medicine, 240 East 38th street, 19th floor, New York, NY, USA.
| | - Allison L Brodsky
- NYU Langone Health, Division of Gynecologic Oncology, New York University School of Medicine, 240 East 38th street, 19th floor, New York, NY, USA
| | - Joseph A Sparano
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Mimi Kim
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Brian F Kiesel
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Jan H Beumer
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | - Franco Muggia
- NYU Langone Health, Division of Gynecologic Oncology, New York University School of Medicine, 240 East 38th street, 19th floor, New York, NY, USA
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Safra T, Waissengrin B, Gerber D, Bernstein Molho R, Amit A, Salman L, Josephy D, Chen-Shtoyerman R, Bruchim I, Frey MK, Pothuri B, Muggia F. Assessment of breast cancer risk in BRCA carriers with ovarian cancer: Evaluation of data from longitudinal observation. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13062 Background: To confirm data from older studies reporting reduced risks of breast cancer (BC) in BRCA mutated (BRCA+) ovarian cancer (OC) patients and to re-evaluate BC surveillance and/or prophylactic mastectomy in OC patients. Methods: Data on 430 BRCA+ mutation carriers diagnosed with OC between 2000 and 2017 in 6 medical centers (one in the USA and five in Israel) were analyzed. Data included demographics, breast surveillance type, family history, BRCA mutation types, timing of BC diagnosis (before or after OC diagnosis) and family history of cancer. Results: Median age at diagnosis of OC was 55.4 years (range, 31.3-90) and median follow-up was 4.6 years. Most patients were BRCA1 (66.6%), and 35.7% had 185delAG. Most patients (68.4%) were Ashkenazi Jews, 27.4% had a family history of BC and 16.5% were diagnosed with BC before OC. Five percent developed BC following OC diagnosis with a median time to BC diagnosis of 68 months (range, 11-210). Of those diagnosed with BC, 50% had triple-negative BC, 40% had luminal B ER+, PR-, Her2-neg and 10% had luminal A -ER+, PR+, her2-neg. There was a non-significant increase in BC after OC, and in BC prior to OC diagnosis; there was no correlation of BC with family history. No definite deaths from BC were recorded. Conclusions: The incidence of BC after OC diagnosis in the BRCA+ population at a median follow-up of 4.6 years is consistent with prior series. Prophylactic bilateral Surveillance measures should be re-evaluated in this population and may only be needed in long-term disease-free survivors and/or subpopulations to be identified. Clinical trial information: 07-146.
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Affiliation(s)
- Tamar Safra
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Barliz Waissengrin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | - Deanna Gerber
- New York University School of Medicine, New York, NY
| | | | - Amnon Amit
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Ilan Bruchim
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Technion Israel Institute of Technology, Hadera, IA, Israel
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Kwa MJ, Tray N, Esteva FJ, Novik Y, Speyer JL, Oratz R, Meyers MI, Muggia F, Ty V, Troxel A, Schneider R, Adams S. Phase II trial of nivolumab with chemotherapy as neoadjuvant treatment in inflammatory breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS604 Background: Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer with poor prognosis and is often resistant to neoadjuvant chemotherapy with risk of early recurrence and systemic spread of disease. PD-L1 expression in IBC is frequent (Bertucci et al. Oncotarget 2015), and blockade of the PD-1/PD-L1 axis with checkpoint inhibitors has emerged as a promising treatment to enhance anti-tumor immunity and clinical response. We hypothesize that PD-1 blockade with nivolumab in combination with neoadjuvant (primary) chemotherapy will increase the rate of pathologic complete response (pCR) and reduce risk of recurrence in patients with IBC. Methods: This is a single-arm open-label multicenter phase II study of nivolumab with neoadjuvant chemotherapy in patients with non-metastatic IBC (n = 52) (ClinicalTrials.gov: NCT03742986). All breast cancer subtypes (based on ER/PR/HER2) will be allowed. Patients will receive nivolumab 360 mg IV on day 1 (21-day cycle) for four cycles in addition to standard chemotherapy. Cohort 1 (patients with triple negative breast cancer or hormone receptor-positive (HR)/HER2-negative IBC) will receive nivolumab in combination with paclitaxel followed by doxorubicin and cyclophosphamide (AC). Cohort 2 (patients with HER2-positive IBC) will receive nivolumab in combination with a taxane (docetaxel or paclitaxel), trastuzumab, and pertuzumab followed by AC. All patients will then undergo mastectomy followed by radiation. The primary study objective is pCR rate (ypT0/Tis ypN0). Secondary objectives will be safety, tolerability and invasive recurrence-free interval. Association of correlative biomarkers with pCR and sensitivity or resistance to therapy with the combination of nivolumab and chemotherapy will be evaluated. Analyses will include mutational and neoantigen load, tumor-infiltrating lymphocytes (TILs) by histopathological assessment, T-cell receptor (TCR) by immunosequencing, and immune gene profiles in the tumor. PD-L1 expression in tumor tissue is not required for enrollment but will be assessed as a predictive marker. Clinical trial information: NCT03742986.
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Affiliation(s)
| | - Nancy Tray
- New York University Cancer Institute, New York, NY
| | | | - Yelena Novik
- New York University Cancer Institute, New York, NY
| | | | - Ruth Oratz
- New York University Cancer Institute, New York, NY
| | | | | | - Victor Ty
- New York University Cancer Institute, New York, NY
| | - Andrea Troxel
- New York University School of Medicine, New York, NY
| | | | - Sylvia Adams
- New York University Cancer Institute, New York, NY
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Fleisher KE, Muggia F, Glickman RS. Medication-related osteonecrosis of the jaw: Evidence for infection versus oversuppression. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18268 Background: Antiresorptive medications are important in maintaining bone health for patients with osteoporosis, metastatic cancer and multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) may compromise quality of life and treatment of the underlying disease. There are many controversies regarding the pathogenesis, risk and management of MRONJ. Evidence-based data that suggest osteonecrosis of the jaw (ONJ) is triggered by infection and reports of ONJ unrelated to antiresorptive therapy (ART) have confounded previous hypotheses that pathogenesis is directly attributed to ART by oversuppression of bone remodeling. The aim of this study is to determine the outcome for management of MRONJ based on eradication of infection. Methods: The investigators designed a retrospective cohort study for patients who underwent surgical management of MRONJ. Identification of infected and necrotic bone was achieved via nuclear imaging (i.e., technetium bone scan, positron emission tomography), computed tomography and/or cone beam computed tomography. Surgical techniques included bone resection (i.e., marginal, segmental), local flap, reconstruction with microvascular free flap, and/or autogenous platelet graft. Perioperative modalities included hyperbaric oxygen therapy and culture-guided antibiotic administration. We recorded medical history, location of the MRONJ lesion, type of antiresorptive therapy and duration of perioperative antiresorptive therapy. The outcome variable was postoperative healing defined by mucosal closure without signs of infection or exposed bone at the time of follow-up including cases with complications related to subsequent dental infection or treatment. Descriptive statistics were calculated for successful management, medical history and duration of perioperative antiresorptive therapy. We excluded cases treated by palliative intent, when surgery was limited or contraindicated, and/or inadequate follow-up. Results: A total of 54 patients with 59 MRONJ lesions were evaluated (40 with cancer and 14 with osteoporosis). All patients were successfully treated with 13 patients continuing ART after surgery (average follow-up 10 months) and 8 patients requiring more than 1 surgery for lesions associated with osteosclerosis. Conclusions: This study suggests that MRONJ is an infection-driven process that can be managed with various modalities to control diseased bone and facilitate healing. Patients may resume ART following successful management of MRONJ.
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Khouri OR, Frey MK, Musa F, Muggia F, Lee J, Boyd L, Curtin JP, Pothuri B. Neoadjuvant chemotherapy in patients with advanced endometrial cancer. Cancer Chemother Pharmacol 2019; 84:281-285. [DOI: 10.1007/s00280-019-03838-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
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Murthy P, Muggia F. Women's cancers: how the discovery of BRCA genes is driving current concepts of cancer biology and therapeutics. Ecancermedicalscience 2019; 13:904. [PMID: 30915162 PMCID: PMC6411414 DOI: 10.3332/ecancer.2019.904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Over the last two decades, discoveries related to the breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) have profoundly changed our understanding and management of hereditary breast and ovarian cancers. The concept of synthetic lethality, which arises when cells become vulnerable to a combination of deficiencies in DNA repair, has driven the expanding roles of poly (adenosine diphosphate (ADP)-ribose) polymerase inhibitors in breast and ovarian cancers, and prevention strategies are taking into account the tissue specificity, natural history (fallopian tube origin of some high-grade serous ovarian cancers) and hormone sensitivity of BRCA-associated cancers. Current research has focussed on further elucidating the roles of BRCA proteins in DNA repair, investigating other key DNA repair processes and proteins and linking aberrant DNA repair with carcinogenesis. The ultimate goal is to translate this evolving knowledge into improving the clinical care and treatment of patients with pathogenic BRCA variants or other deficiencies in homologous recombination (HR). In this review, we will discuss 1) the role of BRCA proteins in DNA repair; 2) emerging concepts in the biology of HR deficiency and 3) implications for prevention and treatment.
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Affiliation(s)
- Pooja Murthy
- New York University School of Medicine, New York, NY 10016, USA
- Maimonides Cancer Center, Brooklyn, NY 11220, USA
| | - Franco Muggia
- New York University School of Medicine, New York, NY 10016, USA
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Murthy P, Muggia F. PARP inhibitors: clinical development, emerging differences, and the current therapeutic issues. CDR 2019; 2:665-679. [PMID: 35582575 PMCID: PMC8992523 DOI: 10.20517/cdr.2019.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022]
Abstract
Following years in development, poly-adenosyl-ribose polymerase (PARP) inhibitors continue to advance the treatment of ovarian and breast cancers, particularly in patients with pathogenic BRCA mutations. Differences in clinical trial design have contributed to distinct indications for each of the PARP inhibitors. Toxicity patterns are also emerging that suggest agents differ in their normal tissue tolerance - beyond what might be expected by dose variations and/or exposure to prior treatment. PARP inhibitor resistance is an increasingly relevant issue as the drugs move to the forefront of advanced ovarian/breast cancer treatment, and is an active area of ongoing research. This review examines the PARP inhibitor clinical trials that have led to approved indications in ovarian and breast cancers, PARP inhibitor targets and pharmacological differences between the PARP inhibitors, emerging mechanisms of resistance, and key clinical questions for future development.
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Affiliation(s)
- Pooja Murthy
- Department of Medicine, Maimonides Cancer Center, Brooklyn, NY 11220, USA
- Correspondence Address: Dr. Pooja Murthy, Department of Medicine, Maimonides Cancer Center, 6300 8th Avenue, Brooklyn, NY 11220, USA. E-mail:
| | - Franco Muggia
- New York University School of Medicine, New York, NY 10016, USA
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15
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Muggia F, Kudlowitz D. Platinum type is key in determining degree of neuropathy. Gynecol Oncol Rep 2018; 26:32. [PMID: 30211291 PMCID: PMC6129724 DOI: 10.1016/j.gore.2018.08.010] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/28/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Franco Muggia
- Medical Oncology, Perlmutter Cancer Center, NYU Langone Medical Center, USA
- Corresponding author.
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Cadena I, Werth VP, Levine P, Yang A, Downey A, Curtin J, Muggia F. Lasting pathologic complete response to chemotherapy for ovarian cancer after receiving antimalarials for dermatomyositis. Ecancermedicalscience 2018; 12:837. [PMID: 29910834 PMCID: PMC5985755 DOI: 10.3332/ecancer.2018.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 01/07/2023] Open
Abstract
Could hydroxychloroquine and quinacrine antimalarial therapy for dermatomyositis later attributed to a paraneoplasic manifestation of an ovarian cancer enhance its subsequent response to chemotherapy? Five months after being diagnosed with dermatomyositis, while somewhat improved with hydroxychloroquine, quinacrine and methotrexate, this 63-year-old woman presented with an advanced intra-abdominal epithelial ovarian cancer documented (but not resected) at laparotomy. Neoadjuvant carboplatin/paclitaxel resulted in remarkable improvement of symptoms, tumour markers and imaging findings leading to thorough cytoreductive surgery at completion of five cycles. No tumour was found in the resected omentum, gynaecologic organs, as well as hepatic and nodal sampling thus documenting a complete pathologic response; a subcutaneous port and an intraperitoneal (IP) catheter were placed for two cycles of IP cisplatin consolidation. She remains free of disease 3 years after such treatment and her dermatomyositis is in remission in the absence of any treatment. We discuss a possible role of autophagy in promoting tumour cell survival and chemoresistance that is potentially reversed by antimalarial drugs. Thus, chemotherapy following their use may subsequently lead to dramatic potentiation of anticancer treatment.
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Affiliation(s)
| | | | | | - Annie Yang
- New York University, New York, NY 10003, USA
| | | | - John Curtin
- New York University, New York, NY 10003, USA
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Yang AD, Curtin J, Muggia F. Ovarian adult-type granulosa cell tumor: focusing on endocrine-based therapies. International Journal of Endocrine Oncology 2018. [DOI: 10.2217/ije-2017-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adult-type granulosa cell tumors (GCTs), although rare, are the most commonly diagnosed neoplasms arising in the endocrine-active ovarian stroma. They are characterized by excessive production of estrogens, antimullerian hormone and inhibins. In 2009, a specific mutation in FOXL2 was identified to be pathognomonic of GCTs. How dysregulation of this transcription factor, resulting in upregulation of aromatase, leads to unchecked proliferation, and progression to a malignancy, remains unclear. The key pathological and clinical feature of GCTs that affects their usually favorable outcomes is a diagnosis of greater than Stage 1 disease at presentation. Chemotherapy is given as adjuvant upon an advanced stage diagnosis; however, its effect on survival upon recurrence is modest. On the other hand, aromatase inhibitors also lead to tumor regression and are suitable for long-term maintenance.
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Affiliation(s)
- Annie D Yang
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
| | - John Curtin
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
| | - Franco Muggia
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
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Muggia F, Wenzel L. Abstract NTOC-101: INTRAPERITONEAL (IP) THERAPY FOR ADVANCED STAGE EPITHELIAL OVARIAN CANCER (EOC): THE CURRENT SPOTLIGHT IS ON CARBOPLATIN AND QUALITY OF LIFE. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-ntoc-101] [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
PURPOSE: First-line treatments for (EOC) have been platinum-based for more than three decades; 16 years ago the landmark Gynecologic Oncology Group (GOG158) non-inferiority trial for optimal stage III patients led to the universal adoption of IV carboplatin/paclitaxel as the standard systemic regimen. However, IV cisplatin-based doublets were the comparators in the first 3 GOG studies assessing IP cisplatin-based regimens. Our purpose is to describe recent randomized trials that have assessed IP carboplatin and highlight quality of life (QOL) findings.
METHODS: Gynecology Oncology Group (GOG) studies comparing IP to IV cisplatin regimens formed the basis of the National Cancer Institute (NCI) 2005 Clinical Announcement that considered IP cisplatin-based therapy as a new standard for optimally debulked EOC. Recently, randomized trials with IV carboplatin/paclitaxel-based regimens as comparators have been part of preliminary reports: 1) GOG252 on March 2016 at the Society of Gynecologic Oncology (SGO), completing accrual in 2015, and 2) OV21/PETROC neoadjuvant randomized ‘pick the winner’ study at the June 2016 American Society of Clinical Oncology (ASCO). Beyond 2016, additional data is expected from the ongoing randomized study by the Japan GOG of IP versus IV carboplatin, --both with IV paclitaxel.
RESULTS: GOG252, the largest Phase III study of IV versus IP platinum-based therapy for the first line treatment of ovarian cancer, is the first IP GOG trial with a IV carboplatin-based control arm. None of the 3 arms differed in median progression-free survival. However, the companion QOL study, --contrary to prior GOG studies utilizing IV cisplatin-based controls—showed a clear advantage for the two non-cisplatin arms (not different whether IV or IP). In the OV21/PETROC trial, adverse toxicities coupled with no obvious therapeutic advantage led to dropping the IP cisplatin arm. With additional accrual in the two remaining arms, IP carboplatin was superior to IV carboplatin in time to progression.
CONCLUSIONS: Cisplatin has an unfavorable impact on QOL in women with ovarian cancer whether given IP or IV relative to carboplatin. With IV carboplatin as part of the comparator, unfavorable effects of cisplatin-based chemotherapy are further highlighted. IP carboplatin randomized studies and their final publications are awaited. On the other hand, revisiting the role of IP cisplatin at this time is not warranted.
Citation Format: Franco Muggia MD, Lari Wenzel, PhD. INTRAPERITONEAL (IP) THERAPY FOR ADVANCED STAGE EPITHELIAL OVARIAN CANCER (EOC): THE CURRENT SPOTLIGHT IS ON CARBOPLATIN AND QUALITY OF LIFE [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr NTOC-101.
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Affiliation(s)
- Franco Muggia
- New York University, New York NY and UC Irvine, Irvine CA
| | - Lari Wenzel
- New York University, New York NY and UC Irvine, Irvine CA
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Kwa MJ, Iwano A, Esteva FJ, Novik Y, Speyer JL, Oratz R, Meyers MI, Axelrod DM, Hogan R, Mendoza S, Goldberg JD, Muggia F, Adams S. Phase II trial of pembrolizumab in combination with nab-paclitaxel in patients with metastatic HER2-negative breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS1124 Background: Immunotherapy has shown therapeutic promise in several cancers, including breast cancer. Monotherapy with anti-PD-1/anti-PD-L1 antibodies has demonstrated durable responses in patients with metastatic triple-negative breast cancer (mTNBC) (Nanda et al, JCO 2016) and metastatic estrogen receptor-positive (mER+)/HER2-negative breast cancer (Rugo et al, SABCS 2015). Furthermore, response rates have been increased with combination approaches with chemotherapy (Adams et al, ASCO 2016). Based on these results, we seek to study the anti-tumor efficacy and safety of pembrolizumab (anti-PD-1 antibody) and nab-paclitaxel, the impact of therapy on the tumor microenvironment, and predictive markers of response. Methods: This is an ongoing single-arm open-label multi-cohort phase II study of pembrolizumab and nab-paclitaxel in patients treated with ≤2 prior lines of therapy for metastatic HER2-negative breast cancer (n = 50) (ClinicalTrials.gov: NCT02752685). Thirty patients with mTNBC and 20 patients with mER+/HER2-negative breast cancer will be enrolled. Enrollment of patients with metaplastic breast cancer is encouraged. Patients will receive pembrolizumab 200 mg IV on day 1 plus nab-paclitaxel 100 mg/m2 IV on day 1 and 8 (21-day cycle). Prior taxane therapy given > 3 months before cycle 1 is allowed. Primary objective is treatment efficacy, as determined by overall response rate (RECIST 1.1). Secondary objectives include safety, progression-free survival, overall survival, and duration of response. Serial tumor biopsies will be performed to assess changes in the tumor microenvironment from baseline with chemotherapy alone (cycle 1) and then with chemoimmunotherapy (cycle 2 and subsequent cycles). Mutational and neoantigen load, TILs by histopathological assessment, TCR by immunosequencing, and immune gene profiles in tumors will be evaluated. PD-L1 expression in tumor tissue is not required for enrollment but will be assessed as a predictive marker. The potential role of the gut microbiome in modulating the immune response will also be evaluated by 16S rRNA. An initial safety run-in with 12 subjects has been completed with no unexpected toxicity. Clinical trial information: NCT02752685.
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Affiliation(s)
| | - Alyssa Iwano
- New York University Cancer Institute, New York, NY
| | | | - Yelena Novik
- New York University Cancer Institute, New York, NY
| | | | - Ruth Oratz
- New York University Cancer Institute, New York, NY
| | | | | | | | | | | | | | - Sylvia Adams
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY
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Caron JM, Ames JJ, Contois L, Liebes L, Friesel R, Muggia F, Vary CPH, Oxburgh L, Brooks PC. Inhibition of Ovarian Tumor Growth by Targeting the HU177 Cryptic Collagen Epitope. Am J Pathol 2017; 186:1649-61. [PMID: 27216148 DOI: 10.1016/j.ajpath.2016.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/22/2015] [Accepted: 01/19/2016] [Indexed: 12/17/2022]
Abstract
Evidence suggests that stromal cells play critical roles in tumor growth. Uncovering new mechanisms that control stromal cell behavior and their accumulation within tumors may lead to development of more effective treatments. We provide evidence that the HU177 cryptic collagen epitope is selectively generated within human ovarian carcinomas and this collagen epitope plays a role in SKOV-3 ovarian tumor growth in vivo. The ability of the HU177 epitope to regulate SKOV-3 tumor growth depends in part on its ability to modulate stromal cell behavior because targeting this epitope inhibited angiogenesis and, surprisingly, the accumulation of α-smooth muscle actin-expressing stromal cells. Integrin α10β1 can serve as a receptor for the HU177 epitope in α-smooth muscle actin-expressing stromal cells and subsequently regulates Erk-dependent migration. These findings are consistent with a mechanism by which the generation of the HU177 collagen epitope provides a previously unrecognized α10β1 ligand that selectively governs angiogenesis and the accumulation of stromal cells, which in turn secrete protumorigenic factors that contribute to ovarian tumor growth. Our findings provide a new mechanistic understanding into the roles by which the HU177 epitope regulates ovarian tumor growth and provide new insight into the clinical results from a phase 1 human clinical study of the monoclonal antibody D93/TRC093 in patients with advanced malignant tumors.
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Affiliation(s)
- Jennifer M Caron
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Jacquelyn J Ames
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Liangru Contois
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Leonard Liebes
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Robert Friesel
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Franco Muggia
- New York University Langone Medical Center, Division of Hematology and Medical Oncology, New York, New York
| | - Calvin P H Vary
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Leif Oxburgh
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine
| | - Peter C Brooks
- Maine Medical Center Research Institute, Center for Molecular Medicine, Scarborough, Maine.
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Affiliation(s)
- Franco Muggia
- New York University Medical Center, New York, New York, USA
- Correspondence: Franco Muggia, M.D., New York University Medical Center, New York, New York, USA. Telephone: 212‐263‐6485; e‐mail:
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Abstract
Gonadotropin-releasing hormone (GnRH) agonists are used for gonadal suppression in the treatment of breast and prostate cancers. In older men, their use has occasionally been associated with cardiovascular side effects such as supraventricular tachyarrhythmias (SVTs). Several reports document their occurrence in men receiving leuprolide for prostate cancer. We now report this complication with concomitant occurrence of migratory trunk and extremity urticaria in a young woman receiving this treatment after diagnosis of a T1cN0 premenopausal breast cancer. Changing from leuprolide to another GnRH agonist, goserelin, no additional problems with SVT or accompanying urticaria were encountered during the nearly two years of treatment and three subsequent years of follow-up.
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Affiliation(s)
- Sharan Prakash Sharma
- Department of Internal Medicine, Englewood Hospital and Medical Center, Englewood, 07631 NJ, USA
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Abstract
Details on the 28-year treatment history of a patient with an endocrine-responsive breast cancer are provided. She was originally diagnosed as having a T1N0M0 cancer after a modified radical mastectomy at age 41. Fifteen years later, in 1998, she presented with hemoptysis and pleuritic chest pain: a 10 cm right atrial tumor and estrogen receptor (ER) positive endobronchial and adjacent lung parenchyma adenocarcinoma were documented. Epithelial markers normalized as she manifested a partial response (PR) lasting 3 years with tamoxifen treatment. From 2001 to 2007 she benefitted from exemestane treatment. Upon progression in the previous lung area and left adrenal, exemestane withdrawal led to transient decrease in markers. Six months later (in July 2008), with growth in her adrenal tumor, laparoscopic adrenalectomy was performed: in addition to ER positivity, the tumor showed Her2 overexpression and amplification. She has subsequently had some control of disease with fulvestrant, letrozole + trastuzumab, and subsequently letrozole + lapatinib. In addition to the chronicity of disease, this history illustrates the expanding range of treatments available for endocrine-responsive breast cancer commensurate to our greater understanding of tumor biology.
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Affiliation(s)
| | | | - F Muggia
- Correspondence to: F Muggia. E-mail:
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Abstract
This clinical vignette illustrates how our therapeutic approaches to early stages of multiple myeloma have changed over the past decade with novel therapies reducing disease and preventing disease progression. Recent paradigms of multiple myeloma describe the disease as a spectrum of clinical stages, including asymptomatic ‘smoldering’ states that progress to symptomatic states. The average 5-year survival rate of patients with multiple myeloma diagnosed between 1996 and 2004 according to surveillance epidemiology and end results (SEER) data is 35.9%. Here, we describe the use of novel therapeutic agents including bortezomib, lenalidomide, bisphosphonates, Doxil/Caelyx, and dexamethasone, and their success in affecting the course of disease. Multiple trials have shown an increased benefit of these newer agents over prior multiple myeloma treatment regimens. At 13 years and 8 months from diagnosis, our patient is doing well, and thus is a model of how long-term control of multiple myeloma prolongs survival.
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Affiliation(s)
| | - F. Muggia
- Division of Medical Oncology, NYU School of Medicine, New York, NY-10016, USA
- Correspondence to: Dr. F. Muggia,
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Musa F, Pothuri B, Blank SV, Ling HT, Speyer JL, Curtin J, Boyd L, Li X, Goldberg JD, Muggia F, Tiersten A. Phase II study of irinotecan in combination with bevacizumab in recurrent ovarian cancer. Gynecol Oncol 2016; 144:279-284. [PMID: 27931751 DOI: 10.1016/j.ygyno.2016.11.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of irinotecan and bevacizumab in recurrent ovarian cancer. The primary objective was to estimate the progression free survival (PFS) rate at 6months. Secondary objectives included estimation of overall survival (OS), objective response rate (ORR), duration of response, and an evaluation of toxicity. METHODS Recurrent ovarian cancer patients with no limit on prior treatments were eligible. Irinotecan 250mg/m2 (amended to 175mg/m2 after toxicity assessment in first 6 patients) and bevacizumab 15mg/kg were administered every 3weeks until progression or toxicity. Response was assessed by RECIST or CA-125 criteria every 2cycles. RESULTS Twenty nine patients enrolled (10 were platinum-sensitive and 19 were platinum-resistant). The median number of prior regimens was 5 (range 1-12); 13 patients had prior bevacizumab and 11 prior topotecan. The PFS rate at 6months was 55.2% (95% CI: 40%-77%). The median number of study cycles given was 7 (range 1-34). Median PFS was 6.8months (95% CI: 5.1-12.1months); median OS was 15.4months (95% CI: 11.9-20.4months). In this study, no complete response (CR) was observed. The objective response rate (ORR; PR or CR) for all patients entered was 27.6% (95% CI: 12.7%-47.2%) and the clinical benefit rate (CR+PR+SD) was 72.4% (95% CI: 52.8%-87.3%); twelve patients experienced duration of response longer than 6months. In the 24 patients with measurable disease, a partial response (PR) was documented in 8 (30%) patients; 13 patients maintained stable disease (SD) at first assessment. The most common grade 3/4 toxicity was diarrhea. No treatment-related deaths were observed. CONCLUSIONS Irinotecan and bevacizumab has activity in heavily pre-treated patients with recurrent ovarian cancer, including those with prior bevacizumab and topoisomerase inhibitor use.
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Affiliation(s)
- Fernanda Musa
- Gynecologic Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Bhavana Pothuri
- Gynecologic Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Stephanie V Blank
- Gynecologic Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Huichung T Ling
- Medical Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - James L Speyer
- Medical Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - John Curtin
- Gynecologic Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Leslie Boyd
- Gynecologic Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Xiaochun Li
- Biostatistics, New York University School of Medicine, United States
| | - Judith D Goldberg
- Biostatistics, New York University School of Medicine, United States
| | - Franco Muggia
- Medical Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States
| | - Amy Tiersten
- Medical Oncology, Perlmutter Cancer Center at the New York University Langone Medical Center, United States.
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Kwa M, Novik Y, Oratz R, Jhaveri K, Wu J, Gu P, Meyers M, Muggia F, Bonakdar M, Abidoglu C, Kozhaya L, Li X, Joseph B, Iwano A, Friedman K, Goldberg JD, Unutmaz D, Adams S. Abstract P2-11-11: Phase II trial of exemestane with immunomodulatory oral cyclophosphamide in metastatic hormone receptor (HR)-positive breast cancer: Prolonged progression-free survival (PFS) in patients with distinct T regulatory cell (Treg) profile. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-11-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Resistance to endocrine therapies in HR-positive breast cancer is a significant challenge. The steroidal aromatase inhibitor (AI) exemestane (EXE) has demonstrated short-term efficacy in metastatic HR-positive HER2-negative breast cancer (mHR+BC) that has progressed during treatment with a non-steroidal AI. Combination strategies have not shown a survival benefit. Immunotherapy represents a promising approach as it may increase durability of responses. Low dose cyclophosphamide (CTX) has demonstrated efficacy in combination with neoadjuvant letrozole in HR+BC, conceivably by enhancing anti-tumor immune responses. Here we investigated whether EXE combined with immunomodulatory CTX could provide durable responses in heavily pretreated patients and assessed immunological profiles (NCT01963481).
Methods: Phase II trial of EXE (25mg PO daily) with CTX (50 mg PO daily) enrolled postmenopausal women (n=23) with mHR+BC who had progressed on prior endocrine therapy (including nonsteroidal AI, tamoxifen, and/or fulvestrant); prior chemotherapy was allowed. The primary endpoint was PFS (per RECIST 1.1) at 3 months; secondary endpoints were response rate, tolerability, and immune correlates. Detailed functional immune profiling of peripheral T cell subsets were performed by flow cytometry at baseline, 1, 3, 6, 9 & 12 months, with healthy donors available as controls.
Results: All 23 patients have been enrolled, and 21 are evaluable for response. Median age was 54 (range 31-77), median prior lines of endocrine therapy was 2 (1-3) and chemotherapy was 1 (0-5). The majority (15/23) had visceral organ involvement. Combination treatment was well tolerated with one grade 3 urinary tract infection but no grade 4 or 5 toxicity. An objective response was observed in 19% of patients (4/21, 1 CR and 3 PR) and an additional 33% (7/21) had SD, resulting in a 3-month-PFS of 48.5% (95% CI, 30.5-77.1). Responses were durable in all patients, lasting =/> 9 months and included patients with liver metastases.
Comparison of peripheral immune cell subsets of patients (n=16) at baseline to age/sex-matched healthy controls demonstrated an increased proportion of CD4+ memory T cells with central memory phenotype (CD45RO+CD27+, p<0.0001). When patients were stratified based on PFS at 3 months, the proportion of naïve Tregs (CD4+CD45RO-FOXP3+Helios+) at baseline was significantly lower (p=0.003) in the non-progressor group compared to patients with progression. Remarkably, when these patient groups were compared for changes in T cell subsets during treatment, the proportion of both naïve and memory Treg subsets increased from baseline to 3 months (p<0.01), but only in the non-progressor patient group. While preliminary, these findings are possibly indicative of novel predictive biomarkers.
Conclusion: EXE and CTX had a favorable safety profile with evidence of clinical activity in patients with heavily pretreated mHR+BC, including durable responses in liver and bone. Correlative studies are ongoing to identify potential biomarkers of response or resistance to therapy.
Citation Format: Kwa M, Novik Y, Oratz R, Jhaveri K, Wu J, Gu P, Meyers M, Muggia F, Bonakdar M, Abidoglu C, Kozhaya L, Li X, Joseph B, Iwano A, Friedman K, Goldberg JD, Unutmaz D, Adams S. Phase II trial of exemestane with immunomodulatory oral cyclophosphamide in metastatic hormone receptor (HR)-positive breast cancer: Prolonged progression-free survival (PFS) in patients with distinct T regulatory cell (Treg) profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-11-11.
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Affiliation(s)
- M Kwa
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Y Novik
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - R Oratz
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - K Jhaveri
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - J Wu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - P Gu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - M Meyers
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - F Muggia
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - M Bonakdar
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - C Abidoglu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - L Kozhaya
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - X Li
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - B Joseph
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - A Iwano
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - K Friedman
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - JD Goldberg
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - D Unutmaz
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - S Adams
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
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Bonetti A, Giuliani J, Muggia F. [Platinum antitumor complexes]. Recenti Prog Med 2016; 106:618-28. [PMID: 26780071 DOI: 10.1701/2094.22652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the last 50 years the oncology has experienced remarkable changes resulting in transforming malignant germ-cell testicular tumors from highly fatal to nearly uniformly cured neoplasms. This clinical landmark was justly attributed to the identification of cisplatin by Barnett Rosenberg in his experiments dating to 1965. On this 50th anniversary of this discovery, one is reminded of the following key aspects in cancer therapeutics: 1) the life-story of Barnett Rosenberg and his legacy that included organizing nearly quadrennial "platinum" meetings incorporating advances in cancer biology into evolving therapeutic strategies; 2) the search for less toxic analogs of cisplatin leading to the development of carboplatin; 3) clinical research into attenuation of cisplatin toxicities; 4) oxaliplatin and the expansion of the therapeutic spectrum of platinum compounds; and 5) the ongoing multifaceted investigations into the problem of "platinum resistance".
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Kwa M, Muggia F. Clinical Trials of Hyperthermic Intraperitoneal Chemotherapy in Advanced Ovarian Cancer: Unanswered Questions. Oncology (Williston Park) 2015; 29:702-704. [PMID: 26384808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kwa MJ, Muggia F. Intraperitoneal (IP) port cytology after IP cisplatin therapy for ovarian cancer: A simple test to predict platinum resistance and outcome? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16537] [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: 11/20/2022] Open
Affiliation(s)
| | - Franco Muggia
- NYU Clinical Cancer Center/NYU Medical Center, New York, NY
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Zagar TM, Vujaskovic Z, Formenti S, Rugo H, Muggia F, O'Connor B, Myerson R, Stauffer P, Hsu IC, Diederich C, Straube W, Boss MK, Boico A, Craciunescu O, Maccarini P, Needham D, Borys N, Blackwell KL, Dewhirst MW. Two phase I dose-escalation/pharmacokinetics studies of low temperature liposomal doxorubicin (LTLD) and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer. Int J Hyperthermia 2015; 30:285-94. [PMID: 25144817 PMCID: PMC4162656 DOI: 10.3109/02656736.2014.936049] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Unresectable chest wall recurrences of breast cancer (CWR) in heavily pretreated patients are especially difficult to treat. We hypothesised that thermally enhanced drug delivery using low temperature liposomal doxorubicin (LTLD), given with mild local hyperthermia (MLHT), will be safe and effective in this population. Patients and methods This paper combines the results of two similarly designed phase I trials. Eligible CWR patients had progressed on the chest wall after prior hormone therapy, chemotherapy, and radiotherapy. Patients were to get six cycles of LTLD every 21–35 days, followed immediately by chest wall MLHT for 1 hour at 40–42 °C. In the first trial 18 subjects received LTLD at 20, 30, or 40 mg/m2; in the second trial, 11 subjects received LTLD at 40 or 50 mg/m2. Results The median age of all 29 patients enrolled was 57 years. Thirteen patients (45%) had distant metastases on enrolment. Patients had received a median dose of 256 mg/m2 of prior anthracyclines and a median dose of 61 Gy of prior radiation. The median number of study treatments that subjects completed was four. The maximum tolerated dose was 50 mg/m2, with seven subjects (24%) developing reversible grade 3–4 neutropenia and four (14%) reversible grade 3–4 leucopenia. The rate of overall local response was 48% (14/29, 95% CI: 30–66%), with. five patients (17%) achieving complete local responses and nine patients (31%) having partial local responses. Conclusion LTLD at 50 mg/m2 and MLHT is safe. This combined therapy produces objective responses in heavily pretreated CWR patients. Future work should test thermally enhanced LTLD delivery in a less advanced patient population.
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Affiliation(s)
- Timothy M Zagar
- Department of Radiation Oncology, University of North Carolina Hospital , Chapel Hill , North Carolina
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Janosky M, Bian J, Dhage S, Levine J, Silverman J, Jors K, Moy L, Cangiarella J, Muggia F, Adams S. Primary large cell neuroendocrine carcinoma of the breast, a case report with an unusual clinical course. Breast J 2015; 21:303-7. [PMID: 25823996 DOI: 10.1111/tbj.12403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Large cell neuroendocrine carcinoma of the breast (NECB) is an extremely rare type of breast cancer; little is known about effective chemotherapies, and data on pathologic response to treatment are unavailable. We report the case of a 34-years-old woman with large cell NECB with initial clinical and pathologic evidence of treatment response to anthracycline-containing neo-adjuvant therapy. Histologic reassessment early during anthracycline chemotherapy revealed cell death with necrosis of 50% of the tumor cells seen in the biopsy specimen. After completing neo-adjuvant chemotherapy, the patient underwent breast-conserving surgery. Pathologic evaluation of the surgical specimen showed a partial response but margins were positive for residual carcinoma. Despite repeated neo-adjuvant chemotherapy, radiotherapy, and surgical resection, the tumor grew rapidly between surgeries and recurred systemically. Therefore, we review the literature on large cell NECB and its treatment options.
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Affiliation(s)
- Maxwell Janosky
- New York University Cancer Institute, NYU School of Medicine, New York, New York
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Guerrero A, Ruoff R, Gavila J, Logan S, Gozlabo F, Climent Duran MA, Guillem V, Muggia F, Ruiz A. Changes in androgen receptor (AR) expression and its phosphorylated isoforms, in breast cancer (BC) patients treated with neoadjuvant letrozole. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.541] [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: 11/20/2022] Open
Affiliation(s)
- Angel Guerrero
- Medical Oncology. Instituto Valenciano de Oncología, Valencia, Spain
| | - Rachel Ruoff
- New York University School of Medicine, New York, NY
| | | | - Susan Logan
- New York University School of Medicine, New York, NY
| | | | | | | | - Franco Muggia
- New York University School of Medicine, New York, NY
| | - Amparo Ruiz
- Instituto Valenciano de Oncología, Valencia, Spain
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Ling HT, Muggia F, Speyer JL, Curtin JP, Blank SV, Boyd LR, Pothuri B, Li X, Goldberg JD, Tiersten A. A phase II trial on the combination of bevacizumab and irinotecan in recurrent ovarian cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5564] [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: 11/20/2022] Open
Affiliation(s)
| | - Franco Muggia
- New York University School of Medicine, New York, NY
| | | | | | | | | | | | - Xiaochun Li
- New York University School of Medicine, New York, NY
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Affiliation(s)
- David Kudlowitz
- NYU Clinical Cancer Center , Rm 429, 160 East 34th Street, NY 10016 , USA
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Randon G, Nicoletto MO, Milite N, Muggia F, Conte P. Squamous cell carcinoma of the oral cavity in a woman with a 9-year history of ovarian cancer: is exposure to pegylated liposomal Doxorubicin a factor? Oncologist 2014; 19:429. [PMID: 24668330 DOI: 10.1634/theoncologist.2013-0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Giovanni Randon
- II Medical Oncology, Istituto Oncologico Veneto, Padua, Italy
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Warner E, Liebes L, Levinson B, Downey A, Tiersten A, Muggia F. Continuous-infusion topotecan and erlotinib: a study in topotecan-pretreated ovarian cancer assessing shed collagen epitopes as a marker of invasiveness. Oncologist 2014; 19:250. [PMID: 24563078 DOI: 10.1634/theoncologist.2013-0398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Continuous-infusion topotecan with erlotinib has the potential to reverse topotecan resistance due to drug efflux mechanisms. We assessed the activity of such a regimen in ovarian cancer patients previously failing bolus topotecan. Assay for shed collagen epitopes recognized by antibody HU177 during treatment explored its ability to reflect tumor invasion. METHODS Topotecan 0.4 mg/m(2) per day was administered by continuous infusion for 9-10 days every 3 weeks. Erlotinib, 150 mg orally, was administered on days 1-10 of each cycle. Cycles were repeated until progression or toxicity. Serum for shed HU177 collagen epitopes was collected weekly. This was a two-stage design to detect a CA-125 response rate of at least 20% in 30 patients after completing two treatment cycles. The trial would be terminated early if there were less than two CA-125 responses in 16 patients. Four or more CA-125 responses in 30 patients would justify further study of this regimen in prior topotecan treatment failures. RESULTS Six patients were enrolled, with four receiving three or more cycles and one achieving a partial response by cancer antigen 125 (CA-125) criteria. Shed epitope levels became undetectable on at least one measurement in all patients who received three or more cycles (Fig. 1A) and reappeared concomitantly with rises in CA-125 and clinical progression (Fig. 1B). After logistical delays, the trial was closed by the sponsor's decision to stop developing erlotinib in ovarian cancer. FIGURE 1: Monitoring of combination treatment. A, B, C, D, and F refer to patients. (A):: Topotecan and erlotinib. (B):: CA-125 in units/mL. CONCLUSION Continuous-infusion topotecan with erlotinib was found safe in six pretreated ovarian cancer patients; one met CA-125 criteria for partial response. Serial shed epitope levels to reflect invasiveness deserve further study.
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Affiliation(s)
- Eiran Warner
- Beth Israel Medical Center, New York, New York, USA
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Muggia F, Safra T. 'BRCAness' and its implications for platinum action in gynecologic cancer. Anticancer Res 2014; 34:551-556. [PMID: 24510983 PMCID: PMC4682661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gynecological carcinomas are major therapeutic targets of platinum-containing regimens. They may be particularly susceptible to these agents if their origins are related to hereditary breast cancer (BRCA) mutations; this implicates defective DNA repair secondary to inherited alterations in BRCA function. The concept of 'BRCAness' was introduced by Ashworth and colleagues in order to identify phenotypic changes in sporadic cancer that would lead to analogous treatment susceptibility. In fact, recent analyses of genetic alterations in ovarian cancer have led to further extending this concept to all women with high-grade serous cancer, the predominant form of ovarian cancer arising in association with hereditary mutations in BRCA genes. Presumably, most serous types of cancer of gynecological origin share BRCA dysfunction to some extent. This renders these types of cancer susceptible to platinum and to other DNA-damaging agents, justifying the general inclusion of this histology in trials of new drugs and therapeutic strategies that have shown activity against hereditary cancer. More recently, however, differences in outcome between BRCA mutation carriers vis-à-vis those with no mutations or those with epigenetic or acquired forms of BRCA genes (somatic mutations) in their respective tumors have been identified. These findings raise additional questions on modifiers of 'BRCAness' and other pathways that appear to contribute to the effects of platinum and other DNA-damaging agents in ovarian cancer. The Cancer Genome Atlas analyses delineate the complexity of genomic alterations in ovarian cancer and other malignancies of Mullerian epithelial origin promising further refinements of the 'BRCAness' concept.
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Affiliation(s)
- Franco Muggia
- NYU Cancer Institute, New York University Langone Medical Center, 550 First Avenue, New, NY 10016, U.S.A.
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Abstract
Ovarian cancer is the leading cause of gynecologic cancer deaths and accounts for 4% of women's cancer diagnoses and 5% of all cancer mortalities. Despite the ability of current chemotherapy and cytoreductive surgery to put patients in remission, most patients with advanced cancer will eventually relapse. Many advances in the treatment of ovarian cancer have been reported in the past several years and a historical background is provided. Attention will then turn to analogs of current chemotherapeutic agents, new cytotoxic drugs, targeted molecular therapy, intraperitoneal therapy and immunotherapy. This review will give a perspective on current drugs, potential agents and upcoming clinical trials.
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Affiliation(s)
- Franco Muggia
- New York University Clinical Cancer Center, NY 10016-9196, USA.
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Muggia F, Leone R, Bonetti A. Platinum and other heavy metal coordinating compounds in cancer chemotherapy: overview of Verona ISPCC XI. Anticancer Res 2014; 34:417. [PMID: 24403516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Bonetti A, Giuliani J, Muggia F. Targeted agents and oxaliplatin-containing regimens for the treatment of colon cancer. Anticancer Res 2014; 34:423-434. [PMID: 24403498] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Oxaliplatin and fluoropyrimidines are synergic combinations very active for the treatment of advanced colorectal cancer and for the adjuvant treatment of stage III colon cancer. Oxaliplatin-based regimens can be further strengthened by the addition of a third component, either a traditional drug such as irinotecan or targeted agents such as anti-vascular endothelial growth factor (VEGF) drugs, bevacizumab and aflibercept, or the anti-epidermal growth factor receptor (EGFR), cetuximab and panitumumab. The availabilty of all these active agents prompted several clinical trials on different lines of treatment of advanced colorectal cancer patients and in the adjuvant setting. Clinical studies involving the administration of anti-EGFR drugs also helped identify mutations in KRAS as a negative marker for the activity of these agents. However, positive selection criteria for targeted agents have not been identified. The results of oxaliplatin-containing regimens are critically presented and discussed in this review.
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Affiliation(s)
- Andrea Bonetti
- Department of Oncology, ASL 21 della Regione Veneto, Via Gianella 1-37045 Legnago (Verona), Italy.
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Rugo HS, Zagar TM, Formenti SC, Vujaskovic Z, Muggia F, O'Connor BM, Myerson RJ, Hsu ICC, Borys N, Blackwell KL, Dewhirst MW. Abstract P4-15-05: Novel targeted therapy for breast cancer chest wall recurrence: Low temperature liposomal doxorubicin and mild local hyperthermia. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-15-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Unresectable breast cancer chest wall recurrence (CWR) following radiation is very difficult to treat and often responds poorly to standard chemotherapy. Symptoms include pain, reduced range of motion, disfigurement, and skin erosions with bleeding and infection. We hypothesized that thermally enhanced drug delivery using low temperature liposomal doxorubicin (LTLD, ThermoDox®), given with mild local hyperthermia (MLHT) would be a safe and effective targeted therapy. LTLD is given by iv infusion; it then localizes in CWR tumors due to their leaky vasculature. When heated to ≥ 39.5°C, LTLD releases a high concentration of the heat-enhanced cytotoxic doxorubicin.
Methods: The results of 2 similarly-designed independent phase I trials were combined for analysis. Eligible patients had CWR progressing after radiation, hormone therapy, and chemotherapy. Subjects were to get up to 6 cycles of LTLD every 21-35 days, followed immediately by chest wall MLHT for 1 hour at 40°- 42°C. In Trial A, 18 subjects received LTLD at 20, 30, or 40 mg/m2; in Trial B, 11 subjects received LTLD at 40 or 50 mg/m2. The primary endpoint of each trial was to determine the maximum tolerated dose (MTD); secondary endpoints were local objective response and the pharmacokinetic (PK) and safety profiles of LTLD. Local response was assessed by serial photography and measurements of CWR. PK samples for total plasma doxorubicin and doxorubicinol were collected at Cycle 1 and Cycle 2 for both trials.
Results: Twenty-nine subjects were enrolled and received ≥ 1 cycle (median 4, range 1-6). Median age was 57; 16 (55%) had triple negative disease and 13 (45%) had distant metastases. The median prior exposure to anthracylines was 256 mg/m2 and the median prior dose of radiation was 6,100 cGy. Thirteen subjects were evaluable for MTD in Trial A and 9 in Trial B. Trial B established a phase II dose of 50 mg/m2 recommended by a Data Safety Monitor Board, based on 1 of 6 subjects at the 50 mg/m2 dose level having a DLT (grade 3 hypokalaemia unrelated to study treatment). In Trial A, 2 of 7 subjects at 40 mg/m2 had a DLT (grade 4 neutropenia lasting > 5 days; grade 3 dehydration lasting 27 days). The Cmax concentrations between 18,400 to 20,700 ng/mL were consistent at an equal dose level (40 mg/m2) between trials. Altogether, 7 (24%) subjects developed reversible grade 3-4 neutropenia and 4 (14%) reversible grade 3-4 leukopenia. No cardiac toxicity or hand-foot syndrome was seen. One case of CW thermal burn (grade 3) and one case of radiation recall (grade 2) were reported. Five (17%) complete local responses and 9 (31%) partial local responses were seen. The rate of local response was 48% (14/29; 95% CI: 30%-66%). Seven of 29 subjects (24%) progressed outside the study treatment field.
Conclusion: LTLD plus MLHT is a novel therapy that is safe and produces objective responses in heavily pretreated CWR patients with limited therapeutic options. The primary toxicity is reversible bone marrow suppression. A phase II trial is ongoing at the MTD (50 mg/m2). Future work should test thermally enhanced LTLD delivery in a less advanced, less heavily pretreated patient population.
*Author note-M.W.D. and K.L.B. equally contributed.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-15-05.
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Affiliation(s)
- HS Rugo
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - TM Zagar
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - SC Formenti
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - Z Vujaskovic
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - F Muggia
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - BM O'Connor
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - RJ Myerson
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - IC-C Hsu
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - N Borys
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - KL Blackwell
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - MW Dewhirst
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
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Muggia F, Tommasi S, Lynch H, Paradiso A. Hereditary breast and ovarian cancer: lessening the burden. Ann Oncol 2013; 24 Suppl 8:viii5-viii6. [PMID: 24298633 DOI: 10.1093/annonc/mdt318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kwa M, Edwards S, Downey A, Reich E, Wallach R, Curtin J, Muggia F. Ovarian Cancer in BRCA Mutation Carriers: Improved Outcome After Intraperitoneal (IP) Cisplatin. Ann Surg Oncol 2013; 21:1468-73. [DOI: 10.1245/s10434-013-3277-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Indexed: 11/18/2022]
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Kobrinsky B, Joseph SO, Muggia F, Liebes L, Beric A, Malankar A, Ivy P, Hochster H. A phase I and pharmacokinetic study of oxaliplatin and bortezomib: activity, but dose-limiting neurotoxicity. Cancer Chemother Pharmacol 2013; 72:1073-8. [PMID: 24048674 DOI: 10.1007/s00280-013-2295-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/06/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The potential synergy of modulating platinum-induced DNA damage by combining the proteasome inhibitor bortezomib with oxaliplatin was studied in patients with solid tumors, with special attention to avoidance of cumulative neurotoxicity (NT). PATIENTS AND METHODS In a 3 + 3 dose escalation design, patients received bortezomib at 1.0-1.5 mg/m² on days 1 and 4 and oxaliplatin at 60-85 mg/m² on day 1 of a 14-day cycle. NT assessments were performed at the start of every two cycles. Oxaliplatin pharmacokinetics (PK) were determined pre- and post-bortezomib. RESULTS Thirty patients were enrolled with 25 (11 men, 14 women) fully evaluable for NT assessments at cycle 2. The median age was 56 years (range 35-74 years); median number of cycles received 2 (range 1-10). At dose levels 2-5 (B 1.3 mg/m²), patients manifested NT grades 3 and 4 at a median 3.4 cycles (range 2-9 cycles): 3 had ataxia (one also with sensory neuropathy or neurogenic hypotension, respectively) and 3 had just sensory neuropathy. A 6th dose-level reducing bortezomib to 1.0 mg/m² with oxaliplatin 85 mg/m²) was explored and no NT or dose limiting toxicities were noted among 7 evaluable patients (5 receiving two or more cycles). Four patients experienced a partial response--one with platinum-resistant ovarian cancer, another with gastroesophageal cancer, another with ampulla of Vater carcinoma, and a patient with cholangiocarcinoma. PK studies at dose levels 1 and 2 showed greater mean ultrafiltrable platinum when oxaliplatin was dosed after bortezomib. CONCLUSIONS Bortezomib 1.0 mg/m² × 2 every 14 days combines safely with oxaliplatin. At higher doses, cumulative NT (i.e., cerebellar signs and sensory neuropathy) occurs at an accelerated pace perhaps from a PK interaction.
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Affiliation(s)
- B Kobrinsky
- Division of Hematology and Oncology, NYU School of Medicine, 550 First Avenue, OBV C&D Bldg Rm 556, New York, NY, 10016, USA
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Teplinsky E, Cheung D, Weisberg I, Jacobs REA, Wolff M, Park J, Friedman K, Muggia F, Jhaveri K. Fatal hepatitis B reactivation due to everolimus in metastatic breast cancer: case report and review of literature. Breast Cancer Res Treat 2013; 141:167-72. [PMID: 24002736 DOI: 10.1007/s10549-013-2681-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/21/2013] [Indexed: 12/12/2022]
Abstract
Hepatitis B reactivation can occur with cytotoxic chemotherapy in patients with hepatitis B and cancer. Reactivation can occur in a patient with chronic hepatitis, an inactive carrier, or one with resolved hepatitis. Clinical presentation may range from subclinical elevation of liver enzymes to fatal fulminant hepatic failure. Mammalian target of rapamycin inhibitors, which include everolimus, are a new generation of targeted agents that are currently approved for many cancers (since March 2009) including advanced hormone receptor positive, human epidermal growth factor receptor 2-negative breast cancer, in conjunction with exemestane (as of July 2012). We are therefore still learning the various adverse events that occur with this new class of agents. Here, we present an unfortunate case of fatal hepatitis B reactivation in a woman with metastatic breast cancer treated with everolimus and exemestane. We have detailed the controversies around hepatitis B screening prior to immunosuppressive therapy. Clinicians and patients should be aware of this rare but fatal complication prior to everolimus use, and a detailed history, screening for hepatitis B and prophylactic antiviral treatment should be considered.
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Ling H, Muggia F, Speyer J, Curtin J, Blank S, Boyd L, Pothuri B, Li X, Goldberg J, Tiersten A. Combination of irinotecan and bevacizumab for heavily pretreated recur- rent ovarian cancer: A phase II trial. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Sensory neuropathy is a common but difficult to quantify complication encountered during treatment of various cancers with taxane-containing regimens. Docetaxel, paclitaxel, and its nanoparticle albumin-bound formulation have been extensively studied in randomized clinical trials comparing various dose and schedules for the treatment of breast, lung, and ovarian cancers. This review highlights differences in extent of severe neuropathies encountered in such randomized trials and seeks to draw conclusions in terms of known pharmacologic factors that may lead to neuropathy. This basic knowledge provides an essential background for exploring pharmacogenomic differences among patients in relation to their susceptibility of developing severe manifestations. In addition, the differences highlighted may lead to greater insight into drug and basic host factors (such as age, sex, and ethnicity) contributing to axonal injury from taxanes.
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Affiliation(s)
- David Kudlowitz
- New York University School of Medicine and Cancer Institute, New York, New York 10016, USA
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Teplinsky E, Muggia F. HE4: another 'player' in the epithelial tumor marker arena? Oncology (Williston Park) 2013; 27:556-563. [PMID: 23909070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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